A large new dermatology study published in JAMA Dermatology sheds light on how acne develops in transgender individuals compared with cisgender peers, revealing important trends tied to gender-affirming hormone therapy.
Conducted by researchers at Emory University and Kaiser Permanente, the retrospective cohort study analyzed electronic health records from nearly 281,000 people, including more than 11,000 transmasculine and 9,400 transfeminine individuals. The research examined acne incidence and severity over up to five years, comparing transgender people with cisgender male and female counterparts matched by age, race, and region.
Transmasculine Individuals Face Higher Acne Risk
The study found that transmasculine individuals, those assigned female at birth who are taking testosterone, experienced significantly higher rates of acne than both cisgender men and women. Over five years, roughly 15.8 percent of transmasculine participants developed acne, compared with 3.8 percent of matched cisgender men and 10.5 percent of matched cisgender women.
Acne risk in transmasculine people was particularly elevated during the first year after starting testosterone therapy, where it was more than eight times higher than cisgender men and more than 2.5 times higher than cisgender women. While risk decreased over time, it remained elevated compared with cisgender men throughout the follow-up period.
Moderate to severe acne, defined by treatment with oral antibiotics or isotretinoin, followed similar patterns, with transmasculine individuals more likely to require clinical intervention.
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Transfeminine Individuals Also Show Elevated Acne Compared With Cisgender Men
The study also examined acne among transfeminine individuals, those assigned male at birth who are taking estradiol. While acne incidence in this group was generally lower than in transmasculine participants, it remained higher than in cisgender men and lower than in cisgender women across the five-year period.
Researchers noted that transfeminine acne risk appeared most pronounced early in hormone therapy and declined over time, suggesting hormonal stabilization may play a role.
Clinical Implications for Gender-Affirming Care
According to the study authors, these findings highlight the need for clinicians to anticipate and monitor acne in transgender patients initiating gender-affirming hormones. The first year of testosterone therapy, in particular, may require proactive dermatologic counseling and early intervention.
The authors emphasized that acne can significantly affect quality of life and mental well-being, especially for transgender individuals navigating physical changes during transition.
The Bottom Line
While the study drew on a large and diverse dataset, it did not include patient-reported outcomes, skincare routines, or details about hormone dosing. Future research may explore how different hormone regimens, acne treatments, and supportive care strategies affect long-term dermatologic outcomes.
As access to gender-affirming care continues to expand, the study provides important data to guide more responsive and inclusive dermatologic care for transgender patients.
