Short- and long-term clinical skin effects of testosterone treatment in trans men

J Sex Med. 2014 Jan;11(1):222-9. doi: 10.1111/jsm.12366. Epub 2013 Oct 31.


Introduction: Our knowledge concerning the effects of testosterone (T) therapy on the skin of trans men (female-to-male transsexuals) is scarce.

Aim: The aim of this study was to evaluate the short- and long-term clinical effects of T treatment on the skin of trans men.

Methods: We 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 measures: Acne 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.

Results: T 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.

Conclusions: T 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.

Keywords: Female-to-Male Transsexual; Gender Dysphoria; Gender Identity Disorder; Skin; Testosterone; Transsexualism.

MeSH terms

  • Acne Vulgaris / chemically induced
  • Adolescent
  • Adult
  • Alopecia / chemically induced
  • Cross-Sectional Studies
  • Fatty Acids
  • Female
  • Hair / drug effects
  • Hair / growth & development
  • Hirsutism / chemically induced
  • Humans
  • Male
  • Prospective Studies
  • Sex Reassignment Procedures / adverse effects*
  • Sex Reassignment Surgery
  • Skin / drug effects*
  • Skin / pathology
  • Testosterone / adverse effects*
  • Testosterone / therapeutic use
  • Transgender Persons*
  • Transsexualism / drug therapy*
  • Transsexualism / surgery
  • Young Adult


  • Fatty Acids
  • undecanoic acid
  • Testosterone