Hormonal acne in men: causes and treatment

Most writing about hormonal acne is written for women, because the hormonal pill treatments are for women. Men get hormonal acne too. Acne is driven in part by androgens, the male-type hormones that make the skin's oil glands grow and produce oil, and MedlinePlus says women make testosterone in much smaller amounts than men. This guide covers how hormones cause acne in men, the causes that are specific to adult men, such as testosterone therapy and steroids, and the treatments that fit. For the full plan, see the hormonal acne treatment guide.

Skinli gives general education and is not a doctor. Deep, painful acne, or acne that started with a new medicine, needs a doctor's review.

How hormones cause acne in men

NIAMS, part of the US National Institutes of Health, explains the process. At puberty, androgens rise in both boys and girls. They enlarge the sebaceous glands, the oil glands in the skin, and make them produce more sebum, the skin's oil. Extra oil mixes with dead skin cells, plugs the pore, and bacteria grow inside. That plug becomes a blackhead, a whitehead or a pimple.

This is why NIAMS says acne in the teenage years is more common in males. Adult acne is different. NIAMS says that when acne continues into adulthood, it is more common in women. A 2023 study of US dermatology visits from 2002 to 2016 found that after age 20, acne made up 10.1% of visits by women and 4.1% of visits by men.

Adult acne in men is still common. A 2008 survey of 1,013 adults in the Journal of the American Academy of Dermatology asked people whether they had acne:

Age	Men who reported acne	Women who reported acne
20 to 29	42.5%	50.9%
30 to 39	20.1%	35.2%
40 to 49	12.0%	26.3%
50 and older	7.3%	15.3%

These are people's own reports, and the authors list that as a limit. Still, they show that adult acne in men usually fades with age.

Causes of acne that are specific to men

Testosterone therapy

Some men are prescribed testosterone because their body makes too little. MedlinePlus names testosterone among the medicines that can trigger acne, and the FDA label for a testosterone gel lists acne among its side effects.

The same label carries a boxed warning, the strongest warning on a drug label, about testosterone passing to other people. Women and children who touch treated skin can absorb it. The label says women exposed this way may notice more acne or other signs of male hormones, and should tell a doctor. Wash your hands after applying the gel and cover the skin, as the label directs.

Anabolic steroids

Anabolic steroids are man-made versions of testosterone. MedlinePlus says some bodybuilders and athletes take them to build muscle, at doses 10 to 100 times higher than doses used to treat medical conditions, and that using them this way without a prescription is not legal or safe. MedlinePlus and the National Institute on Drug Abuse both list acne among their effects.

A 2007 review from Germany estimated that acne occurs in half of people who misuse anabolic steroids, and called it an important sign of steroid misuse in men aged 18 to 26. It said severe forms of acne, including deep lumps that join together, can follow. The UK's NICE guideline tells doctors to consider specialist care when "self-administered anabolic steroids" may be causing a person's acne. Tell your doctor about any steroid or testosterone use, including products bought online.

Other medicines

NIAMS says medicines that contain hormones, corticosteroids or lithium can cause acne. The American Academy of Dermatology (AAD) advises anyone who suspects a medicine to keep taking it and talk to the doctor who prescribed it.

Causes that come from what touches the skin

Some acne on a man's jaw, chin and neck comes from what touches the skin:

• Shaving. The AAD says shaving can irritate the skin and make acne worse.
• Helmet straps and pads. The AAD says football and hockey players can get acne mechanica on the chin, where gear rubs.
• Hair products. Oily products can cause acne along the hairline and the back of the neck. See acne on the back of the neck.

The AAD describes the jawline pattern of hormonal acne in adult women. For more on that pattern, see the jawline acne guide.

How to treat hormonal acne in men

Standard acne treatment

The treatments with the strongest evidence work the same in men and women. The AAD's dermatologists recommend these ingredients for mild to moderate adult acne:

Ingredient	What it does
Adapalene	A retinoid that clears blackheads, whiteheads and pimples
Benzoyl peroxide	Kills acne bacteria. The AAD suggests starting at 2.5%
Salicylic acid	Unclogs pores. Best for whiteheads and blackheads
Azelaic acid	Fights acne and fades dark spots

Use one product on the whole area for 6 to 8 weeks before judging it. The AAD says to expect fewer breakouts in 4 to 8 weeks and clearing at 16 weeks if it works. The salicylic acid vs benzoyl peroxide guide helps you choose where to start.

A cream that works on hormones

The AAD says clascoterone is the first FDA-approved medicine that can treat the hormonal causes of acne in both males and females. It is a prescription cream for people aged 12 and older, applied twice a day. According to its FDA label, it blocks androgen receptors, the parts of skin cells that respond to androgens.

In the two 12-week trials on the label, 18.8% and 20.9% of people using the cream reached clear or almost clear skin, compared with 8.7% and 6.6% using a cream without the medicine. The label says the most common side effects were redness, itching and dryness. It also warns that the cream can affect the body's stress hormone system and raise potassium in some people, so a prescriber watches for these.

Hormonal pills are for women

The two hormonal pills used for acne are for women only:

• Spironolactone. The AAD says it is not prescribed to men for acne, because men have developed breasts while taking it. The AAD also lists erectile problems as a possible side effect in men.
• Birth control pills. The FDA labels for the pills approved to treat acne limit that use to females who have started having periods and also want birth control.

The details are in spironolactone for acne and birth control for acne.

Severe acne

For deep, painful acne or acne that scars, the AAD says a dermatologist may prescribe antibiotic pills with a medicine on the skin, or isotretinoin. It says 85% of patients see permanent clearing after one course of isotretinoin. See the Accutane guide and when to see a dermatologist for severe acne.

A simple daily routine for men with acne

Men's skin differs from women's in a few measurable ways. A 2016 review in Dermatologic Clinics says oil production, skin pH and water loss through the skin all differ between the sexes, which may matter when choosing acne treatment. The basic routine is still the same:

When	Step	Source of the advice
Morning and night	Wash with a gentle cleanser. Do not scrub	NHS
Before shaving	Wet the skin and beard, then use a shaving cream or gel	AAD
Shaving	Sharp blade, light strokes, in the direction the hair grows. Rinse the blade after each stroke	AAD
Night	A thin layer of your acne treatment over the whole area	AAD
Daily	Moisturizer and sunscreen labeled "non-comedogenic," meaning they do not clog pores	AAD and NHS

The AAD says to change blades or throw away disposable razors after 5 to 7 shaves, and to let the razor dry between shaves. If an electric razor irritates the skin less, use it.

Acne on the chest and back

Men often get acne on the chest, back and shoulders as well as the face. NIAMS names pressure from sports helmets, tight clothes and backpacks among the things that can make acne worse. The treatments above work there too, used in forms that reach the body. The body acne guide and the back acne guide cover washes, sprays and habits for those areas.

When to see a doctor

See a doctor if:

• Acne is deep, painful or leaving scars
• Acne started or got worse after testosterone, steroids or another new medicine
• Acne appeared suddenly and severely in adulthood
• You have tried a product for 6 to 8 weeks with no change

Skinli's free acne plan builds a starting routine from a photo. It uses the same ingredients the AAD recommends for men and women.