Acne is a common skin condition that can be caused by a variety of factors, including hormonal changes. It is perhaps one of the most common skin conditions affecting both men and women and the number one cause of shame for teenagers. Acne can be extremely embarrassing and can cause a great deal of anxiety, depression, and even social withdrawal.
Acne, despite its reputation as a teenager’s torment, can affect people of all ages. According to the American Academy of Dermatology (AAD), about 50 million Americans suffer from acne. 
Every year, thousands of men use testosterone replacement therapy (TRT) to counter the effects of low testosterone, such as fatigue and low libido. Used properly, it can gradually improve these symptoms and help you feel like your old self again.
However, TRT (like most medications) may also come with some side effects, which include acne. In fact, acne is one of the most common side effects associated with testosterone therapy.
Let’s explore what TRT, how TRT and acne are realted, as well as the available treatments.
What is Testosterone Replacement Therapy?
Testosterone replacement therapy (TRT) is a common treatment for men with low testosterone levels. As men age, it is not uncommon for their testosterone levels to decline, which can lead to a number of changes and symptoms that can be both inconvenient and uncomfortable.
This is where TRT comes in to save the day. If testosterone levels are not where they should be, it could have a profound impact on your quality of life. That’s why TRT is used to bring testosterone levels back up to where they should be.
Some research has shown that testosterone levels in men change substantially around the age of 40.  Although testosterone levels tend to decline with age, not all men develop hypogonadism as they grow older.
TRT usually involves taking testosterone in the form of injections, gels, patches, or pellets that are placed under the skin (though injections are the most common). The aim of TRT is to bring your testosterone levels back to where they should be so that you can experience the benefits that come with having normal testosterone levels.
This is a long-term treatment, which means that it is something you will likely have to do for the rest of your life. However, it is important to bear in mind that TRT is not a cure for low testosterone levels – it is simply a way of managing the condition.
Testosterone has, unfortunately, been linked to the development of acne in many men–the kind that affects your face and body. In the below section, we’ll explore how testosterone can cause acne and what you can do about it.
How Does Testosterone Cause Acne?
Acne is caused by a variety of factors, but one of the most common is hormonal changes. When your hormones are out of balance, it can lead to an increase in sebum production. Although it most commonly affects teenagers, it is also a common problem for adults, which can be a result of hormonal changes happening when you begin testosterone replacement therapy.
Because testosterone has anabolic and androgenic properties (meaning it helps to build muscle and increase hair growth), it can also cause sebaceous glands to increase sebum production and lead to oily skin. This will lead to clogged pores, allowing germs to flourish around your hair follicles and lead cystic acne (a red inflamed pimple that has bursted under the skin rather than on the outside) to develop. 
[Note: There are several research which link testosterone to acne development which has also helped link hormonal acne formation from the constant flood of hormones in teens. Though there is no research to indicate the acne severity in men undergoing TRT.]
Acne caused by testosterone therapy is usually seen on the face, chest, and upper back–the areas of the body with the highest concentration of sebum. However, it can also occur on the arms, legs, and buttocks.
One thing to keep in mind is that not all men who use TRT will develop acne. In fact, only a small minority of men using TRT (between 5 and 10 percent) will experience this side effect. However, if you are one of the unlucky few, there are some things you can do about it.
What Can You Do About TRT-Induced Acne?
If you are using TRT and develop acne, the first thing you should do is talk to your doctor or healthcare provider. They will be able to advise you on the best course of action and may be able to help with
There are also a number of things you can do at home to help manage and treat your acne breakouts while on TRT.
Maintain Proper Skin Hygeine
Although this is not a quick fix, maintaining proper skin hygiene is important for preventing and treating acne. This means washing your face at least twice a day with a mild cleanser, use body wash when showering, and apply topicals such as benzoyle peroxide or salicylic acid to areas where acne develops.
You should also avoid touching your face, as this can transfer bacteria from your hands to your face and make acne worse. If you must touch your face, make sure you wash your hands first.
There is no one-size-fits-all solution when it comes to acne, but, in general, drinking plenty of water and staying hydrated can help. Water helps to flush toxins out of your system and keeps your skin healthy.
Try to drink at least eight glasses of water a day, or more if you can. You should also avoid sugary drinks, as they can contribute to dehydration.
When a pimple appears, you may be tempted to pop it. However, this can actually make acne worse and cause scars. Instead, try using a one of the more common topical ointment available such as benzoyl peroxide or salicylic acid. These ointments can help to reduce inflammation and kill bacteria.
Retinoids are another form of a topical acne treatment. They work by helping to unclog pores and prevent an excess build up of dead skin cells. However, they can sometimes make acne worse before it gets better, so it is important to start with a small amount and increase gradually as your skin adjusts.
Zinc is perhaps one of the most well-known treatment that helps reduce acne. Zinc helps to reduce inflammation and can also kill bacteria. It is available in pill form or as a topical ointment.
If you choose to take zinc orally, it is important not to take more than the recommended dosage, as too much zinc can be harmful. In general, one study showed that the safe recommendation for zinc intake while undergoing TRT is about 220 mg per day, twice a day. 
Other Acne Treatments
Aside from natural, at home, remedies. There are also potent prescription treatments available.
One well known prescription medication used to treat acne is isotretinoin (also known as Accutane). It is one of the most potent prescription treatments. The medication works by reducing the size of the sebaceous glands and the amount of skin oil production. It also helps to unclog pores and prevent the formation of new acne.
Isotretinoin is a very effective treatment, but it does have a reputation for being prescribed for severe acne. This medication has some serious side effects, so it is important to talk to your doctor before starting this medication.
The Ultimate Benefit
Despite knowing the link between testosterone and acne, men still seek out testosterone therapy to increase their levels of the hormone. This risk does not happen to everyone, but it is important to be aware of the potential side effects before starting TRT.
If you are concerned about your acne as a result of TRT, you may also want to consider speaking to your doctor about changing to any of the other forms to administer testosterone (i.e. gels, creams, or patches). These methods may help to reduce the risk of developing acne.
At the end of the day, the decision to start TRT is a personal one. It is important to weigh the pros and cons before starting any form of hormone therapy.