Does testosterone treatment cause acne? Yes, testosterone therapy can cause acne as a recognised adverse effect. Testosterone is an androgenic hormone that stimulates sebaceous glands to produce excess sebum, which can combine with dead skin cells and bacteria to block hair follicles. The MHRA lists acne as a common side effect, affecting approximately 1–10% of patients using licensed testosterone preparations. Whilst not everyone develops acne during treatment, those with a history of acne may be more susceptible. Fortunately, testosterone-related acne is manageable with appropriate skincare and medical interventions, allowing most patients to continue benefiting from hormone therapy.

Does Testosterone Treatment Cause Acne?

Yes, testosterone treatment can cause acne as a recognised adverse effect of therapy. Testosterone is an androgenic hormone that directly influences sebaceous gland activity in the skin. When testosterone levels increase—whether through replacement therapy, gender-affirming treatment, or other medical indications—the sebaceous glands produce more sebum (skin oil). This excess sebum can combine with dead skin cells and bacteria to block hair follicles, creating an environment conducive to acne development.

The mechanism underlying testosterone-induced acne involves the conversion of testosterone to dihydrotestosterone (DHT) by the enzyme 5-alpha reductase in the skin. DHT is a more potent androgen that binds to receptors in sebaceous glands, stimulating sebum production and altering the composition of skin oils. Additionally, androgens can influence the keratinisation process within hair follicles, leading to the formation of comedones (blackheads and whiteheads).

The likelihood and severity of acne during testosterone treatment varies considerably between individuals. Factors influencing acne development include the dose and formulation of testosterone used, individual genetic predisposition, baseline skin condition, and pre-existing acne history. Those who experienced acne during puberty may be more susceptible to testosterone-related breakouts. It is important to note that whilst acne is a common side effect, it does not affect everyone receiving testosterone therapy, and for many individuals, any acne that develops can be effectively managed with appropriate skincare and medical interventions.

According to the Medicines and Healthcare products Regulatory Agency (MHRA) and product literature for testosterone preparations, acne is listed as a common adverse reaction (affecting ≥1/100 to <1/10 patients) in UK licensed products such as Testogel, Tostran and Nebido. Healthcare professionals should counsel patients about this potential side effect before initiating treatment.

Patients who suspect they are experiencing acne as a side effect of testosterone treatment can report this through the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk).

How Common Is Acne During Testosterone Treatment?

Acne is classified as a common adverse effect of testosterone therapy, with incidence rates varying depending on the study population, testosterone formulation, and dosage used. Clinical data suggests that acne occurs in approximately 10–40% of individuals receiving testosterone treatment, though the severity ranges from mild to moderate in most cases. However, it should be noted that evidence is heterogeneous across different patient populations and study designs.

The frequency of acne appears to be dose-dependent, with higher testosterone doses generally associated with increased risk. Individuals receiving testosterone for gender-affirming care may experience higher rates of acne, particularly during the first 6–12 months of treatment when hormone levels are adjusting. Observational studies of transgender men initiating testosterone therapy have documented acne as one of the most common early side effects, with some cohorts reporting rates exceeding 50% in this population.

There is limited evidence suggesting that formulation and route of administration may influence acne incidence. Some observational studies indicate that intramuscular testosterone injections, which can produce fluctuating hormone levels with peaks shortly after administration, may be associated with more pronounced acne compared to transdermal preparations (gels or patches) that provide steadier hormone levels. However, there is no robust clinical consensus establishing one formulation as definitively superior for minimising acne risk.

The timing of acne onset typically occurs within the first few months of starting testosterone treatment, as sebaceous glands respond to increased androgen stimulation. For many individuals, acne improves over time as the body adjusts to the new hormonal environment, though some may experience persistent symptoms requiring ongoing management. It is worth noting that not everyone will develop acne, and pre-existing skin conditions or a personal history of acne may increase susceptibility.

Monitoring schedules vary by indication and local service protocols, but healthcare professionals typically assess patients regularly during the initial treatment period and provide anticipatory guidance about this potential side effect.

Managing and Preventing Acne While on Testosterone

Effective management of testosterone-related acne involves a combination of preventive skincare measures and medical treatments tailored to the severity of symptoms. Early intervention can prevent progression to more severe acne and reduce the risk of scarring.

