Testosterone replacement therapy (TRT) is becoming an increasingly sought-after option for men who have been experiencing symptoms of low T levels. But one of the side effects that many men dread is acne development.
To help our readers better understand this issue. I spent three days researching scientific evidence as well as over four hours talking to a couple of doctors with expertise in hormone therapy and dermatology.
I also found some options for effective acne treatment that patients can fall back on in case they start seeing acne breakouts.
Quick Summary
- Testosterone replacement therapy (TRT) is an effective way to overcome low T levels, but depending on the treatment type and dosage, it can lead to varying degrees of acne.
- The effects are similar to the way increases in testosterone during puberty can lead to blocked and overactive sebaceous glands in the skin.
- There are simple over-the-counter remedies and medical prescriptions that can provide an effective topical acne treatment.
Does Testosterone Therapy Cause Severe Acne?
Yes, testosterone therapy can cause severe acne in some men.
The severity of hormonal acne can vary a lot between men, and some might experience issues even if they suffered from such skin conditions during puberty.
Studies have shown that serum testosterone levels are directly linked to acne severity and overall sebum production in the skin [1].
This is skin oil production that can build up in the pores and lead to infections.
“Sebum is a type of natural skin oil that’s produced by your body’s sebaceous glands.”
- Mary Lucas, RN, MD.
There is no clear early indicator of whether sebum production will definitely lead to acne breakouts.
However, it seems like acne development on the face, neck, and back is quite common with TRT.
During my research, I talked to a dermatologist who mentioned that the dosage could be a considerable factor.
In his experience, high-dose injections were most likely to result in acne around hair follicles.
Because acne develops differently in men, it’s one of the things that doctors monitoring TRT pay careful attention to.
From the earliest signs of oily skin, it’s important to let your doctor know and take preventative steps in your daily hygiene routine.
Is it Different from Normal Acne?
Testosterone acne isn’t substantially different from normal acne that people can experience predominantly in their teens.
Even adults sometimes continue to suffer from acne throughout their lives, which often links back to hormonal imbalances, diet, and even allergies.
While there are many causes of “normal” acne, there is a slight difference in the way it develops with TRT [2].
Men who start developing TRT acne will likely get confirmation from their doctor that it’s directly linked.
The problem is that if you leave it untreated, mild acne can get worse. And that can lead to acne lesions and even painful cystic acne.
The big question is how much of it is dosage-dependent and whether you can control it through the use of other forms of TRT.
Here’s what I mean.
My cousin Henry has been going through TRT for a few years, and he started developing acne early on.
By changing the dosage, his doctor was able to control it a bit better, and after a while, he switched to a topical gel.
It seems like, in his case, the slower release of the gel didn’t cause sudden spikes in testosterone levels and reduced the severity of his inflammatory acne.
How Long Does Acne From Testosterone Last?
Acne from testosterone can last the entire length of the treatment time, but some men might only have one initial flare-up when they start treatment.
In other cases, it could be completely random and cause breakouts every few months.
Here’s why it’s so difficult to say.
The chemistry of everyone’s skin is different. And just like some people get acne as teenagers and others don’t, the same can happen with TRT.
If your hair follicles are more susceptible to overactive sebaceous glands, then it’s far more likely that they will flare up every time your hormone levels change [3].
Some people can easily clear out the excess oil, resulting in hardly any or only a mild impact on hair follicles and skin cells.
This is definitely something you can discuss with your doctor before starting the treatment.
If you’ve had a history of acne in your teens or adult life, then tell your doctor right away. He might even decide to gradually increase your dosage from a very low level just to monitor how your body reacts.
And that can be a better approach than resorting to treating acne that blows up very aggressively.
How Do You Get Rid of Acne From TRT?
It’s difficult to get rid of acne from TRT, but there are a few treatment options. You can treat acne vulgaris that is due to hormones with prescription and over-the-counter options.
As part of my research, I got a dermatologist to give me some tips he gives to patients going through testosterone therapy.
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Over-The-Counter Acne Treatments
There are plenty of proven options for treating acne without having to resort to prescription medication.
And it all comes down to finding a face and body wash that suits your skin type and effectively deals with dead skin cells and excess sebum.
Here are some options.
Benzoyl Peroxide
Benzoyl peroxide is one of the first things doctors recommend, and studies have shown that it is an effective way to deal with clogged pores [4].
It might not have an instant effect, but you should see improvements after a month or two.
