Introduction to Acne & Testosterone HRT

Starting Testosterone HRT is exciting and sometimes, in a way, so is getting acne because it’s signaling to us that things are starting to change. Of course, it might not be your favorite change, so we’ve developed this content to help you navigate this new chapter of your transition/alignment.

Why Does Testosterone HRT Cause Acne?

You may have heard transmasculine and non-binary folks refer to their facial breakouts as ‘T acne’, this implies that their acne is a result of starting HRT Testosterone. So why is that?

There are a couple different factors that play into this. One factor is that testosterone causes the skin glands to produce more oil, which can cause clogged pores and can lead to acne breakouts. The second factor is that there is increased hair growth on the back, chest, arms, neck and face which can contribute to irritated hair follicles and ingrown hairs in those areas. A third factor is when/if you begin shaving. Using improper shaving techniques this can lead to ingrown hairs, rashes and ultimately further affect the skin.

What Is Acne?

Human skin has pores that connect to oil glands under the skin, their purpose is to lubricate and waterproof the skin and hair of mammals. Acne happens when oily secretions (sebum) from the skin’s oil glands (sebaceous glands) plug the tiny openings for hair follicles (plugged, or ‘clogged’ pores). Pimples grow when these follicles get blocked, and oil builds up under the skin. Bacteria can multiple inside the clogged follicle, when this happens an SOS signal is sent to our white blood cells. The white blood cells respond to the clogged follicle which in turn causes the area to become inflamed and painful.

Simply put, a basic acne lesion is an enlarged and plugged hair follicle. If it remains beneath the skin it produces a white bump (a whitehead). If it reaches the surface of the skin and opens up it’s called a blackhead.

What Causes Acne?

If you’re currently taking testosterone then your oil production has sped up, which can increase your odds of developing acne. Other factors could be:

  • Scrubbing the skin too hard or too much
  • Pressure from tight fitting hats or clothing (binders for example)
  • Heredity
  • Scented products

For folks on HRT testosterone acne could be temporary (like puberty), or it could remain a pesky side effect of T.

Forming Healthy Habits To Treat Acne

Sometimes a simple change in daily habits can help alleviate folks experiencing acne due to being on testosterone HRT. Here’s a simple place to start:

  • Drink more water: Your body is approximately 70% water, because of this water’s an important building block of overall health in addition to skin health. Drinking water everyday helps your body rid itself of toxins more efficiently. However, drinking more water won’t make your breakouts disappear overnight.
  • Don’t touch your face: Seems a little silly, but this may be the first piece of advice a dermatologist will give you. Your fingers have oil and dirt on them except for a brief period after you wash your hands. So, svoid touching your face with your hands. This can spread bacteria and irritate already inflamed facial skin. Avoid picking or popping pimples with your fingers as this can increase infection and scarring.
  • Be mindful of hair products: Avoid using pomades, oils or gels that contain fragrances. If they get on your face they could clog your skin’s pores. Use a gentle shampoo and conditioner as oily hair can add to the oil on your face.
  • Avoid the sun: Just kidding, the sun’s a great source of vitamin D. But actually, ultraviolet rays can increase inflammation and redness so you may want to limit your exposure. Wearing a hat to keep direct sun off of your face is always a good idea or using a ‘dermatologist recommended’ facial sunscreen can help. It’s important to note that if you’re already taking acne medication some can make your skin more sensitive to sunlight.
  • Exercise daily: Just like water, regular exercise is good for the body, including your skin.
  • Nutrition: Avoid greasy foods and add more fresh fruits, vegetables and whole grains. Dairy products and foods high in processed sugar may set off your acne, so avoid excess amounts of both of these.
  • Relax: Some studies have linked stress with the severity of acne or pimples. Finding ways to decompress from the daily life stressors could help your skin (and overall life balance).

3 Simple Facial Care Routines To Treat Acne

Keeping your face clean and moisturized (not too much of either) is key. A simple facial regime concentrates on washing, toning and moisturizing.

 Non-medicated Facial Wash Methods

  • Just water: A good starting point is to just wash your face with water twice daily to remove dead skin cells and excess oils
  • Cetaphil: If water isn’t enough you can use a dermatologist recommended mild facial cleanser such as Cetaphil or other non-harsh facewash with limited ingredients

Facial Toner

The benefits of facial toner varies and so do options. A popular inexpensive and natural option is Witch Hazel. Facial toner’s intended purpose is to:

  • Shrink Pores
  • Restores Skin pH Balance; Our skin is naturally acidic, keeping a balanced pH balance can help your skin to work overtime to return to it’s normal levels
  • Adds Protection: Tones can help close pores and tighten cell gaps after cleansing. Due to this it reduces the infiltration of impurities
  • Prevent In Grown Hairs: This is particularly helpful for transmasculine and non-binary folks on testosterone HRT who are starting to sprout new hairs.

Chemical Exfoliate

Products that contain salicylic acid or glycolic acid (or other alpha hydroxyl acids) can soften the outer layers of skin and make it so that the pores do not remain plugged. There are lots of these products, but one of the simplest and most reliable in Dr. Mosser’s experience is one called Tend Skin Solution that can be easily purchased on Amazon.com (Dr. Mosser has no promotional interest in the Tend Skin company).  Using something like Tend Skin and refraining from touching the acne areas with one’s hands unless freshly washed will go a long way to improve acne in many body areas.

