Acne in Transmasculine Patients

Importance Compounded with barriers to care, stigmatization, lack of trust, and high rates of psychiatric comorbidities, transmasculine patients face a high psychosocial burden from acne. Acne is a common sequela of masculinizing hormone therapy, and understanding its epidemiology may improve care for transmasculine patients. Objective To summarize current literature regarding prevalence and factors associated with acne in transmasculine patients. Evidence Review A search was performed using Ovid MEDLINE, Web of Science, Scopus, CINAHL, ProQuest Dissertations & Theses, Scientific Electronic Library Online, Cochrane Library, and Global Index Medicus. Studies were included if they reported acne prevalence, severity, or treatment among 1 or more transmasculine patients. Findings Of 429 references identified by search terms, 38 met inclusion criteria. There were 12 010 patients across all studies, with 32 of the 38 articles focusing on transmasculine adults rather than adolescents. Methods of acne quantification varied among included studies. Studies using systematic grading scales reported an acne rate of 61.9% (223 of 360 patients) compared to 29.6% (1233 of 4163 patients) among retrospective reviews and 31.3% (892 of 2847 patients) among studies using self-reported data. Most studies showed the largest increase in acne prevalence at 6 to 12 months after masculinizing hormone therapy initiation. There was an association between younger age and increased acne but no meaningful associations between testosterone dosage nor route of administration. Conclusions and Relevance In this scoping review, acne prevalence among transmasculine patients ranged from 29.6% to 61.9%, depending on methodology. Acne commonly developed within 6 to 24 months after testosterone initiation but occurred as early as the first month. Younger age at hormone initiation was associated with acne development, whereas dose and route of administration were not, suggesting that other factors in addition to exogenous testosterone play a role in the pathogenesis of acne for transmasculine patients.