Male hormone therapy linked to acne in trans men

Acne was a common occurrence after the initiation of masculinizing hormone therapy (MHT), the researchers reported.

In a retrospective analysis of nearly 1,000 transgender people who started MHT, the prevalence of acne fell from just 6.3% to 31.1% after an average treatment duration of 3.4 years, according to Erica Dommasch, MD, MPH, of Beth Israel Deaconess Medical Center in Boston and colleagues.

The rate of new acne diagnoses peaked in the first 6 months after starting MHT, they wrote in JAMA Dermatology.

However, in the years after starting hormone therapy, acne continued to become widespread. In the first year of hormone initiation, the proportion of people with acne jumped to 19%, then rose to 25.1% after 2 years.

Age seemed to be the biggest predictor of who would develop acne after starting MHT, with those aged 18 to 21 being the most affected.

“Although we found the highest prevalence of acne in the youngest age group (18-21 years), total serum testosterone levels before starting MHT and 1 to 2 years after starting MHT. MHT were the lowest in this group, ”Dommasch’s group noted. “These results suggest that the higher prevalence of acne in younger patients may be related to factors other than just serum levels or exogenous administration of testosterone.”

These estimates of acne among this cohort might even be relatively low, as the researchers only included patients with a formal diagnosis of acne encoded by ICD-10-CM.

“Many of our patients may have developed mild acne that has not worsened clinically or have chosen not to discuss the acne with their health care clinician,” they noted.

The study included electronic health record data on 998 Fenway Health patients with a median age of 25.8 years. All individuals were assigned a female gender at birth and initiated THD between 2014 and 2017.

Injectable forms of MHT were prescribed for approximately 83% of the cohort; other methods of delivering hormones, such as an implant or transdermal methods, were much less common. Intramuscular and subcutaneous injections were also prescribed more frequently in younger patients, suggesting that the administration of hormone therapy may play a role in the development of acne, the researchers said.

“Injectable forms of MHT are more widely available and cheaper than non-injectable forms,” they explained, adding, “however, the dips and peaks in serum hormone levels via this mode of administration may be greater. larger than those with non-injectable formulations and thus contribute to acne development. “

In a report JAMA Dermatology Research letter, the development of moderate to severe acne associated with MHT has been linked to depression and anxiety in transgender people.

In the study of 283 transmasculin (TM) people, 17.3% had previously suffered from acne while 16.3% currently suffered from acne after receiving testosterone, reported Howa Yeung, MD, MSc, of the Emory University School of Medicine in Atlanta, and colleagues.

Subsequently, nearly half of these people reported experiencing clinically significant levels of depression, and 21% reported significant anxiety symptoms. Overall, the current presence of moderate to severe acne was associated with a 2.4-fold higher likelihood of depression (95% CI 1.1 to 5.4) and a 2.7-fold likelihood of anxiety. times higher (95% CI 1.2 to 6.3).

Clinically significant anxiety levels were defined as a Beck Anxiety Inventory score of 22 or greater, while significant depression was considered to be a score of 10 or greater on the Center for Epidemiological Studies Depression Scale.

Yeung’s group suggested that an effective treatment might be isotretinoin (Accutane), noting that “Although isotretinoin may be rarely associated with mood changes, it has also been shown to improve quality. of life and reduced symptoms of depression in some studies “.

“Isotretinoin has been used to effectively treat moderate to severe acne in transgender people; its potential mental health benefits and risks need to be considered in the context of elevated baseline mental health symptoms in people with MT, ”they concluded.

  • Kristen Monaco is editor-in-chief, specializing in news in endocrinology, psychiatry and dermatology. Based in the New York office, she has been with the company for almost five years.

Disclosures

The study by Dommasch’s group was funded by the Stern Grant / Department of Dermatology, Beth Israel Deaconess Medical Center. Dommasch and a co-author revealed they were co-chairs of the American Academy of Dermatology; Lesbian, Gay, Bisexual, Transgender, Gay / Sexual and Gender Minority Health.

The study by Yeung’s group was supported by the Patient-Centered Outcomes Research Institute (PCORI), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the Dermatology Foundation and the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Yeung revealed a relevant relationship with Syneos Health. The co-authors revealed relevant relationships with PCORI and NICHD.


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