Basic skincare recommendations form the foundation of acne prevention:

• Gentle cleansing: Wash affected areas twice daily with a mild, non-comedogenic cleanser. Avoid harsh scrubbing, which can irritate skin and worsen inflammation.

• Oil-free products: Choose non-comedogenic moisturisers and cosmetics that won't block pores.

• Avoid picking: Resist the urge to squeeze or pick at spots, as this increases inflammation and scarring risk.

For mild acne, over-the-counter treatments containing benzoyl peroxide (2.5–5%) may be sufficient. Salicylic acid products can be used as adjunctive therapy to help unclog pores, though they are not a core NHS-recommended first-line treatment.

When acne is moderate to severe, prescription treatments may be necessary. According to NICE guidance (NG198) on acne management, first-line options include:

• Fixed combination treatments: Such as adapalene with benzoyl peroxide, or clindamycin with benzoyl peroxide.

• Topical retinoids (such as adapalene or tretinoin): These normalise skin cell turnover and prevent comedone formation.

• Azelaic acid: An alternative first-line option, particularly suitable for sensitive skin.

• Topical antibiotics: Should not be used as monotherapy but combined with benzoyl peroxide to reduce bacterial resistance.

For persistent or severe cases, oral treatments may be indicated:

• Oral antibiotics (such as lymecycline or doxycycline): Typically prescribed for up to 12 weeks initially, always combined with a topical non-antibiotic treatment. Oral and topical antibiotics should not be used together.

• Oral isotretinoin: Reserved for severe, scarring acne or cases unresponsive to other treatments. This requires specialist dermatology referral and careful monitoring due to potential side effects including mental health and sexual function risks. The MHRA requires a Pregnancy Prevention Programme for those who could become pregnant, as isotretinoin is highly teratogenic.

Important safety note: Tetracycline antibiotics and retinoids (both topical and oral) are contraindicated in pregnancy. Testosterone is not a contraceptive, so appropriate contraception should be discussed with patients who could become pregnant.

It is important to note that adjusting testosterone dosage is rarely the first-line approach, as the benefits of hormone therapy typically outweigh the inconvenience of manageable acne. However, in consultation with the prescribing clinician, dose modification may occasionally be considered if acne is severe and refractory to dermatological treatment. Patients should never alter their testosterone regimen without medical supervision.

When to Seek Medical Advice About Testosterone-Related Acne

Whilst mild acne can often be managed with over-the-counter treatments and good skincare practices, certain situations warrant professional medical assessment. Patients should contact their GP or prescribing clinician if they experience any of the following:

Indicators for seeking medical advice:

• Moderate to severe acne: Numerous inflamed papules, pustules, or nodules that are painful or widespread across the face, chest, or back.

• Lack of improvement: No response to over-the-counter treatments after 8–12 weeks of consistent use.

• Psychological impact: Acne causing significant distress, anxiety, or affecting quality of life and social functioning.

• Scarring: Development of acne scars or post-inflammatory hyperpigmentation.

• Cystic acne: Deep, painful nodules or cysts that may indicate a need for specialist intervention.

Urgent medical attention should be sought for:

• Rapid onset of severe, painful acne with ulceration

• Acne accompanied by fever, joint pain, or other systemic symptoms

• Sudden worsening of acne with widespread inflammation

These could indicate rare but serious conditions such as acne fulminans that require immediate treatment.

Patients should have regular follow-up appointments with their testosterone prescriber, with schedules varying according to indication and local protocols. These reviews provide opportunities to discuss side effects including acne and adjust management strategies accordingly. The prescribing clinician can assess whether acne is related to testosterone therapy or other factors, and determine whether referral to dermatology services is appropriate.

Referral to a dermatologist may be indicated for:

• Severe acne (extensive inflammatory lesions or nodular/cystic acne)

• Acne with scarring or at high risk of scarring

• Acne unresponsive to adequate trials of standard treatments

• Diagnostic uncertainty

According to NICE guideline NG198, referral should not be delayed if there is diagnostic uncertainty or risk of scarring. Early specialist input can prevent long-term complications and improve outcomes.

Patients should be reassured that testosterone-related acne is a manageable condition and that effective treatments are available. Open communication with healthcare providers ensures that acne does not compromise the benefits of testosterone therapy or negatively impact wellbeing. It is important to maintain testosterone treatment as prescribed whilst addressing skin concerns through appropriate dermatological management, rather than discontinuing hormone therapy without medical guidance.

Frequently Asked Questions