What is the relationship between acne and testosterone replacement therapy (TRT)?

From the Guidelines

Testosterone replacement therapy (TRT) may exacerbate acne in some individuals, but the relationship is not well-established, and acne is considered an infrequent side effect 1. When considering the relationship between acne and TRT, it's essential to weigh the potential benefits of testosterone therapy against the possible risk of worsening acne.

• The evidence suggests that testosterone can increase sebum production, which may lead to more clogged pores and acne 1.
• However, a study published in the Journal of the American Academy of Dermatology in 2019 found that spironolactone, a medication with antiandrogenic properties, can be effective in treating acne, particularly in women 1.
• Given the potential for testosterone to worsen acne, individuals undergoing TRT should be monitored for acne and other skin reactions.
• If acne persists or worsens, healthcare providers may recommend adjusting the testosterone dose or administration method, or prescribing topical or oral treatments for acne.
• In severe cases, consulting a dermatologist for stronger treatments like isotretinoin may be necessary. It's crucial to balance the benefits of testosterone therapy with potential side effects, and healthcare providers should work closely with patients to find the right approach for managing acne while undergoing TRT.
• A basic acne-fighting skincare routine, including gentle cleansing, topical treatments, and non-comedogenic moisturizers, can help manage acne in individuals undergoing TRT.
• Spironolactone, at a starting dose of 100mg/day, may be considered as an alternative treatment for acne, particularly in women, due to its antiandrogenic properties 1.

From the Research

Relationship Between Acne and Testosterone Replacement Therapy (TRT)

• The relationship between acne and testosterone replacement therapy (TRT) is complex, with evidence suggesting that increased testosterone concentrations can lead to the development of acne 2.
• A study found that the prevalence of moderate to severe acne increased from 11.8% to 39.1% after one year of gender-affirming masculinizing testosterone therapy (GATT) 2.
• Risk factors for the development of moderate to severe acne in testosterone-treated transgender men include high body mass index (BMI), younger age at initiation of GATT, testosterone concentrations within or above the target range, and the presence of acne at baseline 2.

Effects of Testosterone on Acne

• Testosterone can increase sebum production and keratinization, leading to the development of acne 3.
• The effects of testosterone on acne can be influenced by individual factors, such as genetic disposition and local androgen metabolism 3.
• Estrogens may antagonize the androgen-induced actions on sebaceous glands and hair follicles, suggesting a potential role for hormonal therapies in the treatment of acne 3.

Treatment of Testosterone-Induced Acne

• Treatment of testosterone-induced acne in transmasculine patients requires a comprehensive approach, including the creation of a welcoming clinical setting, taking a gender-inclusive history, and conducting a patient-centered physical examination 4.
• Assessment of reproductive potential and the appropriate contraceptive methods before prescribing acne treatment with teratogenic potential is essential 4.
• Interactions between acne treatments and gender-affirming therapies should be carefully considered, and multidisciplinary approaches to acne care may be necessary 4.