Salicylic Acid
You will find salicylic acid in many different skin care products, and it can be an effective way to improve skin health [5].
Ask your local pharmacy about a face and body wash that contains salicylic acid and see how your skin reacts.
“Many of your sebaceous glands are concentrated around hair follicles. Sometimes, these follicles can become blocked with sebum, dead skin cells, and other particles. When this blockage becomes inflamed, you get the elevated bumps that are commonly referred to as acne.”
- Cynthia Cobb, DNP, APRN
Prescription Medication
If any over-the-counter topical treatments don’t work, then it might be time to talk to your doctor.
Most potent prescription treatments will directly impact skin pores and dead skin cells to get to the root of the cause.
Here are some common options.
Isotretinoin
Doctors have been prescribing isotretinoin for many years, and studies have shown that it’s an effective treatment for acne [6].
According to the dermatologist who helped me with this research, there can be some side effects to isotretinoin, so talk to your doctor about whether it’s the best option.
Spironolactone
Anti-androgen medications like spironolactone are typically prescribed for women with hormone imbalances to control androgen receptors [7].
But it might also be an option for men being treated for hormone fluctuations.
Topical Antibiotics
These are often not favored, as they don’t tend to be an option for long-term use.
And while they don’t get to the heart of the problem of eliminating dead skin cells and sebum that trigger acne, they may help reduce infections.
Retinoid
This is one of the most recent acne treatments, and Trifarotene is the only topical retinoid currently available.
Studies have shown that it has powerful impacts on severe cases of acne [8].
Tips for Managing Testosterone Acne
During my research, I also got some feedback on ways to prevent acne while going through testosterone replacement therapy.
Discuss Your Symptoms With a Doctor
Before you start your treatment, let your doctor know if you have ever suffered from acne before.
Also, provide details of the severity, how long it lasted, and how you treated it.
Then, when you start your testosterone injections or gels, pay careful attention to your skin and any early signs of change.
As soon as you see inflammation or redness, let your doctor know and keep monitoring it.
If it develops into a breakout, then discuss the severity with your doctor and start trying some of the above treatment options. The more your doctor knows, the better he’ll be able to help.
Consider Adjusting the Dosage
There is plenty of scientific evidence that testosterone can increase sebum production and worsen acne [9].
And one way to try to control it is to adjust your dosage. For some men, it can help to take more regular but smaller doses, which may help reduce sudden spikes.
What I would say, though, is that you should only do this after consulting your doctor. Adjusting your dosage without medical input could end up having other health impacts.
The good news is that when you work with a reputable and trusted TRT clinic, the service should include follow-up consultations and access to medical advice when you encounter problems.
FAQs
Does Too High Testosterone Cause Acne?
Yes, too high testosterone can cause acne. It doesn’t just affect men who suffered from acne as teenagers. Sudden and significant changes in hormone levels can cause your skin to produce more oil and your pores to clog up.
What Does Acne From Testosterone Look Like?
Acne from testosterone often looks like red inflammation and can include both blackheads and whiteheads. In severe cases, it can result in pustules and cysts that may become very sore.
Will Stopping Testosterone Replacement Therapy Stop Acne?
Yes, stopping testosterone replacement therapy could stop acne. If you didn't have any acne symptoms before starting treatment, then it’s likely to stop. But you should also talk to your doctor about changing the dosage to see if you can control breakouts.
Does TRT Cause Oily Skin?
Yes, TRT can cause oily skin. Testosterone has been linked to triggering skin responses that increase sebum production. And if your skin's pores can’t remove the excess, then it can build up and get infected.
Use a Trusted Clinic to Support Your Treatment
Acne is an unfortunate and common side effect of TRT, but there are ways to try and deal with it to limit the impacts.
But you’ll need the support of experienced doctors who will guide you through regular adjustments to your treatment plan.
Our team has spent months researching and testing different online TRT clinics to find which ones offer the most comprehensive and effective services.
These are licensed clinics that have gained the trust of thousands of patients, including some of our team and clients.
References:
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6408631/
- https://www.niams.nih.gov/health-topics/acne
- https://www.ncbi.nlm.nih.gov/books/NBK499819/
- https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/benzoyl-peroxide
- https://pubmed.ncbi.nlm.nih.gov/33070577/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2835909/
- https://www.aad.org/dw/dw-insights-and-inquiries/2020-archive/july/spironolactone
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9166940/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3051853/
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