Minimizing Acne Issues While on TRT

Solutions from Your Friendly Neighborhood Biohackers!

Welcome Anon

Today we have our resident skin care expert @BowTiedFawn for a guest post. She has helped countless individuals solve problem-specific issues like acne, stretch marks, dandruff, and more. She also provides general knowledge of skin care & health, the science behind it, and gives actionable, anti-aging advice.

Fawn is here to discuss skin care while on TRT. Many of you are either on it, considering it, or just generally curios.

One issue some men can run into is skin issues (namely acne) while on TRT; however, as you’ll find out, we have steps we can follow and mitigations we can make to ensure we keep our skin clear and healthy-looking.

Without further adieu, @BowTiedFawn:

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Disclaimer: I am not a doctor, just a cartoon deer on the internet with a background in chemistry and a hyperfixation on skin. This is not medical advice.

Today, I’ve teamed up with @BowTiedUM and @BowTiedLoon to talk about acne and TRT. We’ll review the two causes of acne on TRT (hormonal fluctuations and high androgens) and how to mitigate them. Let’s discuss!

Hormonal Fluctuations:

Some doctors have patients injecting once a week (or worse, once every 2 weeks). Infrequent injections are disastrous as the active half life of testosterone cypionate active is ~5.5 days. This means that on Day 1, you have a huge unnatural spike in testosterone, and by the end of the week, you have less than half of that testosterone in your body. This causes two problems:

1. Testosterone levels fluctuating will cause acne

2. The body has too much testosterone on Day 1 and 2, so it converts it to estrogen and DHT as a mechanism of homeostasis. The extreme fluctuation of DHT and estradiol are even more troublesome for acne!

Thankfully, the solution is relatively simple. Either:

• Split the dosage in half and inject twice a week

• Split the dosage into thirds and inject every other day

High Androgens

Let’s say you had acne as a teen when your testosterone was the highest, and the acne subsided as you got older. Your acne went away because your sex hormones stabilized after puberty and/or your testosterone dropped as you aged. If you’re on TRT now, it’s no surprise that your acne is back. For your genetics, high androgens cause excess sebum production. You have a few options here:

• Lower dose and see if that helps

• Cut out dairy, sugar, and casein and lower your fat consumption

  • Whey and casein protein can cause acne trouble in plenty of people (myself included), especially on the trunk. You could try switching to an A2 protein, like whey made from goat milk and see if that helps

  • This is a good meta analysis of the role of diet and acne for those inclined to dig deeper

• Check out my guides for oily skin to test if any of the topical treatment methods work for you

  • Clearing Back Acne and Hyperpigmentation

  • How to Structure a Routine for Oily Skin

One other option to try could be taking oral doses of pantothenic acid. Pantothenic acid (vitamin B5) is the precursor to coenzyme A which metabolizes fatty acids. Essentially, by taking large doses of B5, we’ll downregulate sebum production. The less oil your body produces, the lower your chances of developing acne. Thus, B5 could be a solution for acne prone individuals. Make sense?

Now, UM did the following (definitely not medical advice):

• 5000mg (5g) B5 in the morning after breakfast

• A B-complex vitamin during the day

• 5000mg (5g) B5 after dinner

He stacked each dosage of B5 with 1000mg (1g) of l-carnitine to potentiate (note: store l-carnitine in the fridge so it doesn’t go all fish-y on you). After his skin cleared up, he stuck to 5g B5 once daily for maintenance.

Loon did something similar as well, though his protocol was 750mg of B5 and 250mg of l-carnitine 3x per days. Some refer to this regimen as the modified Leung B5 protocol.

Consider consulting with your dermatologist if taking high dose B5 could be right for you. Again, none of this is medical advice. If you take too much, you can get temporary digestion issues (ick) or worse.

If any of these solutions work, that’s great! However, you may still have acne. In this case, your best chance of permanently resolving your acne would be to run a course of Accutane under the supervision of a licensed dermatologist. Accutane shrinks the glands that produce sebum. Unfortunately, while your acne issue will more than likely be resolved for good, Accutane can also lead to a lifetime of dry skin and other health issues.

Some people may need a second course or a low maintenance dose of 10mg 3x a week, but this is rare. In fact, UM ran his own low dose course of Accutane (again, definitely not medical advice, do not do this) because it can be effective for people with mild to severe cystic acne with minimal side effects. With this option, the risk of permanently dry skin is near zero, and UM only experienced dry lips. You may want to show the study linked above to your dermatologist and have a discussion about whether a low dose of Accutane may be right for you.

If you try the B5/l-carnitine protocol, you can continue using salicylic acid or benzoyl peroxide as active ingredients in your normal skin routine. However, if you’re running Accutane, you’re better off just opting for just a gentle cleanser with no active ingredients, moisturizer, and facial SPF in the mornings. This is because Accutane is so drying that you’ll want to be as gentle with yourself as possible otherwise.

Closing Notes:

• If you try any of these solutions, be sure to take progress pictures! I’d love it if you’d share them with me via DM on Twitter as well.

• Dr. Loon is a cardiologist that provides blood work interpretation services via his website. Be sure to keep him in mind!

Aaaand finally, please make sure to give my team a follow on Twitter as well! Both Loon and UM are brilliant in their respective fields, and I could not have synthesized this information without them.

That’s all for now! Happy Skincare!

@BowTiedFawn

Note: you can now book consultations with me! Check it out here or DM me on Twitter to book with ETH. 

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Ox Note: Something big to consider if you get oily skin from TRT or just in general is showering after the gym or washing your face at a minimum - not doing this will exacerbate acne from grime and gunk in the gym.

I have personally had many friends (some on a lot more than just TRT) run this protocol with great success—the deer knows a thing or two.

I want to thank her for taking the time to write this extremely helpful article, and please take the time to check out her substack and follow her on Twitter.

#WAGMI

Your friend,

- BowTiedOx

DISCLAIMER

This is not Legal, Medical, or Financial advice. Please consult a medical professional before starting any workout program, diet plan, or supplement protocol. These are opinions from a Cartoon Ox.