Does TRT Cause Acne? What the FDA Labels and Testosterone Studies Show About Breakouts, Oily Skin and What Helps

Acne shows up on every testosterone label, but in the trials of men with low testosterone it affected 2.7% to 5.2%. Why it happens, when it tends to peak, who is most at risk, and what the dermatology guideline recommends.

Does TRT cause acne? It can, but in men treated for low testosterone it is uncommon. In the FDA label trials of hypogonadal men, acne affected 2.7% of men on weekly Xyosted injections over one year and 5.2% of men on Aveed injections over 84 weeks. Acne is listed on every testosterone label because testosterone drives the oil glands in the skin, and those glands keep responding to androgens throughout adult life.

Much higher acne figures circulate online, and they usually come from two other groups: transgender men starting testosterone from a much lower baseline, and men using anabolic steroids at doses far above the normal range. Both groups are useful for understanding timing and risk factors, but their numbers do not transfer directly to a man restoring his own testosterone to the normal range. This article separates the three, explains why TRT acne happens, and covers what the American Academy of Dermatology recommends for treating it.

TRT can cause acne, and every testosterone label lists it, but the rates in men treated for low testosterone are low. The Depo-Testosterone (testosterone cypionate) label lists seborrhea, meaning oily skin, and acne among its skin effects without giving a rate. The labels that do give rates come from trials of hypogonadal men, and they range from fewer than 1% to 5.2%.

In the one-year Xyosted study, 150 men started at 75 mg of testosterone enanthate weekly and were adjusted to 50 mg or 100 mg to keep pre-dose levels between 350 and 650 ng/dL. Acne occurred in 4 men (2.7%). For comparison, the same label reports a rise in hematocrit in 14.0% and high blood pressure in 12.7%, so acne was far from the most common problem. In the Testim gel trial, acne occurred in fewer than 1% of men, though more often than on placebo.

Aveed, the long-acting testosterone undecanoate injection, had the highest label rate. In its 84-week study, 153 hypogonadal men received 750 mg at the start, at 4 weeks and every 10 weeks after that. Acne was the single most common adverse reaction, at 5.2% (8 men). Of the 7 men (4.6%) who stopped treatment because of side effects, acne was one of the listed reasons. Label rates from different trials cannot be compared head to head, because the trials used different men, doses and ways of collecting side effects.

Testosterone causes acne by stimulating the sebaceous glands, the small oil glands attached to hair follicles. A 2019 review by Motosko and colleagues (British Journal of Dermatology) describes three steps: androgens make oil-gland cells grow, the glands produce more sebum, and the lining of the follicle thickens. More oil inside a narrower follicle is the setting in which acne lesions form.

Sebaceous glands in adult men stay responsive to testosterone. Pochi, Strauss and Downing (Journal of Investigative Dermatology, 1979) found that sebum output in men rises through the late teens under the influence of androgens and then stays essentially unchanged until about age 80. They also showed that the glands still respond when extra androgen is given. A man whose testosterone has been low for years may notice oilier skin when it is restored, because his glands have been running below their usual output.

Acne becomes common when testosterone rises from a low baseline to the male range. In a prospective three-year study of 323 transgender men starting testosterone, Madsen and colleagues (European Journal of Dermatology, 2024) found that moderate or severe acne rose from 11.8% before treatment to 39.1% after one year.

The largest data set is a Kaiser Permanente cohort published by Smith and colleagues in JAMA Dermatology (2026). It matched 280,997 people without acne at the start, including 11,234 transmasculine individuals, to cisgender men and women of similar age. Over 5 years, acne developed in 15.8% of transmasculine individuals, 3.8% of matched cisgender men and 10.5% of matched cisgender women. Risk was highest in the first year after starting testosterone, with a hazard ratio of 8.29 compared with cisgender men.

Anabolic steroid use sits at the far end. Melnik, Jansen and Grabbe (JDDG, 2007) report that acne occurs in about 50% of anabolic steroid users and is a useful clinical sign of steroid use, especially in men aged 18 to 26. Severe forms, acne conglobata and acne fulminans, can be triggered. These are men taking supraphysiologic doses, not men on monitored TRT.

Testosterone-related acne usually appears in the first year and tends to settle afterward. In a prospective study of 20 people starting testosterone, Wierckx and colleagues (Journal of Sexual Medicine, 2014) found that acne presence and severity rose during the first year and peaked at 6 months. In a second group of 50 people who had been on testosterone for an average of 10 years, 93.9% had no acne or mild acne.

Settling is the usual pattern, not a guarantee. In the Kaiser cohort, acne risk in transmasculine individuals stayed above that of cisgender men after the first year, with a hazard ratio of 5.29. A man whose acne is still active well past the first year of TRT should not assume it will fade on its own.

The strongest risk factors for testosterone-related acne in the Madsen study were a higher body weight, a younger age at starting, higher testosterone levels during treatment and having acne before treatment. Each was linked to a higher relative risk of moderate or severe acne. These findings come from transgender men, so they point to patterns rather than exact risks for TRT patients.

