AndroGel (Testosterone Topical) and Acne: When to Call the Doctor

How often does testosterone gel cause acne?

Acne appears in the label's adverse reactions summary as one of the most common reactions of testosterone gel 1%, listed with application site reaction, abnormal lab tests and prostatic disorders at an incidence of 5% or more [1]. In the 180-day phase 3 trial the rate climbed with dose: 1% of 77 men on 50 mg, 3% of 40 men on 75 mg and 8% of 78 men on 100 mg [1]. The 3-year extension study of 162 men put acne at 3.1% [1].

Other testosterone data land in a similar band. A scoping review of 10 studies published between 2006 and 2025 found acne to be 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 higher rates of acne and systemic reactions with injectable formulations than with topical or oral ones [2]. In a survey of 905 men treated for low testosterone in the UK, 24% named acne as a side effect [3].

The label quoted here is the generic testosterone gel 1% label, not the AndroGel 1.62% label. The label says that dosage and administration differ between the 1% and 1.62% gels and that the application site and dose of gel 1% are not substitutable with other topical testosterone products [1].

When to call the doctor

Someone else who touched the gel develops signs. The gel's boxed warning is about secondary exposure, and the label reports virilization in children exposed to testosterone gel; children should avoid contact with unwashed or unclothed application sites [1]. Signs reported in children include enlargement of the penis or clitoris, pubic hair, increased erections and libido, aggressive behavior and advanced bone age [1]. In adult women the label names a significant increase in acne, along with changes in body hair distribution and other signs of virilization, and says these should be brought to a physician's attention along with the possibility of secondary exposure; it says the gel should be promptly discontinued until the cause of virilization has been identified [1]. This is the one place in the label where acne itself triggers an instruction.

Acne that is severe. The label sets no severity threshold for a man's own acne [1]. The American Academy of Dermatology guideline on acne covers grading acne and its topical and systemic management [6].

Acne with fever and bone or muscle pain. Acne fulminans is an ulcerative form of acne with an acute onset and systemic symptoms, and it most commonly affects adolescent boys [7]. In a series of 24 Finnish patients, all had ulcerative acne of acute onset, 22 had a high fever lasting at least a week and all had musculoskeletal pain; eight patients given antibiotics alone responded poorly, while systemic steroids added to antibiotics produced a rapid response [7].

What is used for ordinary acne

Benzoyl peroxide is a nonantibiotic antibacterial agent that is highly effective against P. acnes and against which no resistance has been detected, and retinoids are important components of combination therapy [8]. For moderate to moderately severe acne, a Cochrane review of minocycline covering 39 randomized trials and 6,013 participants found it effective, though the trials were generally small and poor quality and the review notes no evidence of greater benefit than other acne treatments [9]. These findings are for acne in general, not for testosterone gel users.