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Testosterone Cypionate Acne When It Doesn't Go Away

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At a glance

  • Label status / Acne is listed among skin and appendage reactions that have occurred with some androgens [1]
  • Other skin reactions listed / Seborrhea, hirsutism and male-pattern baldness [1]
  • Acne biology / Increased sebum secretion is considered the major feature of acne [6]
  • DHT / 5-alpha reductase converts testosterone to the more potent androgen DHT [5]
  • General guideline / The 2016 AAD guideline covers acne grading and topical and systemic treatment [2]
  • Testosterone-specific review / A 2022 guide discusses acne in people receiving testosterone, including isotretinoin for severe or refractory cases [3]

What does the label say about acne?

The Depo-Testosterone label lists acne under skin and appendage reactions, with seborrhea, hirsutism and male-pattern baldness, among adverse reactions that have occurred with some androgens [1]. It gives no treatment advice for acne.

Acne that does not clear is assessed with a general acne framework. The 2016 American Academy of Dermatology guideline covers acne grading and both topical and systemic management [2]. For testosterone-related acne specifically, a 2022 practical guide discusses treatment in people receiving testosterone [3]. It focuses on transmasculine patients and is not a cypionate-specific trial in men with hypogonadism [3].

Why can acne persist while cypionate continues?

Acne involves increased sebum production, altered sebum lipids, inflammatory processes, follicular hyperkeratinisation and Propionibacterium acnes within the follicle [4]. Increased sebum secretion is considered the major feature involved in acne [6]. Testosterone is converted by 5-alpha reductase to dihydrotestosterone, which is more potent than testosterone, and acne develops rarely in 5-alpha-reductase type 2 deficiency [5].

What matters when acne is severe or scarring?

Nodules and cysts occur in more severe acne and can cause scarring and psychological distress [7]. The AAD guideline covers grading and systemic treatment options [2]. The 2022 practical guide to testosterone-induced acne discusses isotretinoin for severe or treatment-refractory cases, including the US iPLEDGE program as a prescribing barrier [3].

Frequently asked questions

Is acne a listed side effect of testosterone cypionate?
Yes. The Depo-Testosterone label lists acne among skin and appendage reactions, along with seborrhea, hirsutism and male-pattern baldness, under adverse reactions that have occurred with some androgens [1].
Why does testosterone affect acne?
Testosterone is converted to DHT, a more potent androgen, and acne develops rarely in people with 5-alpha-reductase type 2 deficiency [5]. Acne itself involves excess sebum, follicular hyperkeratinisation, inflammation and Propionibacterium acnes [4].
Can isotretinoin be used for acne on testosterone?
A 2022 practical guide for testosterone-induced acne discusses isotretinoin for severe or treatment-refractory acne and notes the US iPLEDGE program as a prescribing barrier [3]. The guide focuses on transmasculine patients receiving testosterone, not specifically men treated for hypogonadism.
When is persistent acne more serious?
Nodules and cysts occur in more severe acne and can cause scarring and psychological distress [7]. The AAD guideline covers acne grading and systemic treatment options [2].
Which other skin reactions does the cypionate label list?
Seborrhea, hirsutism and male-pattern baldness appear alongside acne under skin and appendages. Hypersensitivity reactions including skin manifestations, and inflammation and pain at the injection site, are listed separately [1].

References

  1. U.S. National Library of Medicine, DailyMed. Depo-Testosterone (cypionate) intramuscular, Pharmacia & Upjohn/Pfizer (testosterone cypionate) prescribing information. Depo-Testosterone (cypionate) intramuscular, Pharmacia & Upjohn/Pfizer (testosterone cypionate) label
  2. Zaenglein AL, Pathy AL, Schlosser BJ, Alikhan A, Baldwin HE, Berson DS, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74(5):945-73.e33. Guidelines of care for the management of acne vulgaris
  3. Radi R, Gold S, Acosta JP, Barron J, Yeung H. Treating Acne in Transgender Persons Receiving Testosterone: A Practical Guide. Am J Clin Dermatol. 2022;23(2):219-229. Treating Acne in Transgender Persons Receiving Testosterone: A Practical Guide
  4. Makrantonaki E, Ganceviciene R, Zouboulis C. An update on the role of the sebaceous gland in the pathogenesis of acne. Dermatoendocrinol. 2011;3(1):41-9. An update on the role of the sebaceous gland in the pathogenesis of acne
  5. Azzouni F, Godoy A, Li Y, Mohler J. The 5 alpha-reductase isozyme family: a review of basic biology and their role in human diseases. Adv Urol. 2012;2012:530121. The 5 alpha-reductase isozyme family: a review of basic biology and their role in human diseases
  6. Picardo M, Ottaviani M, Camera E, Mastrofrancesco A. Sebaceous gland lipids. Dermatoendocrinol. 2009;1(2):68-71. Sebaceous gland lipids
  7. Purdy S, de Berker D. Acne vulgaris. BMJ Clin Evid. 2011;2011. Acne vulgaris
Evidence overview for Testosterone Cypionate Acne When It Doesn't Go Away