Testosterone therapy can worsen acne and oily skin, with the clearest rise often occurring during the first year of treatment. The evidence supports early acne planning rather than stopping or changing hormone treatment without a clinician's guidance. Testosterone therapy includes replacement treatment for men with low testosterone and masculinizing treatment for transmasculine people. Acne risk is real, but it does not affect every person in the same way.
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
- What the research establishes
- Who may be more likely to develop significant acne?
- Why the first year deserves attention
- What treatment can look like
- Important limits in the evidence
What the research establishes
The Endocrine Society identifies acne and oily skin as adverse effects associated with testosterone replacement in men with hypogonadism, based on randomized and open-label trials. The Endocrine Society guideline places these skin changes among the practical effects to discuss when starting treatment.
Research in transmasculine patients shows a larger and more measurable change. In a prospective study of 323 transgender men, moderate-to-severe acne increased from 11.8% before masculinizing testosterone therapy to 39.1% after one year. The 2024 Amsterdam UMC and Ghent University Hospital study supports treating acne as a common treatment issue, not a cosmetic afterthought.
Who may be more likely to develop significant acne?
The 2024 prospective study found higher moderate-to-severe acne risk among people aged 18 to 25, those with a BMI above 25, those who had acne before therapy, and those with testosterone levels above 10 nmol/L. Baseline acne mattered: its relative risk was 1.82 in that study.
These findings are useful for planning, not for predicting any one person's skin. Someone with prior acne may benefit from discussing a preventive routine before treatment begins, while someone with clear skin should still watch for new breakouts.
Why the first year deserves attention
A 2026 Kaiser Permanente–based matched cohort found five-year acne incidence of 15.8% among transmasculine people without baseline acne, compared with 3.8% of matched cisgender men and 10.5% of matched cisgender women. The 2026 Emory University and Kaiser Permanente cohort also found the greatest relative risk during the first year after testosterone initiation.
That timing gives patients and clinicians a practical window for action. Start with a simple plan, reassess when breakouts begin, and seek treatment before acne becomes extensive or distressing.
- Note when acne starts and whether it is worsening.
- Tell the clinician managing testosterone about skin changes.
- Ask a dermatology clinician about treatment if acne is persistent, moderate, severe, or scarring.
What treatment can look like
Standard acne care remains relevant during testosterone therapy. The American Academy of Dermatology recommends options including benzoyl peroxide, topical retinoids, selected antibiotics, and isotretinoin; when systemic antibiotics are used, they should be limited and paired with benzoyl peroxide. The American Academy of Dermatology acne guideline supports matching treatment intensity to acne severity.
For a mild breakout, a clinician may begin with topical treatment. More widespread or inflammatory acne may need a broader plan. Isotretinoin requires particular discussion of reproductive potential and pregnancy prevention requirements where applicable.
Important limits in the evidence
The strongest recent cohort evidence used acne-coded visits and acne-treatment fills, so it measures healthcare-recorded acne rather than every breakout a person experiences. Earlier dermatology literature also describes limited testosterone-acne studies in transgender populations.
There is no dedicated evidence-based hormonal-acne guideline for testosterone-treated transmasculine patients. Care therefore draws on general acne guidance while accounting for transition goals and reproductive potential, particularly when isotretinoin is considered. The 2022 Emory University and VA review frames that individualized approach.