T Nation

Fighting Acne on Long Term TRT

I’m new to this forum and want to apologize in advance if this question has been asked before. I’ve searched online for individuals who have fought and conquered acne in order to gain insight into how I can do so myself. My searches continually yielded “T-Nation” but the primary topic I came across concerned individuals “on cycle”. I am prescribed TRT, have been on it for 2 years now and will be on it forever. My hope is this doesn’t translate to acne forever, but someone’s experience “on cycle” doesn’t exactly correlate to mine or other individuals who take TRT long term, hence why I am asking for any input from this forum.

Anyways - I’m 26 and began taking TRT when in Feb. 2011. The exact reason as to why I require TRT is a very long discussion and not the point of this topic, however some background information: my test bottomed out in late 2008 for no explainable reason; after going to see 6 endocrinologists who all accused me of steroid abuse due to my rapid drop in test and my muscular physique, I returned to my GP who prescribed me testosterone cypionate.

I self inject 250 mg (1 1/4 mL) testosterone cypionate bi-weekly. I have pretty bad acne on my back, shoulders and chest and have had it for the majority of my TRT. I took Doxy - 200 mg / daily for several months but eventually its efficacy dwindled. I’m now on accutane and have been for 4 months. My doses have been as follows Month1: 20mg ed, Month2:40mg ed, Month3: 40mg ed, Month4: 60mg ed, Month 5 & 6 will be 80 mg ed.

I’ve seen some improvement in my acne but overall I’m still pretty broken out. If this doesn’t work, I intend to wait 6 months and take accutane again at a much higher dosage.

My question is - to anyone out there who is also on TRT and has struggled with acne, did anything work long term? My fear is I am exposing myself to the inherent risks of taking accutane all for nothing because (I fear) as long as I take TRT, I’ll have acne. I’ve never had acne prior to all of these hormonal issues and I’m just not coping well with it at all, emotionally. I haven’t taken my shirt off in front of people in years. If someone mentions the beach my mind is like “man, I wish I could go there…”

I have a juicer at home and I intend to began drinking carrot juice (vitamin A) and supplement zinc - I’ve read this helps acne quite a bit.

Thanks for any insight. I’ll try to answer any questions that may arise

Hey man, I feel for you. I’ve had acne on my chest and back as well (although I’ve never been on TRT).

You have to keep in mind that acne is multifactorial and there are other things at play besides Testosterone. Your immune system and your cortisol are a couple of examples. Then there is the whole lifestyle and food sensitivities thing. Look into those things and, in the meanwhile, go to acne.org and do the regime they explain there. You can use their products or not, but if you stick religiously to the protocol, you’ll clear up. I did. No need to use accutane.

I know this only treats the symptoms but at least it will keep you clear and give you some peace of mind until you find what’s causing your condition.

i look back at my use of Accutane as a teenager, and often wonder if it contributed to my current low T situation. i’ll never know for sure, but it makes me wonder how things might of been different otherwise.

[quote]eaboadar wrote:
Hey man, I feel for you. I’ve had acne on my chest and back as well (although I’ve never been on TRT).

You have to keep in mind that acne is multifactorial and there are other things at play besides Testosterone. Your immune system and your cortisol are a couple of examples. Then there is the whole lifestyle and food sensitivities thing. Look into those things and, in the meanwhile, go to acne.org and do the regime they explain there. You can use their products or not, but if you stick religiously to the protocol, you’ll clear up. I did. No need to use accutane.

I know this only treats the symptoms but at least it will keep you clear and give you some peace of mind until you find what’s causing your condition. [/quote]

Thanks I will definitely look into that. I definitely do have immune system issues and likely high cortisol levels due to the stress I’m persistently under. I have Crohn’s Disease and take immunosuppressive medication (Remicade) to treat it. My GP believes the Remicade is the reason my testosterone bottomed out, although I’m skeptical of that since I had been taking it for 3 years with no problems when my test decided to stop working. I believe the real reason my test stopped was from emotional trauma. I had a series of bad, emotionally scarring “life events” that I think did me in. Regardless, test cypionate has at least restored my brain functionality and hard ons lol

[quote]tiredguy wrote:
i look back at my use of Accutane as a teenager, and often wonder if it contributed to my current low T situation. i’ll never know for sure, but it makes me wonder how things might of been different otherwise.[/quote]

You’re not the first person I’ve come across who has mentioned that they suffer from low-T and have taken accutane in the past. Are you currently on TRT or are you here searching for answers? Either way I’m sorry to hear about your low T situation. I’ve never been so mad in my life over what has happened to me. I’m an educated, over the top analytical thinker - hell I’m a civil engineer, and I was going to these endo’s and they all accused me of steroid abuse. They said “well you’ve got to be taking something, it just doesn’t make sense.” One of them flat out said they didn’t believe me. All because I had played football and worked out all my life and had the physique of a badass when my T hit the floor. Anyways, I feel for you, as does everyone here it appears. I’m thankful to have found this site.

