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Female-to-male transgender patients experience severe acne

Researchers have reported two cases of severe acne in female-to-male transgender patients whose symptoms required continuous therapy with isotretinoin.

The first was a female-to-male transsexual patient (trans man) who had begun standard testosterone therapy (testosterone undecanoate, 1000 mg every 3 months), 6 months prior. He was in his 20s and presented with inflammatory acne with scarring in the face and chest. It had continued for 4 months and was resistant to topical retinoids. The patient had blood testosterone levels of 505.6 ng/dL. Acne symptoms resolved after 9 months of oral isotretinoin (30 mg per day) treatment. The acne recurred 3 months after treatment was discontinued. Retreatment with isotretinoin, 20 mg per day, resulted in a good response at the most recent follow-up visit.

The second patient was a trans man in his 20s with severe acne on the face and trunk and seborrhea, which appeared 6 months after beginning standard testosterone treatment. Secondary male characteristics, including facial and body hair growth, had developed and the patient’s testosterone levels after starting hormonal treatment were 496 ng/dL.

After treatment of isotretinoin, 20 mg per day, for 8 months, the patient’s acne resolved, but scarring persisted. A new acne breakout resistant to oral doxycycline developed 6 months after discontinuing treatment. Retreatment of isotretinoin (20 mg, 3 times a week) is ongoing, with a good response and following.

“It is reasonable to think that if the patient keeps receiving masculinizing doses of [testosterone], virilizing characteristics such as acne will persist,” the researchers wrote.

“Previous data support that severe skin problems are rare after long-term [testosterone] treatments,” the researcher concluded. “However, we present two cases of severe acne in trans men that required continuous isotretinoin therapy. Special requirements of patients with [gender identity disorder] and their dermatological problems during sex hormone treatment are important to address because of their potential to disrupt the hormone treatment process.”  — by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.