in the registry is voluntary for those patients who might have become pregnant. Requirements of the program also mandate, per FDA requirements, monthly pregnancy tests for patients who may become pregnant. The website does include a privacy statement, which discusses what information is collected, how it is used, and where questions can be directed. Required participation of patients who cannot become pregnant The iPLEDGE Program requires all patients to participate whether they can become pregnant or not, and this has been a subject of criticism over the course of the program's lifetime. Program administrators say all patients must participate as they are concerned about the potential sharing of medication with people who can become pregnant. Dermatologist Ned Ryan said "They [the FDA and drug manufacturers] want a wide net, understandably. But this is completely over the top." Though they must be part of the iPLEDGE Program, requirements for patients who cannot become pregnant are more lenient than requirements for patients who can become pregnant. Patients who cannot become pregnant do not need to take either pregnancy or comprehension tests on a monthly basis, and their prescription window is 30 days from the date of the office visit, rather than seven days as it is with patients who can become pregnant. Economic burden on patients who can become pregnant A study of 71 female patients who received isotretinoin treatment from 2010 to 2020 at Children's National Hospital found that iPledge requirements unjustifiably increased the cost of treatment for patients with the potential to become pregnant, especially when windows were missed requiring additional follow up medical appointments and repeated laboratory pregnancy tests. The financial cost is a significant burden that, along with other iPledge imposed barriers, leads to more patients discontinuing treatment before completion. Disproportionate impact on minorities and lower socioeconomic status groups A 2019 study of patients at two academic institutions in Boston, Massachusetts demonstrated differences in delayed starting, interruption, and early termination of isotretinoin treatment course across race. Non-white patients were more likely than white patients to experience medication interruptions and early terminations and were more likely to achieve sub-optimal doses of isotretinoin. The most common cited reasons for delays were logistics associated with the iPLEDGE system, including computer issues, missed pick-up windows, and missed/delayed appointments/tests. Misgendering of transgender patients Some transgender men taking testosterone treatments develop acne as a side effect which can be successfully treated with isotretinoin. Since