Volfan,

I know you’re just looking for an answer to a specific question, but you will get a much better response by posting all labs/stats/info per the advice for new guys sticky at the top of the forum. It sounds like you haven’t had much luck with doctors, and most on this forum probably know more about it than they do (sad, but true).

For starters, your testosterone probably didn’t bottom out for no reason. Were you going through a lot of stress at the time? Adrenal fatigue? Have you had a thyroid panel? Do your labs indicate you are primary or secondary? People here can help answer those questions.

Read up on the protocol for injections sticky. If you are secondary, adding hCG will help more than you know. Are you using an aromatase inhibitor to control your E2 levels? With 250mg every two weeks, you are riding a hormonal roller coaster. Do you notice any particular time between injections that its worse?

Give us more info and we’ll try to give you more answers.

Vol,
I am currently in the 2nd month of topicals, which i have little to no faith in (i regret getting talked into them), after the results of the first month. before TRT, i had readings around 380. after a month of one topical, my # was 190. to say i was dismayed would be an understatement. switched to a different topical, 1 1/2 weeks into it. giving it a month, and if results aren’t MUCH improved I am insisting topicals are out. if i wait that long. i’m about out of patience already.

if living with low T isn’t hell - it definately is purgatory. a steady, miserable existence, during which you often lose hope of ever getting out. ugh. and to look back and see the signs of this going on for years before finally ‘detected’ - makes me sick to think of the time i’ve wasted as a zombie.

[quote]Kaynon311 wrote:
Volfan,

I know you’re just looking for an answer to a specific question, but you will get a much better response by posting all labs/stats/info per the advice for new guys sticky at the top of the forum. It sounds like you haven’t had much luck with doctors, and most on this forum probably know more about it than they do (sad, but true).

For starters, your testosterone probably didn’t bottom out for no reason. Were you going through a lot of stress at the time? Adrenal fatigue? Have you had a thyroid panel? Do your labs indicate you are primary or secondary? People here can help answer those questions.

Read up on the protocol for injections sticky. If you are secondary, adding hCG will help more than you know. Are you using an aromatase inhibitor to control your E2 levels? With 250mg every two weeks, you are riding a hormonal roller coaster. Do you notice any particular time between injections that its worse?

Give us more info and we’ll try to give you more answers.[/quote]

I’ll try to get some data to post. In the mean time, as you stated, I’m looking for personal accounts on TRT & acne. Surely I’m not the only one on TRT and thus surely I’m not the only one who has dealt with acne.

Adrenal fatigue was a term mentioned by my GP. Again, all of the endo’s simply told me that I had abused steroids (never in my life) and that was why my T had plummeted. They never said anything about secondary or primary, just that my T would recover once I stopped taking steroids (which I wasn’t…assholes). In reality, I believe it was a series of events that resulted in my T disappearing. I have Crohn’s Disease (autoimmune disorder - or so they believe) and I take remicade. It’s a relatively new medicine and my GP believes that this medication may be causing my low T, in conjunction with some of the “life events” that happened to me. My dad died, sister died, all of my grandparents died, I got sick with Crohn’s and then after a long bumpy road, my gf of 3 years left me. Needless to say I’ve dealt with a lot, but the gf leaving was the final blow. Within 3-4 months of her leaving is when my symptoms of fatigue, poor sleep, brain fog, dry skin, nipple sensitivity, etc began. They checked my test and it was 852 ng/dl (I think those are the units) at age 21. 3 months later they were 119 ng/dl. Over the course of the next 3 years my T never again reached above the low 400’s and typically was in the 250-330 range. I was told this is “within the normal range” which I laughed at, as I knew what my body was feeling and also knew what my T had been prior to these issues. Man I was so pissed.

