Hormones and Acne: How Gender-Affirming Hormone Therapy Shapes Acne Risk in Transgender Individuals

Original Article : Acne Incidence and Severity in Transgender Individuals

What are the key takeaways of this article?

This large retrospective cohort study evaluated the incidence of acne among transgender individuals undergoing gender-affirming hormone therapy (GAHT), compared with matched cisgender controls. Using electronic health record data from over 280,000 patients without baseline acne across multiple health systems, the study provides robust, population-level insight into how hormone therapy influences acne risk following therapy initiation. 

The findings demonstrate that transmasculine individuals experience substantially higher rates of acne compared to both cisgender men and women. After 5 years on GAHT, the cumulative incidence of acne was 15.8% in transmasculine individuals, compared to 3.8% in cisgender men and 10.5% in cisgender women. This elevated risk was especially pronounced following testosterone initiation, with the highest incidence occurring within the first year (hazard ratio up to 8.56 vs cisgender men). Although incidence decreased after the first year it remained consistently elevated over time. Moderate to severe acne showed similar patterns, highlighting the clinical significance of these findings.

In contrast, transfeminine individuals had a lower incidence of acne after therapy initiation (6.0% at 5 years) compared to transmasculine patients. Their risk was higher than that of cisgender men but lower than that of cisgender women. After initiation of estradiol therapy, acne development increased compared to cisgender counterparts but remained lower than the incidence of acne in cisgender women. These findings suggest that estrogen-based therapy may not fully eliminate acne and that hormonal influences on acne are complex and not solely androgen-driven.

Importantly, this study highlights the clinical relevance of hormone-related acne in transgender care. Transmasculine patients, particularly early in testosterone therapy, represent a high-risk group who may benefit from anticipatory guidance, early monitoring, and timely management. Given the known psychosocial burden of acne, including associations with anxiety and depression, proactive dermatologic care is essential in this population.

In summary, transgender individuals exhibit distinct patterns of acne incidence influenced by GAHT, with the greatest increase seen in transmasculine individuals. Integrating proactive acne counseling and management into routine gender-affirming care may help optimize both dermatologic and psychosocial outcomes.

Publication Date: June 9, 2026

Reference:

Smith CA, Kaabi O, Manatunga AK, Lash TL, Silverberg MJ, Getahun D, Vupputuri S, McCracken CE, Chen SC, Tangpricha V, Goodman M, Yeung H. Acne Incidence and Severity in Transgender Individuals. JAMA Dermatol. 2026;162(3):255–263. doi:10.1001/jamadermatol.2025.5597

Summary By: April Foote