Acne More Prevalent in Transmasculine Than in Transfeminine Adults

male, female and transgender symbol on chalkboard
male, female and transgender symbol on chalkboard
The first multisite study of acne prevalence in transgender adults finds that transmasculine individuals are more likely to report moderate to severe acne than are transfeminine individuals.

Moderate to severe acne is prevalent among transgender adults, cross-sectional study data published in the Journal of the American Academy of Dermatology suggest. Compared with transfeminine (TF) patients, transmasculine (TM) patients were more likely to report any history of moderate to severe acne and more likely to attribute their acne to hormone therapy (HT).  

Investigators administered a cross-sectional survey to enrollees in the Study of Transition, Outcomes, and Gender (STRONG) study. STRONG participants were transgender adults (≥18 years old) receiving care from Kaiser Permanente in Northern California, Southern California, or Georgia between 2006 and 2014. The survey asked whether participants had ever been diagnosed by a healthcare professional with “moderate-to-severe acne (pimples).” Participants were also asked if they thought their acne was linked to HT. Age-adjusted prevalence ratios (PRs) for moderate to severe acne were calculated for the total cohort, as well as for TM and TF subgroups.  

Of 2136 eligible STRONG enrollees, 696 (32.6%) completed the survey: 346 TM and 350 TF persons. The majority (91.7%) had received some form of HT, and 58.1% had undergone gender-affirming surgery. A total of 20.8% respondents reported a history of moderate to severe acne. TM individuals were more likely than TF individuals to report past (PR, 1.64; 95% CI, 1.17-2.30) and current (PR, 8.27; 95% CI, 2.80-24.41) moderate to severe acne. However, TM patients were less likely to report any past dermatologist visit compared with TF patients (44.5% vs 55.1%; P <.001). Among patients with moderate to severe acne, TM persons were significantly more likely to attribute acne to HT (65.6% vs 4.4%; P <.001). In sub-analyses of HT regimens, however, neither current testosterone use nor route of testosterone administration was associated with acne likelihood in TM patients.

External validity of data may be limited by certain cohort characteristics: all participants were privately insured and had consistent care access. Health trends may differ among transgender adults with limited access to health care.

This analysis represents the first multisite study of acne prevalence in transgender adults. Results align with known effects of estrogen and testosterone, the investigators acknowledged. “Longitudinal, prospective data on the natural history, severity, treatment, and psychosocial impact of acne are needed to optimize skin and quality-of-life outcomes of gender-affirming HT in transgender populations,” investigators wrote.

Related Articles

Disclosure: One study author declared affiliations with the pharmaceutical industry.

Please see the original reference for a full list of authors’ disclosures.

Follow @DermAdvisor


Yeung H, Ragmanauskaite L, Zhang Q, et al.  Prevalence of moderate-to-severe acne in transgender adults: a cross-sectional survey [published online February 25, 2020]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2020.02.053