Acne Development and Testosterone Replacement Therapy

Will Testosterone cause me to get acne?

What are some acne treatments I can use while on Testosterone Replacement?

Do all men experience acne on Testosterone Replacement ?

It is a common question asked by most men are considering testosterone replacement therapy (TRT), “Will testosterone replacement therapy cause acne?”. To answer this question let’s understand how testosterone affects the skin. Testosterone is a sex hormone that has both anabolic and androgenic properties. Anabolic properties of testosterone include improved muscle size, strength and weight loss. Androgenic properties of testosterone include facial hair production, deepening of the voice, and among others an increase in oil production from sebaceous glands in the skin. Within the skin are glands that secrete and oily substance called sebum. Skin glands produce sebum to remove dead skin cells that have accumulated over time for their removal from the surface. When these glands become blocked by an accumulation of both dead skin cells and sebum, acne can result.

Androgen receptors are present in skin glands. Testosterone stimulates the androgen receptors in skin glands to produce more sebum. This is often witnessed more prominently in young men going through puberty who have more oily skin they produce more testosterone in their early teen years. The most common sites for acne formation for men on testosterone replacement therapy, are similar to men who go through puberty, on the face and back predominately.

It is important to note, that not all men will experience the same skin changes, such as acne formation, when undergoing testosterone replacement therapy. There exists in every man androgen receptor variability, small structural changes in the androgen receptor the predisposes some men to respond to testosterone different. This is called androgen receptor polymorphisms. Some men may experience a more robust response when on TRT compared to others, relating to skin manifestations. This is also a very exciting concept in testosterone replacement and an evolving concept in male hormone replacement. Our understanding how testosterone binds to the androgen receptor differently in various parts of the body can lead to new and more effective testosterone preparations and formulations to enhance outcomes most desired desired my men and reduce unwanted side effects. It is worth mentioning, then men on testosterone replacement often see an enlargement in very specific muscle groups compared to others secondary to the differences in the androgen receptor density in different muscles.

For men who are on TRT and who are experiencing an increase oily skin or an increase in acne there are several treatment options available. (please consult with your physician prior to use).

1) Skin Hygiene

For men who are on testosterone replacement therapy and are experiencing an increase in skin oil production or acne formation, utilizing a daily facial and body wash to remove excess oil can help. Often recommend are body and facial washes that contain Salicylic Acid and/or Benzyl Peroxide.

2) Salicylic Acid

Salicylic Acid is a topical agent that has been used extensively for the treatment of acne and as an exfoliating to gently cleanse the skin. Salicylic acid acts as a “keratolytic" agent by breaking down and softening the bonds between keratin cells in the top most layers of the skin for easy removal. In addition, Salicylic Acid also penetrates deep into the pores to remove dead skin cells that may block skin pores.

For men who experience acne while on testosterone secondary to increase sebum production a Salicylic Acid facial and body wash are sold over the counter and can be a great first option to combat acne formation. When choosing a facial wash consider using only 2% Salicylic Acid solution. 3% Salicylic Acid is best for the body and not the face.

3) Benzyl Peroxide

Unlike Salicylic Acid, Benzyl Peroxide works by killing bacteria that live underneath skin cells and removes dead skin cells known to cause acne. Benzyl Peroxide has been used since the early 1950’s to treat and manage acne and can be found in concentrations ranging from 2.5% to 10%. Benzyl Peroxide can be found in over the counter body and facial washes. Be careful, as Benzyl Peroxide can cause skin irritation if over used and may also stain clothing.

4) Topical Retinoids

Topical retinoids work by slowing the buildup of dead skin cells on the outer layer of dermis. Retinoids are available in a variety of gels, creams and liquids and can also function well for spot treatments for severe acne. Men who use retinoids should be aware that use of a topical retinoid and overt sun exposure can harm and irritate the skin. Skin exposure to sun while using retinoid compound is not advised. Most men often use it before bed to avoid sun exposure.