Acne is one of the most annoying skin problems people can develop throughout their lifetime. It basically consists of small lesions, pimples, irritation, redness, and other skin imperfections. Acne can spread over the forehead, neck, face, shoulders and chest area.

Although it's commonly believed that teenagers get the most acne problems, this skin condition can be prevalent in people of all ages. Acne can also develop as a side effect of taking exogenous testosterone, so even if you're well into your forties or fifties, you might still get acne at some point in your life.

Are you wondering if TRT and acne correlate with each other? There are a handful of possible side effects of TRT (testosterone replacement therapy). While most side effects of TRT are manageable, if not avoidable, some can be quite serious if the use of exogenous hormones is abused or if simple genetic factors are not correctly dealt with accordingly. Then there are those potential side effects of TRT that are far less serious, but ones we might place in the vanity category. One of these side effects of TRT is acne.

Acne is something most grown men do not concern themselves with; after all, we all think of it as an irritation long since left behind in adolescence. However, for some men, the use of exogenous testosterone can cause this childhood enemy to rear its ugly head once again.

Before we dive into this particular side effect of TRT, there is a significant genetic factor we would be remised if we left out. Those who are naturally predisposed to acne are at the most risk. Those who never had severe acne issues in their youth will unlikely experience an issue while on TRT. Sure, anyone can get a zit even in adulthood. You may find a few pop up here and there on TRT that you normally wouldn’t get. But as it pertains to a serious issue, the genetically predisposed are at the highest risk.

Testosterone and Acne: The Process

Testosterone is a hormone that converts to an even more powerful hormone known as dihydrotestosterone (DHT). Many studies have shown DHT to be upwards of five times more powerful than the testosterone hormone.

DHT is an extremely important hormone in the male body. It is imperative to our sexual health if for no other reason. DHT also causes the body to produce more oil, leading to oily skin and more oil soaking into your pores, resulting in acne. However, blocking DHT is not a good idea since it has many benefits for men. It’s a relatively simple process, but one that can be quite bothersome if not embarrassing. Your health has greatly improved through TRT; you’re now in better shape, leaner, and more muscular, and your sex drive is back to where it used to be, but your face looks like that of a 14-year-old boy. If this doesn’t sound desirable, that’s because it’s not. However, there’s also some very good news: acne related to TRT is more than manageable if not outright avoidable. Check the DHT test on DiscountedLabs.com.

Acne or Folliculitis? How to Differentiate?

Sometimes what we think is acne isn't. Some men on testosterone replacement therapy (TRT) develop red bumps on their skin when on the hormone. Some doctors have found out that it is folliculitis. You need to see a dermatologist who can accurately diagnose this problem, so do not assume it is just acne. 

Folliculitis is the infection and inflammation of one or more hair follicles. The condition may occur anywhere on hair-covered skin. The rash may appear as pimples that come to white tips on the face, chest, back, arms, legs, buttocks, or head. Eosinophilic folliculitis is an itchy rash with an unknown cause that is most common among individuals with HIV, though it can occur in HIV-negative individuals where it is known by the eponym Ofuji disease.  EF consists of itchy red bumps (papules) centered on hair follicles and typically found on the upper body, sparing the abdomen and legs. The name eosinophilic folliculitis refers to the predominant immune cells associated with the disease (eosinophils) and the involvement of the hair follicles.

Folliculitis can be treated with minocycline, UV light, retionic acid washes, and topical corticoid steroids.

Avoiding TRT Acne Through Hygiene

The best thing you can do to prevent TRT related acne is also the simplest: hygiene. Washing your hands and face multiple times a day will have a positive effect. You can choose not to, but you’re only hurting yourself. This is something you should be doing even if you’re not on TRT.

Carry a small towel with you each day and keep your face dry, but let’s not stop there. Acne can also easily appear on our shoulders, back, and chest, so it will be important to keep our entire body clean, especially if we’re predisposed to acne.

Any time you become sweaty, such as after a gym session, working outside, or any other activity that leaves you a little sweaty, take a shower and put on a clean shirt. If you can’t take a shower immediately, let’s at least put on a fresh, clean, dry shirt and shower as soon as we can.