Facial Moisturizer

Cleaning excess oil from the face is a good thing, but if your skin becomes too dry then your body could produce more oil to compensate, which could lead to more breakouts. It’s important to find what type of moisturizer will work best for you, below are some options.

Moisturizing Options

  • Non- comedogenic Fragrance Free Moisturizer: Non-comedogenic is a fancy word for skin-care products that are supposed to not cause blocked pores. An easy way to spot these products on the store shelf would be to look for ‘dermatologist recommended’ and then some distinguishing text that notes ‘non-comedogenic’.
  • Carrier Oils: Can be used as a moisturizer or to treat skin problem areas. The base of these oils mainly derives from nuts and seeds of different plants so they are a natural product. Carrier Oil’s most valuable property in fighting acne is the presence of ‘linoleic acid’. Acne patients have been shown to have low levels of linoleic acid, a property in our body that helps reduce acne, retain moisture in addition to anti-inflammatory effects as well as others. Low levels of linoleic acid=more oil production which in turn leads to more acne. Look for carrier oils high in linoleic acid, there are many options to choose from. Some options such as Evening Primrose Oil have known hormone balancing properties which is perfect for that T acne!

Razor Burn, Razor Bumps and Ingrown Hairs

Another simple method of avoiding acne breakouts is learning more about proper shaving techniques. One of the effects of testosterone is increased hair growth on the body and face which can lead to ingrown hairs and irritated follicles. If you’re to the point of shaving this can cause razor burn, razor bumps and ingrown hairs.

What Are Ingrown Hairs?

For folks who’ve started Testosterone HRT new hairs can start to sprout so it’s good to be prepared for what ingrown hairs are and how to deal with them. Simply put; when a hair fails to grow out of the follicle itself. It’s basically stuck in the skin but is wanting to get out. Since the hair can’t find its way out it can cause inflammation and can be followed by pus. Improper shaving can increase the likelihood of developing ingrown hairs.

What Are Razor Bumps?

When a hair grows out of the skin, then curls the other way and grows back into your skin.

What Is Razor Burn?

Simply put it’s just a temporary redness or swelling of the skin that’s quite irritating. No need to worry, although it can be unsightly at times it will go away in a few days. You can prevent razor burn by reading up on this comprehensive introduction to safe and correct ways of shaving.

Medicated Facial Wash for Acne

There are a lot of options on the market, and it may be best to consult a dermatologist so they can help assess what kind of facial wash will be best for your skin type. Basically, what constitutes as a ‘medicated facial cleanser’ are cleansers with acne-fighting ingredients such as:

  • Salicylic Acid: Helps clear blocked pores and reduces swelling and redness
  • Glycolic Acid: Removes excess oil, improves skin issues like blackheads, hyperpigmentation, and enlarged pores
  • Benzoyl peroxide: Exfoliates the skin and kills bacteria
  • Sodium Sulfacetamide: Interferes with the growth of bacteria
  • Tea Tree Oil: A deep cleanser, antibacterial and antifungal agents. It can help prevent further outbreaks much like benzoyl peroxide.

Medicated Facial Wash Options

There are so many options when it comes to more aggressive methods for treating acne. It would be best to consult a dermatologist to figure out what will work best for you. Or, if this isn’t an option for you refer to the above list of ingredients and compare it to active ingredients of facial washes at your local store.

Introduction to Prescription Acne Treatment

When all else fails trans and non-binary folks on testosterone HRT struggling with aggressive acne may seek prescribed acne medication. Prescribed acne medication is used to treat severe cystic acne that has not responded to other treatments such as the active ingredients in medicated facial cleansers. Prescribed methods come with more side effects and risks and should be carefully discussed with your doctor.

Oral Prescriptions For Acne Treatment

There are two main forms of oral treatment for acne; Accutane and antibiotics.

Isotretinoin (Accutane)

It’s a natural derivative of vitamin A, which is known to reduce the amount of oil released by your bodies oil glands. It’s been found large doses of vitamin A has the same effects as Accutane. Large doses of vitamin A can build up in tissue so it’s important to not take vitamin A in addition to Accutane (chose one or the other).  It has an estimated 50% success rate in ‘curing’ acne.

What Are The Risk Factors Of Taking Accutane?

A 50% success rate can sound enticing at first, but with all medications it’s important to know what the risks are and how it can affect you. Since Accutane can cause serious side effects it’s best to talk to your doctor about these in addition to doing your own research. A good starting point for your investigation into Accutane can be found here.

Oral Antibiotics

They can help control acne by decreasing your odds of developing bacteria and inflammation on your skin. Just like Accutane and other prescribed medications oral antibiotics also have side effects and should be carefully talked about with your doctor.  Below you can find additional acne resources.

In Conclusion

There’s no perfect method for curing or treating acne as a lot of the work is figuring out what products your skin likes. Through this trial and error process I encourage you to focus on the products/habits that do alleviate your acne symptoms, and avoid focusing on what didn’t work for you. Consulting a dermatologist is always recommended and encouraged.

Additional Acne Resources

Alternative approach to treating acne
www.acnecontrol.net

Free skin regimens and acne message boards
www.acne.org

Medline Plus Drug Information Page
www.nlm.nih.gov/medlineplus/druginformation.html