Testosterone level is the factor a TRT patient can most directly influence, and the data is mixed. The Madsen study linked a testosterone concentration above 10 nmol/L with more moderate or severe acne. The smaller Wierckx study found skin outcomes were not demonstrably related to individual testosterone or dihydrotestosterone levels. A reasonable reading is that levels pushed high raise the odds, but acne also depends on how sensitive a person's oil glands are.

No head-to-head trial has compared acne rates between testosterone injections and gels, so the honest answer is that it is not established. The available label figures come from separate trials: fewer than 1% for Testim gel, 2.7% for weekly subcutaneous Xyosted and 5.2% for long-acting Aveed. Because those trials differed in design, the numbers cannot be ranked.

Topical products add a separate skin question at the application site. In a phase 3 study of a 2% testosterone solution applied to the armpit, Muram and colleagues (Current Medical Research and Opinion, 2012) followed 155 hypogonadal men for 120 days. Irritation and redness where the solution was applied were the most common skin complaints. Two cases of acne, on the face and shoulders, and one case of scalp folliculitis were reported. Our guide to TRT delivery methods compares injections, gels, pellets and oral testosterone on other measures.

Acne caused by TRT is treated with the same evidence-based options as other acne, chosen by severity. The 2024 American Academy of Dermatology guideline (Reynolds and colleagues, Journal of the American Academy of Dermatology) makes 18 evidence-based recommendations. It strongly recommends benzoyl peroxide, topical retinoids, topical antibiotics and oral doxycycline, and strongly recommends oral isotretinoin for acne that is severe, scarring, causing psychological distress or not responding to standard treatment.

The AAD guideline also advises combining topical treatments that work in different ways, limiting oral antibiotic use and pairing any oral antibiotic with a topical treatment. Two of its conditional options, combined oral contraceptive pills and spironolactone, are hormonal treatments that work against androgen effects. They are used in women and do not fit a man on testosterone therapy. A dermatology review of testosterone-related acne by Radi and colleagues (American Journal of Clinical Dermatology, 2022) describes isotretinoin as the option for severe or treatment-resistant cases.

Acne on TRT is also a reason to look at the whole picture. A sudden flare in a man on a stable dose can mean a level that has drifted high, which matters for blood thickness and estradiol as well as skin. Our guides to hematocrit on TRT and estradiol in men explain those checks. This article is for educational purposes only and is not medical advice. It does not diagnose, treat, cure or prevent any disease, and decisions about testosterone therapy and acne treatment belong with a qualified clinician.

• US Food and Drug Administration. XYOSTED (testosterone enanthate) injection prescribing information. DailyMed. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8a3d204c-be26-49e0-8599-0ac12a272e81
• US Food and Drug Administration. AVEED (testosterone undecanoate) injection prescribing information. DailyMed. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f80f025b-17d8-40af-8739-20ce07902045
• US Food and Drug Administration. TESTIM (testosterone gel) prescribing information. DailyMed. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9f2aae1f-898d-4955-be31-678e0cf85395
• US Food and Drug Administration. DEPO-TESTOSTERONE (testosterone cypionate) injection prescribing information. DailyMed. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=cfbb53d4-b868-4a28-8436-f9112eb01c39
• Wierckx K, Van de Peer F, Verhaeghe E, et al. Short- and long-term clinical skin effects of testosterone treatment in trans men. Journal of Sexual Medicine, 2014. https://doi.org/10.1111/jsm.12366
• Madsen MC, Berg JN, Fisher AD, et al. The effects of gender-affirming testosterone therapy in transgender men on the development of acne, acne severity and the relationship with clinical parameters: a three-year follow-up study. European Journal of Dermatology, 2024. https://doi.org/10.1684/ejd.2024.4758
• Smith CA, Kaabi O, Manatunga AK, et al. Acne Incidence and Severity in Transgender Individuals. JAMA Dermatology, 2026. https://doi.org/10.1001/jamadermatol.2025.5597
• Pochi PE, Strauss JS, Downing DT. Age-related changes in sebaceous gland activity. Journal of Investigative Dermatology, 1979. https://doi.org/10.1111/1523-1747.ep12532792
• Motosko CC, Zakhem GA, Pomeranz MK, Hazen A. Acne: a side-effect of masculinizing hormonal therapy in transgender patients. British Journal of Dermatology, 2019. https://doi.org/10.1111/bjd.17083
• Melnik B, Jansen T, Grabbe S. Abuse of anabolic-androgenic steroids and bodybuilding acne: an underestimated health problem. JDDG, 2007. https://doi.org/10.1111/j.1610-0387.2007.06176.x
• Muram D, Melby T, Alles Kingshill E. Skin reactions in a phase 3 study of a testosterone topical solution applied to the axilla in hypogonadal men. Current Medical Research and Opinion, 2012. https://doi.org/10.1185/03007995.2012.681034
• Reynolds RV, Yeung H, Cheng CE, et al. Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology, 2024. https://doi.org/10.1016/j.jaad.2023.12.017
• Radi R, Gold S, Acosta JP, Barron J, Yeung H. Treating Acne in Transgender Persons Receiving Testosterone: A Practical Guide. American Journal of Clinical Dermatology, 2022. https://doi.org/10.1007/s40257-021-00665-w

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