Along with simply being hygienic, there are some good soaps, anti-acne soaps you may want to consider. Any soap containing the ingredients Benzoyl Peroxide or Salicylic acid will be worth a try. Simply wash your troubled areas with this anti-acne soap, rinse and repeat each time you shower.

How to Deal With TRT-related Acne

Want to get rid of pimples or prevent your TRT treatment from causing an outbreak? Here are a few things you can try:

- Use Accutane -- Accutane, or isotretinoin, is one of the most potent prescription treatments to cure acne. It's usually used to treat cystic acne, which is a much more serious form of acne that is likely to cause scarring. The treatment is effective in up to 85% of cases. Taking 40 mg of Accutane every day for a week can do wonders for your acne. However, be aware that the medication does come with side effects, and it may lower testosterone levels and have psychiatric side effects is some people. Consult your physician before mixing TRT and Accutane.

- Use Sporanox -- Sporanox, or itrconazole, is another useful medication to try as a means of curing your acne. It is an anti-fungal drug that may be able to kill off the P. acne bacteria that is increasing your skin cell turnover rate, thereby increasing your risk of clogged pores. Once again, check with your doctor before mixing TRT and Sporanox.

- Try Vitamin B5 -- Vitamin B5, or pantothenic acid, is needed by your body in order to produce CoEnzyme A (CoA). This enzyme helps to oxidize (burn) fatty acids, particularly in your skin. If you don't have enough of this CoA, your body won't be able to eliminate the fatty acids produced by an increase in DHT, so the skin oil will increase and lead to acne. By taking Vitamin B5, you give your body what it needs to keep the fatty acid production under control.

- Try anti-acne soap -- There are a number of anti-acne soaps available at every pharmacy and supermarket in the country. These soaps are often made with Benzoyl Peroxide or Salicylic acid, two highly effective anti-acne treatments. Ideally, you should shower after a heavy workout, and use the soap to wash your face and any body parts where there is an acne breakout. Topix Benzoyl Peroxide is a body wash worth trying.

- Try zinc -- Zinc is one of the most important minerals for a healthy body. It plays a vital role in many important internal functions, not the least of which is your body's immunity to disease. But how can it help to protect against acne? Zinc ensures that your bloodstream carries sufficient Vitamin A to your skin, and it helps to regulate the cellular apoptosis (death) of your skin cells. By ensuring that your skin cells die at a healthy rate, zinc essentially prevents the buildup of dead skin cells that soaks up skin oil to clog your pores.

- Get out -- Your body NEEDS sunlight in order to produce Vitamin D, one of the vitamins that play a role in fatty acid oxidation. However, be warned: too much sunlight can dry out your skin, causing it to produce even more oil. No more than 30 minutes of sunlight per day is needed to encourage healthy Vitamin D production.

If your acne is the result of the TRT, you may want to consider reducing the dose of testosterone. This can reduce the amount of DHT produced in your body, preventing acne. However, this is something you should discuss with your doctor. You can also discuss other useful treatments for dealing with the TRT-related acne.

TRT and Acne: Other Treatments

If your acne is severe due to TRT, there are several medications you may want to consider. These medications can have a positive effect, but they are not without their own potential risk.

One of the most commonly used medications for the treatment of acne is Accutane. Accutane has a success rate of upwards of 85%. However, while it’s generally used for severe cases, such as cystic acne, some TRT users may find it to be the right course of action. The most common side effect many users concern themselves with is that the drug can lower testosterone levels. However, in your case, you’re already using exogenous testosterone. Your natural production is already subpar. This side effect of Accutane should not be an issue for you.

There are other drugs, such as Sporanox, an anti-fungal medication that some may find helpful.

A full lost of FDA approved medications for treating acne that may be worth consideration if this particular side effect of TRT manifest:

  • Trifarotene Cream
  • Aczone Gel
  • Differin Gel
  • Onextron
  • Altreno
  • Sarecycline (Seysara)

Many natural remedies are available that many may find to be effective, not to mention simply healthier. Three of these remedies include B5, zinc and vitamin D. Some may find B5 useful due to its ability to produce Coenzyme A (CoA). This enzyme will help in the oxidization of fatty acids, primarily in the skin, burning the fatty acids that increase due to DHT.

Then we have the overall fantastic mineral zinc. This mineral plays several important roles in the human body. For our purposes here, zinc helps carry vitamin A to the skin. This greatly aids in preventing the buildup of dead skin, which can clog our pores and lead to acne.

