Short‐ and Long‐Term Clinical Skin Effects of Testosterone Treatment in Trans Men

IntroductionOur knowledge concerning the effects of testosterone (T) therapy on the skin of trans men (female‐to‐male transsexuals) is scarce.AimThe aim of this study was to evaluate the short‐ and long‐term clinical effects of T treatment on the skin of trans men.MethodsWe conducted a prospective intervention study in 20 hormone naive trans men and a cross‐sectional study in 50 trans men with an average of 10 years on T therapy.Main Outcome MeasuresAcne lesions were assessed using the Gradual Acne Grading Scale, hair patterns using the Ferriman and Gallwey classification (F&G), and androgenetic alopecia using the Norwood Hamilton Scale.ResultsT treatment increased facial and body hair growth. The F&G score increased progressively from a median value of 0.5 at baseline to a value of 12 after 12 months of T administration. After long‐term T treatment, all but one trans man achieved an F&G score indicative of hirsutism in women, with a median value of 24. Only one trans man acquired mild frontotemporal hair loss during the first year of T treatment, whereas 32.7% of trans men had mild frontotemporal hair loss and 31% had moderate to severe androgenetic alopecia after long‐term T therapy. The presence and severity of acne increased during the first year of T therapy, and peaked at 6 months. After long‐term T treatment, most participants had no or mild acne lesions (93.9%). Dermatological outcome was not demonstrably related to individual serum T or dihydrotestosterone levels.ConclusionsT treatment increased facial and body hair in a time‐dependent manner. The prevalence and severity of acne in the majority of trans men peaked 6 months after beginning T therapy. Severe skin problems were absent after short‐ and long‐term T treatment. Wierckx K, Van de Peer F, Verhaeghe E, Dedecker D, Van Caenegem, E, Toye K, Kaufman JM, and T'Sjoen G. Short‐ and long‐term clinical skin effects of testosterone treatment in trans men. J Sex Med 2014;11:222–229.