Does TRT cause acne?
Yes, it can. TRT acne is one of the best-known side effects of testosterone. Every injection label we checked lists acne, and one gel label names it among the most common.
Most of the time it’s mild: a few more pimples or oilier skin. Some men get deeper, painful breakouts that can scar. Those deserve a dermatologist’s care.
This page covers what labels and studies show, why testosterone affects your skin, and when to get help. For the full list, see our guide to TRT side effects.
How common is acne on TRT?
It depends on the product and the study. Here is what each label reports.
| Product | How it’s given | What the label says about acne |
|---|---|---|
| DEPO-Testosterone (cypionate) | Injection into muscle | Listed among side effects, with no rate given |
| Generic enanthate | Injection into muscle | Listed among side effects, with no rate given |
| Azmiro (cypionate) | Injection into muscle | Listed with oily skin, with no rate given |
| Xyosted (enanthate) | Weekly auto-injector under the skin | 4 of 150 men (2.7%) in a one-year study |
| AVEED (undecanoate) | Long-acting shot given in the clinic | 5.2% of 153 men over 84 weeks; its most common side effect |
| AndroGel 1% | Daily gel | One of the most common side effects; 3.1% at three years |
| AndroGel 1.62% | Daily gel | Seen in 2% of men or fewer |
| Testim | Daily gel | Under 1%, but more often than with placebo (a dummy treatment) |
In AVEED’s study, acne was also one of the side effects that led some men to stop treatment.
Don’t read this table as a ranking. The labels warn that rates from one drug’s trials can’t be compared with another’s. The studies differ in size, length and how they counted side effects.
Here’s the honest gap. We found no reliable figure for how many men on injections for low testosterone get acne. Older labels list it without a number, so we won’t guess.
Some websites quote figures like “15 to 25% of men.” We couldn’t find a study behind them.
Studies in transgender men starting testosterone show much higher rates. A 2026 review of 38 studies found the number depended on how acne was counted. Studies that graded skin carefully found acne in about 62% of people, while record reviews and self-reports found about 30%.
Why does testosterone cause acne?
Acne starts in your pores. The NIH explains that skin oil, called sebum, mixes with dead skin cells and plugs the pores. That plug can turn into a pimple.
Testosterone turns up oil production. The American Academy of Dermatology (AAD) explains that male hormones enlarge the skin’s oil glands during puberty. The glands then make more oil, and TRT can do the same thing in an adult.
Studies back this up:
- More oil: a small study of 17 transgender men measured skin oil before and during testosterone. Oil production went up.
- A key early step: a 2024 review calls extra oil driven by male hormones “a necessary early step” in acne.
- DHT’s role is unsettled: DHT is a stronger hormone your body makes from testosterone. A review says both may matter, but how they reach the oil glands isn’t known.
Your blood level isn’t the whole story. A review notes that hormone levels are often normal in people with mild or moderate acne.
Your genes matter too. The AAD says a parent or close relative with deep, painful acne raises your own risk.
What does TRT acne look like?
Usually like ordinary acne. Labels for cypionate list oily skin, called seborrhea, alongside acne. Many men first notice shinier skin, then more blackheads, whiteheads and pimples.
Severe acne is different. The AAD describes breakouts that reach deep into the skin, called cysts and nodules. They tend to hurt, and they often leave scars when they clear.
Knowing which kind you have matters. Mild acne can wait for your next visit. Deep, painful acne needs a dermatologist sooner, as explained below.
Where does TRT acne show up?
Anywhere your skin has lots of oil glands. The NIH says acne most often appears on the face but can also show up on the back, chest and shoulders. Many men on TRT notice it on the back and shoulders.
We found no study that explains why some men break out mostly on the back. What we do know is what makes acne worse. The NIH lists pressure from tight clothes, backpacks and sports gear.
Back acne also takes patience. The AAD says that when treatment works, you may see results in six to eight weeks. Full clearing can take three or four months.
When does acne start on TRT, and does it go away?
It usually shows up in the first year. The best long-term data come from transgender men starting testosterone. They are a different group, younger and with different target levels, but the patterns are useful.
- When it starts: the 2026 review found acne rose most at 6 to 12 months. It could appear as early as the first month.
- How much it rises: in a three-year study of 323 transgender men, moderate or severe acne rose from about 12% to 39% after one year.
- Whether it lasts: a health-records study of over 11,000 transgender men and nonbinary people assigned female at birth found acne risk was highest in the first year. It stayed higher than in other men in later years too.