Finally, vitamin D: vitamin D, while it’s not the only source of oxidizing fatty acids, it is one that plays an important role. A mere thirty-minutes of sunlight per day will give you all the vitamin D you need to meet the desired end. 

If the use of the various vitamins and minerals discussed doesn’t do the trick, if you’ve found prescription medications to be lacking for your needs, you may need to consider an alternative. This alternative action may be as simple as lowering your testosterone dose. You may only need to lower the total amount per injection and not the weekly dose. For example, if you’re injecting a total of 200mg per week, consider splitting it into 100mg twice a week. If you’re already following such a protocol, you could split the total milligrams injected per week into three or even four smaller injections. If one is following a sub-Q protocol, although injections will be frequent, they will be far less bothersome than 3-4 Intra-muscular injections per week. If that still doesn’t do the trick or you’re simply not interested in multiple injections per week, lowering the total dose of testosterone so that there’s less testosterone to convert to DHT may be your only option.

What Causes Acne? And how to Prevent It?

Acne develops when subcutaneous sebaceous glands on the skin get blocked or filled with excessive amounts of sebum. Sebum is a waxy-like substance which protects the skin. When too much sebum is secreted, the sebaceous glands can get infected which leads to acne.

Contrary to popular belief, acne isn't really caused by a poor diet consisting of fatty foods. Acne might develop as a result of reaching puberty or when a person is getting through a great deal of stress. Taking advantage of testosterone replacement therapy (TRT) can also trigger acne as a side effect. This might be caused by an excessive amount of estradiol present in the bloodstream.

Preventing acne is also quite difficult, but you can manage it much better thanks to a few products recently approved by the FDA. These creams and gels are designed to reduce the effects of acne and prevent it from ruining your image and the aesthetics of your skin.

Let's take a closer look at some of these products and see what are their benefits! They can be used by TRT patients to mitigate the effects of acne on their face, chest, and shoulders.

Latest FDA-Approved Acne Products:

As a rule of thumb, keep in mind that not everyone who goes through TRT gets acne as a side effect. A plethora of patients doesn't experience skin problems at all, ever. Others might get mild acne on their faces and shoulders which can go away on its own. In some rare cases, the acne might be more severe and that's when you need to take advantage of these FDA-approved creams and gels.

Sarecycline

Sarecycline is also known as Seysara and it's a product derived from tetracycline. It can be used to effectively treat acne in people aged 11-30 years. Sarecycline is available in tablet form with dosages of 60mg, 100mg or 150mg. The dosages are given depending on the weight of the patient.

For example, if the patient weighs less than 54kg (119lbs) then the recommended dosage is 60mg. If the patient weighs between 85kg (187lbs) and 136kg (299lbs) then the recommended dosage is 150mg. Patients weighing more than 54kg but less than 85kg should take the 100mg tablet.

Sarecycline is used to treat moderate to severe acne in patients of all ages. Its efficiency was based on studies performed on more than 2,000 patients. The research involved a double-blind, placebo-controlled trial over a period of 12 weeks. Most of the patients experienced improvements after just 3 weeks of treatment and their acne and other skin lesions were significantly healed.

The recommended dosage is to take one tablet per day with or without food. The FDA approves the use of this product, but its safety hasn't yet been established after a period of 12 months, so more research trials need to be conducted in the future. Still, sarecycline is an ideal acne product if you want to get rid of acne caused by TRT.

Altreno

Another great acne product you can try is Altreno, also known as tretinoin 0.05%. This topical treatment can be used on patients who are 9 years of age or older. It consists of a lotion that is applied directly to the damaged skin. The active ingredient is absorbed very quickly by the skin and it can significantly reduce moderate to severe acne in patients.

The FDA approved this treatment option based on studies performed on identical research centers. These were double-blind, vehicle-controlled studies involving more than 1,600 patients. These patients were treated with Altreno for a period of 12 weeks and more than 90% of them were satisfied with the results.

The lotion managed to significantly reduce inflammatory lesions and prevent the spreading of the acne to other body parts. As side effects, these were rare and involved skin exfoliation, mild pain, skin dryness, and dizziness. However, approximately 1% of the patients reported these side effects, so Altreno can be considered a pretty safe acne product to use.