From the biweekly injections I do not feel the roller coaster effect. The test cypionate has a long ester (supposedly) and it lasts the longest of the 3 (test-p, test-e, test-c). I WAS taking 300 mg biweekly, but they checked my T recently and it was 1400+ ng/dl which is of course through the roof. We’ve since dropped it down to 250 mg biweekly.

So you inject 500mg/week. Your dose is too high, T levels too high in terms of acne.

Read the advice for new guys sticky. We cannot do much with so little info.

1 Like

[quote]KSman wrote:
So you inject 500mg/week. Your dose is too high, T levels too high in terms of acne.

Read the advice for new guys sticky. We cannot do much with so little info.

[/quote]

No I inject 250 mg bi weekly. So every 2 weeks I inject 250 mg, or in other words 125mg weekly dose.

I don’t really see how I need to provide any more info than has been provided. I’m asking for other people’s accounts on THEIR acne who are on TRT not cycling.

I intend to provide additional information as I obtain it, but I don’t see my doctor for quite some time. The data I could provide would be pre-TRT, which is pretty useless. I’m not trying to figure out why I needed TRT in the first place.

I’m simply asking other people who are on TRT about their experience with acne, its severity, what worked for them, etc.

1 Like

[quote]tiredguy wrote:
i look back at my use of Accutane as a teenager, and often wonder if it contributed to my current low T situation. i’ll never know for sure, but it makes me wonder how things might of been different otherwise.[/quote]

I’ve thought of what damage taking Accutane caused at a dosage of 60-80mg for 6 months when I was 13! But you know what? I had severe body and face acne and after it, I had very little issue with acne ever again (and never had it on my body)…I used to not be able to sit back in a chair without pain due to the acne.

To the OP, Accutane should work…perhaps lowering your dosage of T can work as well.

My experience has been that any time my hormonal levels fluctuate - whether it is from T or elevated/lowered E2, I get breakouts. Not teenager bad by any means, but I get bumps on my back, shoulders, and the occasional one on my face. I pretty much always have a few bumps somewhere.

What can be done to help this? In your situation, one of the biggest things that will help is “normalizing” your hormone levels. That means instead of dosing once every two weeks, you dose (smaller) 2-3 times per week. I think most guys here dose a minimum of twice per week, some every three days (E3D). This provides a more stable hormone level in your body, rather than the “peaks and valleys” you are getting now. The up and down routine is hard on your system; with TRT, we need to mimic as close to nature as possible within reason and as practically as possible. Pinning every day isn’t practical, but a couple of times per week is doable. On top of that, you’ll feel better!

The second thing is of course general acne-type info - take showers more often, keep clean sheets on the bed, eat a decent diet, etc. Personally, I’ve always been “greasy”, and TRT made it worse. I generally shower twice a day now, regardless and change the sheets more often. Also, FWIW, I’ve seen the Proactive stuff work miracles on people. Typically better results than the presciption stuff, without the sides.

And, don’t discount the information here. There are many guys here who (fortunately? unfortunately?) know more than the endos you’ve seen. Most of us here went through the same thing you did trying to find someone who knew what the hell was going on. On top of helping you get a “proper” protocol dialed in, you’ll get educated about your condition which can lead you to feeling better. You will get pointed in the right direction and feel better!

I understand you’re not looking for info on your protocol. Regardless, read the stickies and post up your labs. It will help us help you, if that makes sense. There could easily be something out of whack causing your acne issue. Getting on a standard protocol might very well help eliminate your issue and help you feel better long-term.

[quote]Volfan4life87 wrote:
In reality, I believe it was a series of events that resulted in my T disappearing. I have Crohn’s Disease (autoimmune disorder - or so they believe) and I take remicade. It’s a relatively new medicine and my GP believes that this medication may be causing my low T, in conjunction with some of the “life events” that happened to me. My dad died, sister died, all of my grandparents died, I got sick with Crohn’s and then after a long bumpy road, my gf of 3 years left me. Needless to say I’ve dealt with a lot, but the gf leaving was the final blow. [/quote]

I’m sorry to hear that. I have a similar story, except in my case it was ankylosing spondylitis, not Chrohn’s, and a 10 year relationship ending.

I am on Enbrel, a biological in the same class as Remicade, also a TNF blocker. I have done a lot of research on this class of drugs and no, there is absolutely no reason Remicade should negatively influence T, no evidence for it, and no possible known mechanism for it. If anything, I should think it may increase T by reducing systemic inflammation.

