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Outsmarting Testosterone-Triggered Acne

Learn why testosterone therapy causes acne and proven treatments to clear breakouts fast.

Acne and testosterone often go hand-in-hand. Still, you don’t have to choose between clear skin and balanced hormones.

According to experts, testosterone replacement can stimulate oil glands and lead to clogged pores and pimples in up to a startling 70% of patients. However, with the right treatments and tweaks to your regimen, these breakouts can be brought under control. 

Read on to learn proven tactics to curb acne rooted in testosterone therapy and restore confidence in your complexion. You can have it all – the energizing benefits of optimized testosterone along with clear, healthy-looking skin.

PRC works with you to help optimize hormones, energy, and skin health. Rediscover your best self today! Contact us now!

Why Does Testosterone Therapy Cause Acne in Some Patients?

Testosterone therapy can cause acne in some patients because it increases sebum production, which can clog pores and cause pimples.

Excessive sebum can end up clogging hair follicles and pores, trapping dead skin cells inside. This creates an ideal environment for Propionibacterium acnes bacteria to multiply rapidly. The result is whiteheads, blackheads, and inflammatory lesions associated with acne breakouts.

DHT formation exacerbates the problem.

Testosterone can be converted into dihydrotestosterone (DHT) via the 5-alpha reductase enzyme. DHT is a more potent androgen than testosterone itself. It further increases sebum production and follicle plugging, making acne worse.

Acne onset peaks within the first year and then improves.

At our clinic, we’ve observed that acne related to testosterone therapy usually begins within the first 1-2 years after starting treatment. Sometimes, improvements may be seen in as little as 6 months. 

Breakouts tend to peak in severity during the first year as the body adjusts to the new hormonal balance. Acne then often improves on its own over the next 6-24 months without having to adjust testosterone doses.

Acne localization and severity

  • Tends to affect androgen-sensitive areas like the face, chest, upper back, and arms
  • Is generally mild
  • Severe inflammatory cystic acne is less common
  • Up to 94% may experience acne per some studies

Those at highest risk are:

  • Transgender patients receiving masculinizing doses
  • Teens taking testosterone for short stature
  • Bodybuilders abusing anabolic steroids

Are Acne Issues Common with Testosterone Replacement Therapy?

Acne issues are common with testosterone replacement therapy, with studies showing 30-70% of patients on TRT develop some degree of acne as a side effect.

One study we reviewed showed acne prevalence increased from just 6.3% before TRT to 31.1% after treatment began. 

Yet another retrospective study at the Children’s Healthcare of Atlanta Pediatric Endocrinology clinic found that 70% of transgender teens developed acne within two years of starting testosterone therapy specifically.

Additionally, a large survey of over 2000 transmasculine patients on TRT revealed the following:

  • 33.3% developed acne with injected testosterone
  • 48.6% experienced acne with transdermal testosterone

So while incidence varies, multiple studies suggest variables like dosage, duration, and genetics impact acne risk.

How Can I Treat Acne Caused by Testosterone Injections?

Acne caused by testosterone injections can be treated with topical creams, oral antibiotics, adjusting testosterone dosage/frequency, and lifestyle measures like skin hygiene and stress reduction.

Topical treatments are usually first-line:

  • Over-the-counter topical creams containing benzoyl peroxide or salicylic acid can reduce bacteria and inflammation when applied consistently.

A cohort study of 20 transmasculine patients found that facial and truncal acne increased over 4 months of testosterone treatment, from 35% to 82% and 15% to 88% respectively.

  • Prescription topical retinoids like tretinoin or adapalene work similarly but tend to be more potent for acne. However, they require diligent daily application.

Oral antibiotics may also help:

  • Antibiotics like doxycycline or minocycline are commonly prescribed if topicals are inadequate. They help control acne-causing bacteria and inflammation.

    A phase II multicenter trial found that 40 mg of modified-release doxycycline was effective for inflammatory acne, supporting doxycycline as a treatment option.
  • It typically takes 4-6 weeks to see improvement. Side effects like nausea or diarrhea are possible.

For more severe acne, isotretinoin is an option:

  • Isotretinoin (Accutane) is an oral retinoid for severe, cystic acne unresponsive to other treatments.

    Studies found isotretinoin greatly reduced psychological issues and quality of life impairments caused by severe acne.
  • It is highly effective but has significant side effects. Close monitoring by a dermatologist is required.

Adjusting hormone dosage or frequency may also be a viable option:

  • In some cases, more frequent smaller testosterone doses may reduce acne vs larger intermittent doses.
  • Consulting an endocrinologist to adjust the dosing regimen can be beneficial for certain individuals.

Will Acne from Testosterone Therapy Eventually Clear Up?

Many patients see initial breakouts resolve within 1-2 years as the body adjusts to the new hormone levels. However, others continue battling acne for as long as they remain on testosterone replacement.

In general, those who start testosterone therapy at a younger age and receive higher doses seem more prone to persistent acne. Adjusting the testosterone dosage downward can sometimes help in these cases.

While waiting for acne to improve, consistent use of topical retinoids, benzoyl peroxide, topical/oral antibiotics, and proper skin hygiene/lifestyle habits may help manage outbreaks. More severe inflammatory acne may need isotretinoin to fully clear up.

Even once breakouts resolve, it’s common for those on testosterone therapy to have oily skin and be prone to minor acne flares due to ongoing higher sebum production. Maintenance treatment is often warranted long-term.

Tired of choosing between hormones and clear skin? PRC offers personalized care to optimize both. Book a consultation today.

To Summarize

Testosterone replacement therapy can frequently trigger acne breakouts due to increased sebum production and pore-clogging. While acne is a common side effect, severity is usually mild to moderate. 

With consistent topical treatments, oral antibiotics if needed, and hormone dosage adjustments, testosterone-related acne can be effectively managed in most patients. Within 1-2 years, breakouts often gradually subside as the body adapts to the new hormonal balance. 

However, maintenance therapy is often required long-term to control acne flare-ups and oily skin resulting from ongoing testosterone therapy. By working closely with our specialists at Physician’s Rejuvenation Center, optimal testosterone levels can be maintained while keeping acne under control.


Why does testosterone therapy acne concentrate on the back?

Testosterone therapy increases sebum production which clogs pores and leads to pimples concentrated on the back because it has the highest concentration of oil glands compared to other areas of skin.

Can testosterone therapy cause acne even with proper skin care?

Yes, testosterone therapy can cause acne even with proper skin care because it increases sebum production and stimulates oil glands, making pores more likely to clog regardless of hygiene.

Does testosterone therapy and cystic acne have a proven link?

Yes, testosterone therapy and cystic acne have a proven link as testosterone stimulates androgen receptors in skin glands to produce more sebum, leading to clogged pores and infected cystic acne.