When Acne on Testosterone Cypionate Becomes a Reason to Stop

What the Depo-Testosterone label says about acne

The label lists acne among the skin reactions that have occurred with some androgens, in a line with hirsutism, male-pattern baldness and seborrhea [1]. It gives no frequency and no severity grade [1].

Its stopping instructions sit in the warnings section and concern other events. If hypercalcemia occurs in an immobilized patient, the label says the drug should be discontinued [1]. If a venous thromboembolic event, such as deep vein thrombosis or pulmonary embolism, is suspected, it says to discontinue treatment with testosterone cypionate and initiate appropriate workup and management [1]. Acne is not one of the label's stopping triggers [1].

Is there an acne grade that means stopping?

The label names none [1]. A 2017 review of testosterone therapy for transgender men lists acne among the potential undesired effects, alongside alopecia, lower HDL cholesterol, higher triglycerides and a possible increase in systolic blood pressure, and notes a paucity of high-quality data, with few prospective long-term studies [4].

Other label warnings that are not stop instructions

Blood pressure. The label says testosterone can raise blood pressure, which can raise cardiovascular risk over time, that blood pressure should be monitored periodically, especially in men with hypertension, and that testosterone products are not recommended in uncontrolled hypertension [1]. FDA's February 2025 labeling action said ambulatory blood pressure studies confirmed a rise in blood pressure with all testosterone products, class-wide [3].

Hematocrit. The label says to check hemoglobin and hematocrit periodically during long-term use [1]. Across 29 placebo-controlled trials in 3,393 men, intramuscular testosterone enanthate or cypionate raised mean hematocrit by 4.0% (95% CI 2.9 to 5.1) versus placebo [2].

What the label allows short of stopping

The label describes dosage as adjusted to the patient's response and the appearance of adverse reactions, within 50 to 400 mg intramuscularly every 2 to 4 weeks [1]. It gives no acne-specific instruction [1].

While testosterone is being used, it suppresses pituitary luteinizing hormone through feedback inhibition, and at large doses follicle-stimulating hormone, which can suppress sperm production [1]. The label describes withdrawal symptoms lasting weeks or months, including depressed mood, fatigue, craving, irritability, insomnia and decreased libido, in people taking supratherapeutic doses, and states that drug dependence at approved doses for approved indications has not been documented [1].