- How many get diagnosed: in that same study, 15.8% had a visit for acne within five years, compared with 3.8% of matched men not in that group. Mild acne that never reached a doctor wasn’t counted.
A smaller one-year study of 53 transgender men on long-acting shots found the same early rise in acne scores.
For men on TRT for low testosterone, the data are thinner. The AndroGel 1% label reports acne in 3.1% of men at three years. No study we found tracked acne over time in men on injections.
“It settles in a few months” is a hope, not a finding.
Is acne a sign your testosterone is too high?
Not by itself. The studies don’t agree.
- One three-year study of transgender men found higher acne risk with blood testosterone above about 290 ng/dL. Being overweight, being 18 to 25 and having acne before starting also raised the risk.
- The 2026 review of 38 studies found no meaningful link between acne and dose or how the testosterone was given.
- We found no study that links acne to the peak in the days after an injection.
If you suspect a pattern, track it. Note the day each breakout starts and how many days it was since your last shot. Our blood test timing planner can help you line up a lab draw with your schedule, so results are easier to compare.
Then bring the pattern to your prescriber. Only they can decide whether anything about your treatment should change. Please don’t change your dose because of your skin.
Do injections cause more acne than gels?
There’s no clear answer. One 2026 records study in transgender patients reported a higher acne risk with injections than with skin gels. But the 38-study review found no meaningful difference by route.
As noted above, label rates can’t be compared across products either. So the form of TRT you use is a poor way to predict your skin.
Gels add one more concern: other people. Testosterone gel can rub off on a partner or child. The AndroGel 1% label lists an increase in acne in a woman as one possible sign of this.
Our comparison of TRT gel vs injections covers the other trade-offs.
What can you do about acne on TRT?
Start by mentioning it to your prescriber. A review of acne in people on testosterone says standard acne care can generally be followed. A dermatologist is the right person to choose it.
The AAD gives a few everyday tips for acne on the back and body:
- Wear loose clothes made of cotton or sweat-wicking fabric when you work out.
- Shower and change soon after exercise.
- Don’t scrub. Scrubbing skin with acne makes it worse.
For acne that needs more, a dermatologist may discuss prescription creams, gels or pills. The AAD’s guideline also covers a stronger medicine for severe or scarring acne. It needs close monitoring, so only a doctor can decide on it.
Acne can come back. A group of acne experts warns that it often returns when treatment stops, so ongoing skin care may be part of the plan.
We don’t recommend products, diets or supplements. Forum favorites such as high-dose vitamins have no trial behind them for TRT acne.
When should you see a doctor about TRT acne?
Mention any new acne at your next visit. See a dermatologist, or ask your prescriber for a referral, if:
- It hasn’t improved after six to eight weeks of care. The AAD says you may need a dermatologist’s help at that point.
- Your back or chest won’t clear, even when your face does.
- You started a new medicine in the last six months and now have breakouts. That’s on the AAD’s own list.
- You have deep, painful lumps called nodules or cysts. The AAD says anyone with deep, painful acne needs a dermatologist’s help.
- You’re getting scars. The more severe the acne, the more likely it is to scar, and early treatment can prevent that.
Acne can also weigh on your mood. The AAD notes studies linking acne to low self-esteem, depression and anxiety, and treatment can help. Tell your prescriber if your skin is getting you down.
Should you stop TRT because of acne?
No, not on your own. Stopping testosterone brings back the symptoms you started it for. We also found no study showing that stopping TRT clears acne in men treated for low testosterone.
The Endocrine Society tells prescribers to check for side effects at follow-up visits. It also tells them to weigh each product’s own side effects when choosing one.
So acne is exactly the kind of thing your prescriber wants to hear about. Together you can decide on skin care, a referral, or whether anything else should change.
What should you note and ask your prescriber?
A few notes make the visit far more useful.
Note:
- Where breakouts appear: face, chest, back or shoulders.
- When they started, compared with when you began TRT or changed anything.
- How many days after your last shot each new breakout shows up.
- Whether any are deep, painful or leaving marks.
- A photo of the worst area every couple of weeks, taken in the same light, so you can both see the trend.
- Anything you’ve already tried on your skin, and for how long.
Ask:
- Is this acne likely related to my testosterone?
- Should I see a dermatologist, and can you refer me?
- Is there anything about my treatment we should look at?
- Which acne products are safe with my other medicines?
Our guide to preparing for your TRT appointment has more questions to bring.