Exogenous testosterone can exacerbate acne, prompting patients to seek dermatological care. Despite the growing awareness of transgender patients in the medical community, a significant gap remains in their treatment.
This is partly due to social and economic marginalization, and lack of medical experience in working with this population plays a significant role.
The estet-portal.com article discusses acne therapy in transgender men while taking testosterone, highlighting the unique considerations in this regard.
Masculinizing hormone therapy and acne: is there a link
Therapy is often started at a low dosage followed by a gradual increase to a replacement dose for an adult male. Testosterone is most commonly administered intramuscularly or topically, but may be administered orally, buccally, nasally, or via subcutaneous implants.
In one study of 20 transgender men starting testosterone treatment, the prevalence of facial acne increased from 35% at baseline to 82% after just 6 months; on the back and/or chest, acne increased from 15% at baseline to 88%. After 1 year, acne persisted on the face in 55% of patients and on the back and/or chest in 50% of patients. Most of these acne were considered moderate.
Studies suggest that acne severity peaks during the first 4 months of treatment, with gradual improvement over the first year.
The same study also evaluated an additional 50 transgender men who received testosterone for an average of 9.9 years. Acne severity was not associated with age, sebum production, duration of treatment, type of hormonal therapy, serum levels of luteinizing hormone, testosterone, estradiol, or sex hormone-binding globulin, demonstrating a variable response to masculinizing therapy.
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How to Reduce the Side Effects of Taking Testosterone
As with the treatment of non-transgender individuals, topical therapy and systemic antibiotics are considered first-line treatment. These methods may not be sufficient to fully treat androgen-induced acne, and escalation is often required.
Isotretinoin remains an effective treatment option for patients who do not respond to first-line treatments, and may also be used as first-line therapy in patients with severe acne.
Topical Retinoids — the gold standard for acne treatment
Systemic isotretinoin may be particularly effective in the treatment of testosterone-induced acne by antagonizing the effects of androgens at the sebaceous gland level, inhibiting sebocyte proliferation and differentiation, leading to sebaceous atrophy and reduced sebum production.
Hormone therapy may compete with testosterone in transgender men. Low-dose ethinyl estradiol in combination with norgestimate, norethindrone, or drospirenone requires careful planning and extensive discussion before use in this patient.
Hormone therapy should be delayed until the masculinizing effects of testosterone have reached their maximum effect, which may not occur for more than 2 years after the start of the drug.
Combination of testosterone and acne drugs: what is the danger
The theoretical risk of isotretinoin or tetracycline hepatotoxicity may be enhanced by exogenous testosterone.
Cholestatic jaundice, hepatitis, and hematoma have historically been associated with the use of 17-alpha alkyl esters of testosterone, which are therefore no longer used.
However, frequent monitoring is still warranted in patients receiving a combination of any testosterone formulation with isotretinoin.
Current evidence does not support an association between isotretinoin and depression, but prescribers should continue to monitor for symptoms of depression for several reasons.
Dermatologist's individual approach to testosterone-induced acne
Acne is a common side effect of masculinizing hormone therapy used to treat gender dysphoria in transgender men.
For this reason, dermatologists can play an important role in the management of these patients. Although acne treatment options are similar to those used in cisgender patients, several medical, social and psychological factors must be considered when treating these patients.
Thank you for staying with estet-portal.com. Read other interesting articles in the "Endocrinology" section. You may be interested in Sexual Orientation: How Hormones Affect Human Basic Instincts
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