One class of drugs that is notorious for reducing T, though, are opioid painkillers. Did you perhaps take any painkillers during the time your T plummeted? There are also other drugs that can reduce T, some that are used for autoimmune diseases, such as methotrexate, and even some sleep medications, so I would look carefully into all the drugs you may have been on. It is also quite possible the Chrohn’s itself may have caused low T if it wasn’t well controlled at the time you are talking about.

[quote]catfish74 wrote:
My experience has been that any time my hormonal levels fluctuate - whether it is from T or elevated/lowered E2, I get breakouts. Not teenager bad by any means, but I get bumps on my back, shoulders, and the occasional one on my face. I pretty much always have a few bumps somewhere.

What can be done to help this? In your situation, one of the biggest things that will help is “normalizing” your hormone levels. That means instead of dosing once every two weeks, you dose (smaller) 2-3 times per week. I think most guys here dose a minimum of twice per week, some every three days (E3D). This provides a more stable hormone level in your body, rather than the “peaks and valleys” you are getting now. The up and down routine is hard on your system; with TRT, we need to mimic as close to nature as possible within reason and as practically as possible. Pinning every day isn’t practical, but a couple of times per week is doable. On top of that, you’ll feel better!

The second thing is of course general acne-type info - take showers more often, keep clean sheets on the bed, eat a decent diet, etc. Personally, I’ve always been “greasy”, and TRT made it worse. I generally shower twice a day now, regardless and change the sheets more often. Also, FWIW, I’ve seen the Proactive stuff work miracles on people. Typically better results than the presciption stuff, without the sides.

And, don’t discount the information here. There are many guys here who (fortunately? unfortunately?) know more than the endos you’ve seen. Most of us here went through the same thing you did trying to find someone who knew what the hell was going on. On top of helping you get a “proper” protocol dialed in, you’ll get educated about your condition which can lead you to feeling better. You will get pointed in the right direction and feel better!

I understand you’re not looking for info on your protocol. Regardless, read the stickies and post up your labs. It will help us help you, if that makes sense. There could easily be something out of whack causing your acne issue. Getting on a standard protocol might very well help eliminate your issue and help you feel better long-term.[/quote]

Great response I appreciate it. I’m at work so my response will be brief, but I’m very surprised that people are injecting multiple times per week. I would think, long term, that is a poor regimen as scar tissue can develop from the intramuscular injections. I’ve noticed it in my quads - the needles don’t go in as easy, and I stick in the quad once a month essentially (alternate quads every injection, inject every other week so right quad once a month, left quad once a month). Anyways, I’m going to do some searching on this forum and see if I can optimize my T regimen. I agree that keeping the levels as close to natural is the best course, though in all honesty on the 250mg biweekly dose of Test-C I haven’t felt in peak and valleys. That’s not to say they aren’t there in my bloodwork, but I do not feel them and have thus far been very very happy with my TRT aside from the acne and fear of infertility (haven’t had this checked yet). I’ve heard mixed reviews about testopel. My GP wanted to put me on it but I was hesitant as it was new and his office was JUST beginning to do the procedures, so I wanted him to get some of his own experience with other patients and let me know how they do (let someone else be the guinea pig lol).

Please read the advice for new guys and protocol for injections stickies: - fertility addressed there too.

You can inject SC with insulin needle and then there is zero muscle damage.

Injecting twice a week is producing hormone peaks that can only make things worse. Try the recommendations here and see how your body responds. This will take time to see benefits as acne involves a lot of tissue damage.

When you have some time, dig through the stickies here - there is tons of great info in there, explains everything in detail and better than I can lol.

In all honesty, I was concerned about IM injection damage too after a year of TRT - however, there are things you can do to mitigate this. You can inject in your inner and outer quads, delts, and buttocks. That gives you a minimum of 8 spots (more if you move around a bit in each area) so you are spacing the injections out. Using a smaller needle helps as well - no reason to be using a 1.5" lawn dart to hit the quads or delts when a smaller gauge 1.0" will work. In reality, most guys here (including me) have moved to SQ injections with an insulin syringe. There is zero damage going this route, and since the volumes are small there is no issue using the insulin syringes. I actually feel a little better since going to SQ - supposedly the absorption rate is more even. I noticed that my total T went down, but free T stayed the same.

