Acne Common Among Transgender Adolescents on Hormone Therapy

Transmasculine patients, particularly those undergoing hormone therapy with progestins, have a high incidence of acne and may not be receiving acne care from the health care providers managing their hormone therapy, according to study findings presented at the 2023 Annual Meeting of the American Academy of Dermatology (AAD), held from March 17 to 21, 2023 in New Orleans, Louisiana.¹

In the general population, 70% to 87% of adolescents experience acne.

In this study, investigators aimed to evaluate the incidence and predictors of acne among transgender adolescents initiating treatment with testosterone. The primary endpoint was clinical change in acne severity and acne status documented in chart history.¹

Investigators conducted a single-center, retrospective chart review from 2016 to 2019 that included 60 patients (<18 years of age at first visit) assigned female at birth who were evaluated for testosterone initiation and at least 1 year of documented follow-up. Association of clinical and demographic factors with new acne that appeared within 2 years of initiation of testosterone therapy were calculated using bivariate analyses.¹

Investigators noted that patients were predominantly White, non-Hispanic/Latinx (85%), and 16 to 17 years of age (45%). Most patients (93%) were receiving subcutaneous or intramuscular testosterone therapy. Among all study participants, 46 (77%) did not have baseline acne, of whom 25 (54%) developed acne within 1 year of the start of testosterone treatment. At 2 years of follow-up, overall acne incidence was 70%. All patients who did have baseline acne had worsening acne after starting testosterone treatment. Progestin users were more likely to develop acne vs nonprogestin users (92% vs 33%; P <.001).¹

Age at menarche, history of anxiety or depression, form of testosterone delivery, testosterone dosage, body mass index, and age were not associated with higher incidence of acne at 2 years. Over the entire study period, 32 patients developed acne, none of whom were prescribed acne therapy by their hormone providers, and 37% of patients with baseline or new acne were referred for dermatologic consultation.²

Study limitations include the nature of retrospective study design, single-center design, and lack of acne severity outcome measures.¹Investigators conclude that among transgender adolescents receiving testosterone treatment, acne is common, particularly among those receiving treatment with progestins. They said, “Despite high incidence of acne, hormone providers in our cohort study did not provide acne care.” The investigators continue, “Gender-affirming care providers should incorporate guideline-driven acne treatment as part of comprehensive hormone treatment with dermatology referral for further management.”¹