AndroGel (Testosterone Topical) Acne: When It Doesn't Go Away

How common is acne on AndroGel?

One randomized trial used AndroGel itself. Fifty patients with dry eye associated with androgen deficiency, including women, received transdermal androgen or placebo for 4 weeks; 4% of the AndroGel group had acne and 20% had oily skin [1]. That trial was built to measure tear film and eye symptoms, and acne was recorded as an adverse event over four weeks, so it does not describe men treating hypogonadism long term [1].

The generic testosterone gel 1% label, which is not an AndroGel label, lists acne among its most common adverse reactions. In its 180-day trial acne was reported in 1% of the 77 men on 50 mg, 3% of the 40 men on 75 mg and 8% of the 78 men on 100 mg, and in 3.1% of 162 men in a 3-year flexible-dose extension [6].

Wider data come from a 2026 scoping review of 10 studies, eight prospective clinical trials and two retrospective chart reviews published between 2006 and 2025. Acne was the most frequent dermatologic adverse effect of testosterone replacement, affecting 0.6% to 9.1% of participants, with the lowest incidence in oral formulations and generally higher rates with injectables than with topical or oral products [3]. The review also found that most included studies lacked standardized reporting or detailed management strategies for these skin effects [3].

Does it go away on its own?

Neither the 4-week AndroGel trial [1] nor the gel 1% label's adverse-event tables [6] report how long an individual's breakout lasted or whether it cleared without treatment, and the scoping review notes that most studies of testosterone skin effects did not report outcomes in a standardized way [3].

What is used when acne does not clear?

Acne-focused dermatology expert groups have consistently recommended combining a topical retinoid with an antimicrobial for most patients with acne, and the American Academy of Dermatology and European Dermatology Forum guidelines both give retinoids an essential role. The American Academy of Dermatology describes retinoids as the core of topical therapy because they are comedolytic, resolve the precursor microcomedone lesion, are anti-inflammatory, and allow maintenance of clearance [2]. That evidence is for acne in general, not testosterone-related acne.

Oral isotretinoin is the option studied for harder cases. A systematic review of 11 randomized trials with 760 patients, mostly men, mean ages 18 to 47.9 years and generally moderate-to-severe acne, found isotretinoin reduced lesion counts by a clinically relevant amount and always by more than control, which was placebo in two trials, oral antibiotics in seven and another comparator in two [4]. Adverse events were twice as frequent with isotretinoin, 751 versus 388, and more than half were dermatological and related to dryness; adverse events that led participants to withdraw included Stevens-Johnson syndrome, cheilitis, xerosis, acne flare, photophobia, elevated liver enzymes, decreased appetite, headaches and depressed mood [4].

Would switching to injections or changing the schedule help?

The comparison that exists does not favor injections for skin. In the 2026 scoping review, injectable testosterone was generally associated with higher acne rates than topical or oral preparations [3].

A 2026 review of injectable testosterone notes that short-acting esters such as cypionate and enanthate can produce meaningful swings in serum exposure across the dosing cycle, particularly when larger doses are given at longer intervals [5]. It adds that some men on weekly dosing continue to report early acne or oily skin, mood or sleep disturbance, breast tenderness, fluid retention or late-cycle symptoms, that the issue may be dose timing and peak-trough variation rather than the total weekly dose, and that more frequent lower-dose schedules are optional tools rather than a universal standard [5]. That review reports no acne outcomes from changing the schedule [5].