Also - if you are worried about fertility, get on hcg pronto. T WILL shut you down, the hcg will keep your boys working. It will also help with pregnolone (?) production - your boys are the primary producers of this hormone. You’ll also still get some T production out of them (if they are indeed still producing). Plus, it’ll keep you from having raisinettes for nads, which looks kinda messed up. Most guys also report a better sense of “well being” with the addition of hcg, possibly related to the pregnolone or other hormone production we don’t really know about.

One last thing - if you aren’t on an AI, you need to be. It won’t be long before your E2 levels get elevated, and that is not what you want. Bloat, irritability, ED, all sorts of nastiness. You may have trouble getting that prescribed from your GP, but there are research chem alternatives.

[quote]KSman wrote:
Please read the advice for new guys and protocol for injections stickies: - fertility addressed there too.

You can inject SC with insulin needle and then there is zero muscle damage.

Injecting twice a week is producing hormone peaks that can only make things worse. Try the recommendations here and see how your body responds. This will take time to see benefits as acne involves a lot of tissue damage.[/quote]

KSman meant once every two weeks.

[quote]seekonk wrote:

[quote]Volfan4life87 wrote:
In reality, I believe it was a series of events that resulted in my T disappearing. I have Crohn’s Disease (autoimmune disorder - or so they believe) and I take remicade. It’s a relatively new medicine and my GP believes that this medication may be causing my low T, in conjunction with some of the “life events” that happened to me. My dad died, sister died, all of my grandparents died, I got sick with Crohn’s and then after a long bumpy road, my gf of 3 years left me. Needless to say I’ve dealt with a lot, but the gf leaving was the final blow. [/quote]

I’m sorry to hear that. I have a similar story, except in my case it was ankylosing spondylitis, not Chrohn’s, and a 10 year relationship ending.

I am on Enbrel, a biological in the same class as Remicade, also a TNF blocker. I have done a lot of research on this class of drugs and no, there is absolutely no reason Remicade should negatively influence T, no evidence for it, and no possible known mechanism for it. If anything, I should think it may increase T by reducing systemic inflammation.

One class of drugs that is notorious for reducing T, though, are opioid painkillers. Did you perhaps take any painkillers during the time your T plummeted? There are also other drugs that can reduce T, some that are used for autoimmune diseases, such as methotrexate, and even some sleep medications, so I would look carefully into all the drugs you may have been on. It is also quite possible the Chrohn’s itself may have caused low T if it wasn’t well controlled at the time you are talking about.
[/quote]

Oh I completely agree, I was just stating what my GP believes. I’m completely of the opinion that the “life events” I’ve incurred were just too much on my system. I lost all the loved ones I mentioned and then became permanently ill, which crushed my dreams of being a career military officer. I think got a gf who completely changed my life - she was the light at the end of the tunnel. My condition improved and soon I put back on all the muscle weight I had lost. When she left it was like my body was just done. My will kept me going on obviously but it’s like physically my body had thrown in the towel.

Anyways, I have taken pain killers but in very moderate amounts for occasional surgical procedures; never longer than a few weeks and even then I typically don’t take them as I have a very high pain threshold. The only medication I take for Crohn’s is remicade. For the first year or two I also took Imuran, but haven’t taken that medicine in many years.

During the time my T plummeted I was taking remicade and sinus medication, that’s it. I truly believe it was all brought on by emotional stress but after 3 years of my T never recovering, I do feel it was permanent. I’d had all I could take, I guess.

I would seriously advise you against making changes to your regimen based on internet avice if you feel good. If you feel fine injecting twice a month, I woul just continue like that. Lots of people will say, based on broscience, that you cannot possibly do that, but how you feel is the most important.

Have you been to a good dermatologist for the acne or just your GP? There are several other possible therapies besides the doxy and the accutane that you don’t appear to have tried.

seekonk,

We are merely suggesting that changing his protocol to a more frequent one would prevent the rise and fall of T, and by proxy, E2. At his current regimen, he is boosting his levels to supra-physiological levels, which WILL increase his E2. By injecting more frequently, he would prevent this two week roller coaster. The body thrives on regularity, which there is none on his current protocol.

The math is much more complicated than this, but here is the dumbed down version.

Testosterone Cypionate has a half-life of about 7 days.

Day 1: 250mg Test Cyp

Day 7: 125mg Test Cyp left

Day 14: 62.5mg Test Cyp left

Day 14 (Cont.): 250mg Test Cyp

Etc.

This entire time his E2 is going up and down with the amount of testosterone in his body. This is not bro-science. That would be in the off-topic section of T Nation.