Testosterone therapy commonly causes acne, and planned monitoring plus prompt skin care control most cases. Testosterone therapy means prescription testosterone used to raise low hormone levels or support gender-affirming care. According to the FDA, acne ranks among the most-common side effects of gels and testosterone undecanoate injection, along with site reactions and lab changes FDA Aveed Medication Guide. New oiliness or pimples after starting treatment deserve quick attention, not waiting.
Medical information disclaimer: This article is for general educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a physician or other qualified health professional about symptoms, medications, tests, or treatment decisions.
Table of Contents
- Why testosterone triggers breakouts
- Who faces the highest early risk?
- What should monitoring include?
- Which skin-care steps help most?
Why testosterone triggers breakouts
The body changes testosterone into stronger dihydrotestosterone with an enzyme called 5-alpha-reductase. Dihydrotestosterone signals sebaceous glands, the tiny oil-making glands, to grow and release more sebum. Excess sebum plus trapped dead skin clogs pores and drives androgen-related acne, according to the 2015 Evidence-Based Complementary and Alternative Medicine review.
Gel users may also notice redness or itching where they spread the product. That local irritation differs from acne pimples driven by whole-body hormone action. Note the location, timing, and product use for your clinician.
Who faces the highest early risk?
Risk peaks during the first year for transmasculine patients starting testosterone, according to Healio reporting on a January 2026 JAMA Dermatology study Healio dermatology report. Researchers found hazard ratios of 8.29 versus matched cisgender men and 2.63 versus matched cisgender women, with 5-year cumulative incidence at 15.8%. Hazard ratio here means relative risk compared with each group. A 988-patient Fenway Health cohort tracked acne before and after testosterone, as summarized by Medscape.
Diagnoses rose from 6.3% before treatment to 31% after starting, and remained 25.1% at two years. Teenagers ages 18 to 20 had the highest rate at 29.6%. Women prescribed testosterone for low sexual desire need skin review before and during therapy, according to Healio dermatology Q and A. Clinicians should check for acne, excess facial or body hair, and hairline thinning, and avoid starting when clinical androgen excess exists.
What should monitoring include?
For men on testosterone replacement, the Endocrine Society advises blood and prostate checks at baseline and three months, as summarized by MDedge MDedge guideline summary. Hematocrit, the share of red blood cells in blood, then needs yearly review. Clinicians withhold or lower the dose if hematocrit exceeds 54%.
FDA testosterone gel labeling also flags skin irritation, increased PSA, red-cell count, cholesterol, and liver tests for follow-up. Ask about these items at each visit: For women with low sexual desire, pretreatment screening for excess hair growth and scalp hair loss guides safe prescribing. Bring photos of breakouts and a list of skin products to help dose decisions.
- testosterone level and red-cell count
- PSA change and prostate symptoms
- new acne, hair growth, or scalp thinning
- gel-site irritation or injection-site pain
- cholesterol and liver-test shifts
Which skin-care steps help most?
The American Academy of Dermatology 2024 acne guidance strongly recommends benzoyl peroxide to lower acne bacteria and topical retinoids to keep pores clear AAD updated guidelines via Newswise. Options include adapalene, tretinoin, tazarotene, or trifarotene, plus topical or oral antibiotics and combinations for moderate to severe disease. Use a gentle cleanser, non-oily moisturizer, and prescribed acne products exactly as directed. Do not pick or scrub hard because that spreads irritation and delays healing.
Tell your clinician if dryness, peeling, or dark marks appear. The 2026 transgender acne analysis inferred severity from prescribed treatments rather than direct grading, as reported by Medscape. Moderate to severe rates may therefore reflect prescribing patterns and care access. Bring your breakout log and lab schedule to each follow-up so dose and skin treatment stay aligned.