Acne Risk in Transgender Men Treated With Masculinizing Testosterone

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Investigators evaluated the timing of acne onset with regard to initiation of testosterone therapy in transgender men and the biologic, behavioral, and sociodemographic predictors of acne in this population.

In transgender men who receive masculinizing doses of testosterone to suppress menstruation and induce virilization and whom begin to develop acne, it may be possible to personalize testosterone therapy according to transition goals, priorities, risk factors, and other comorbidities. An analysis evaluated the timing of acne onset in terms of initiation of testosterone treatment in transgender men, along with the biologic, sociodemographic, and behavioral predictors of acne in this patient population. The results were published in the Journal of the American Academy of Dermatology.

A total of 69 transgender men were identified whose hormone treatment had been managed at the Center for Transgender Medicine and Surgery, Boston Medical Center, Massachusetts, from January 1, 2010 through December 31, 2017. Study exclusion criteria were: age <18; testosterone therapy for <2 years, incomplete medical records, and the presence of acne before receiving testosterone therapy. After a systematic medical chart review to identify individuals who qualified for exclusion from the study, 55 transgender men remained in the analysis.

Multivariable logistic regression was used to establish whether acne occurrence in this population of transgender men is influenced by age at initiation of testosterone treatment, race, smoking status, use of alcohol, body mass index, blood pressure, and/or serum testosterone level. The median serum testosterone level of 630 ng/dL was used to distinguish between higher and lower levels.

According to study inclusion criteria, none of the patients had a history of acne before receiving testosterone. Acne was reported in 9% of the transgender men after 3 months of testosterone therapy, 18% of individuals after 6 months of treatment, and 38% of participants after 24 months of therapy at some time point within the study period.

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Acne was significantly associated with serum testosterone levels >630 ng/dL (odds ratio [OR] 8.137; 95% CI, 1.53-43.43; P <.02). Increased body mass index was also associated with an elevated incidence of acne (OR 1.18; 95% CI, 1.04-1.33; P =.01), which was increased even more in patients with a positive smoking status (OR 5.51; 95% CI, 1.02-29.77; P <.05).

The investigators concluded that the use of personalized testosterone therapy in transgender men, which is based on certain patient risk factors, may help reduce the development of acne in these individuals.

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Park JA, Carter EE, Larson AR. Risk factors for acne development in the first 2 years after initiating masculinizing testosterone therapy among transgender men [published online January 31, 2019]. J Am Acad Dermatol. doi:10.1016/j.jaad.2018.12.040