On top of being efficient in fighting acne, this retinoid can also moisturize the skin and prevent other types of infections or skin scarring. Patients should apply a small dose of Altreno on the affected skin and experience the first positive results in just a few weeks.

Onextron

Onextron has been approved by the FDA in 2014 to be an efficient and safe treatment for acne. It's also known as clindamycin phosphate and benzoyl peroxide and it can be applied as a gel on the affected skin. This treatment is suitable for patients aged 12 or older and the gel should be applied once a day for best results.

This revolutionary cream has been approved by the FDA as a result of multiple studies involving almost 500 patients. These were vehicle-controlled studies performed by experienced researchers. The results of the study were impressive as more than 50% of the patients experienced significant improvements in their skin lesions.

The studies lasted for 12 weeks and most of the patients were happy with the results they got after using Onextron. Approximately 1% of these patients experienced side effects such as burning sensations, allergic reactions or rashes. Such side effects were minor and they went away after a couple of days. That's why Onextron can be successfully and safely used as an acne treatment by people over 12 years of age.

Differin Gel

Differing Gel 0.1% is also known as adapalene and it has been approved to be used as an acne treatment since 1996. This lotion contains powerful active ingredients which are quickly absorbed by the skin. Differin Gel can be applied on the neck, shoulders, face or other body parts which contain skin lesions and imperfections. It is safe to be used by people over 12 years of age, according to the FDA.

This over-the-counter medicine has been approved as a result of multiple clinical studies and trials done on hundreds of people with severe acne. Most of the patients experienced marked improvements in their skin condition. Side effects were minor and only encountered by a fraction of the people who tested this lotion. Some of these side effects include rashes, minor burning sensations, and mild allergic reactions.

With that being said, Differin Gel shouldn't be applied to damaged skin which suffered cuts or scratches. This OTC medicine can be applied daily and its efficiency lasts for at least 12 months.

Aczone Gel

This is another useful acne cream that can be used by people over 12 years of age. Aczone Gel 7.5% is a safe and efficient lotion that can be applied daily on the affected skin. It can be used to treat minor and severe acne as well as other skin lesions from face, neck, shoulders, and chest.

The FDA approved this medicine as a result of numerous multi-center, double-blind studies. More than 4,300 patients participated in these studies and almost all of them had severe acne. Aczone Gel was applied daily for a period of 12 weeks and more than half of the patients involved reported a successful outcome.

The gel was effective in treating skin lesions and reducing the spreading of acne. When it comes to side effects, these are minor and only experienced by a few patients. For example, some side effects include itching or dryness of the skin.

However, patients must be careful not to combine other medications they might use such as benzoyl peroxide with Aczone Gel. These 2 products can provoke serious side effects including the yellowing of the skin and the reduction of blood flow in the lips and other body parts. Aczone Gel should be used as a standalone medication and not in conjunction with other drugs.

Trifarotine Cream

The US Food and Drug Administration (FDA) approved trifarotene cream 0.005% (Aklief, Galderma) on October 2019, the first new retinoid molecule to be approved in the United States in over 20 years for the once-daily topical treatment of acne vulgaris.

Trifarotene is the only topical retinoid that selectively targets retinoic acid receptor (RAR) gamma, the most common RAR found in the skin. It's also the first topical treatment specifically studied and proven to treat both facial (forehead, cheeks, nose, and chin) and truncal (chest, shoulders, and back) acne. It is approved for patients aged 9 years or older.

Picking the Best Acne Treatment

As you can see, there are a lot of great acne treatments and products you can try to get rid of your skin imperfections. Some of them are available by prescription while others are over-the-counter medicine which can be taken as pills or applied as lotions.

As a rule of thumb, make sure that you always speak with your doctor or healthcare provider before beginning treatment with any of these acne products. It's ideal to be monitored by a healthcare professional who can provide recommendations when it comes to dosages or potential side effects.

if you're currently on testosterone replacement therapy (TRT) and experience minor or severe acne, these products might be helpful for you. Talk with your TRT doctor and ask him which one is more appropriate for you.

More information on TRT related acne.

 

References:

Testosterone and Acne: What You Need to Know

The Role of Zinc in the Treatment of Acne: A Review of the Literature