The transition process for many individuals often brings about significant physiological changes, including an increased risk of developingacne. A recent study published in the American Medical Journal has confirmed the experiences of numeroustransmasculineindividuals: the introduction oftestosteronecan lead to skin issues commonly referred to asT acne. Notably, the study also indicates thattransfeminineindividuals undergoingestradioltherapy face similar challenges, underscoring that hormonal treatments associated with male hormones are not the sole contributors to this condition.
These findings raise crucial concerns regarding the necessity for regular monitoring and proactive management of acne in bothtransmascandtransfeminineindividuals during their hormone therapy. The implications are significant, as these treatments are essential for many in the transgender community seeking affirmation of their gender identity.
Study overview and methodology
This extensive study utilized electronic health records from four Kaiser Permanente regions, analyzing data from nearly 281,000 individuals who initially had no history of acne. This cohort included over 20,000 transgender patients, divided into 11,234transmasculineand 9,486transfeminineindividuals, representing about 7% of the total group. Each transgender participant was matched with cisgender individuals based on age, race, ethnicity, and geographic location.
Participants were monitored for up to five years after their transgender status was first documented, with the incidence of acne tracked throughout this period. The results were significant—at the five-year mark, the cumulative incidence of acne amongtransmascindividuals was 15.8%, notably higher than the 3.8% observed in matched cisgender men and 10.5% among cisgender women.
Insights into risk patterns
The data revealed that the risk foracneamongtransmascindividuals peaked within the first year of starting testosterone therapy, with their risk being over eight times greater than that of cisgender men and nearly three times that of cisgender women. Although the risk decreased after the initial year, it remained significantly higher than that of their cisgender counterparts throughout the five-year follow-up.
Conversely,transfeminineindividuals undergoingestradioltherapy exhibited different patterns in acne risk. Their 0%, which surpassed the 2.9% recorded for cisgender men but was lower than the 8.4% for cisgender women. Following the initiation of estradiol, transfeminine individuals experienced a modestly elevated risk compared to cisgender men while remaining at a lower risk than their cisgender female counterparts.
Clinical implications and recommendations
Given the heightened risk of developing acne during hormone therapy, the authors of the study strongly recommend that healthcare providers implement regular acne monitoring. They emphasize that particular attention should be paid during the first year of testosterone therapy, as this is when the risk is most pronounced. Additionally, healthcare professionals should recognize thattransfeminineindividuals may require dermatological evaluations once they beginestradioltherapy.
In light of these findings, organizations like Trans Health HQ have reassured those experiencing acne while on testosterone, stating, “If you’re noticing more breakouts on T, you’re not doing anything wrong.” They acknowledge that acne is a common occurrence during the early stages of testosterone treatment and recommend consulting a dermatologist for effective management strategies. Notably, medications such asspironolactonemay help alleviate some of the effects of testosterone on acne.
This study highlights the critical relationship between hormone therapy and acne risk in transgender individuals. By increasing awareness and promoting proactive care, healthcare providers can better support the well-being of those navigating the complexities of gender-affirming treatments.