Is Testosterone Causing Your Acne? Here’s How to Tell.

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Treating adult acne can feel like one big science experiment—until now. This is the guy’s guide to adult acne. Read the rest of the stories here.

THERE ARE PLENTY of reasons to like testosterone replacement therapy (TRT)—it can boost energy, increase muscle mass, and improve sex drive—but there’s one potentially annoying side effect: acne, or, uh, bacne (acne on your back and shoulders). TRT can increase sebaceous gland activity, which boosts oil production that can clog pores, trap bacteria, and cause breakouts. The areas around the back and shoulders, along with the chest, have a high concentration of androgen-responsive oil glands.

When the total testosterone in your body increases, it gets converted to dihydro­testosterone (DHT), a major androgen, and estrogen. DHT ramps up oil production in the skin, according to Akhil Muthigi, MD, a urologist at Houston Methodist Hospital. This can lead to inflammatory acne (papules, pustules, nodules, and cysts) though whiteheads and blackheads are common as well. Dr. Muthigi says that guys who take higher doses of TRT (anything near or over 200 milligrams per week) are at a greater risk of developing acne, but it can happen at any dose. It largely depends on your skin biology (i.e., the amount of androgen receptors on your skin that trigger sebaceous gland growth and, therefore, oil production), as well as genetic factors.

TRT treatments that provide steadier levels (such as daily creams and gels) are less likely to cause acne than other forms that cause spikes (such as injections), says Danny Guo, MD, a cosmetic and surgical dermatologist. He adds that if you start TRT and see acne forming within a few weeks to a few months of taking it, stopping the therapy won’t necessarily eliminate the acne. So it’s best to talk to a dermatologist before bailing on the therapy altogether. Fortunately, TRT-triggered acne is as treatable as any form, with the strategies here proving effective.

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