Mitigating Acne Issues on TRT
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Mitigating Acne Issues on TRT
Solutions from Your Friendly Neighborhood Biohackers!
Disclaimer: I am not a doctor, just a cartoon deer on the internet with a background in chemistry and a hyperfixation on skin. This is not medical advice.
This post was originally written for @BowTiedOx’s newsletter on fitness, Strong as an Ox.
Today, I’ve teamed up with @BowTiedUM and @BowTiedLoon to talk about acne and TRT. We’ll review the two causes of acne on TRT (hormonal fluctuations and high androgens) and how to mitigate them. Let’s discuss!
Hormonal Fluctuations:
Some doctors have patients injecting once a week (or worse, once every 2 weeks). Infrequent injections are disastrous as the active half life of testosterone cypionate active is ~5.5 days. This means that on Day 1, you have a huge unnatural spike in testosterone, and by the end of the week, you have less than half of that testosterone in your body. This causes two problems:
Testosterone levels fluctuating will cause acne
The body has too much testosterone on Day 1 and 2, so it converts it to estrogen and DHT as a mechanism of homeostasis. The extreme fluctuation of DHT and estradiol are even more troublesome for acne!
Thankfully, the solution is relatively simple. Either:
Split the dosage in half and inject twice a week
Split the dosage into thirds and inject every other day
High Androgens
Let’s say you had acne as a teen when your testosterone was the highest, and the acne subsided as you got older. Your acne went away because your sex hormones stabilized after puberty and/or your testosterone dropped as you aged. If you’re on TRT now, it’s no surprise that your acne is back. For your genetics, high androgens cause excess sebum production. You have a few options here:
Lower dose and see if that helps
Cut out dairy, sugar, and casein and lower your fat consumption
Whey and casein protein are cause acne trouble in plenty of people (myself included), especially on the trunk. You could try switching to an A2 protein, like whey made from goat milk and see if that helps
This is a good meta analysis of the role of diet and acne for those inclined to dig deeper
Check out my guides for oily skin to test if any of the topical treatment methods work for you
One other option to try could be taking oral doses of panthenoic acid. Panthenoic acid (vitamin B5) is the precursor to coenzyme A which metabolizes fatty acids. Essentially, by taking large doses of B5, we’ll downregulate sebum production. The less oil your body produces, the lower your chances of developing acne. Thus, B5 could be a solution for acne prone individuals. Make sense?
Now, UM did the following (definitely not medical advice):
5000mg (5g) B5 in the morning after breakfast
a B-complex vitamin during the day
5000mg (5g) B5 after dinner
He stacked each dosage of B5 with 1000mg (1g) of l-carnitine to potentiate (note: store l-carnitine in the fridge so it doesn’t go all fish-y on you). After his skin cleared up, he stuck to 5g B5 once daily for maintenance.
Loon did something similar as well, though his protocol was 750mg of B5 and 250mg of l-carnitine 3x per days. Some refer to this regimen as the modified Leung B5 protocol.
Consider consulting with your dermatologist if taking high dose B5 could be right for you. Again, none of this is medical advice. If you take too much, you can get temporary digestion issues (ick) or worse.
If any of these solutions work, that’s great! However, you may still have acne. In this case, your best chance of permanently resolving your acne would be to run a course of Accutane under the supervision of a licensed dermatologist. Accutane shrinks the glands that produce sebum. Unfortunately, while your acne issue will more than likely be resolved for good, Accutane can also lead to a lifetime of dry skin and other health issues.
Some people may need a second course or a low maintenance dose of 10mg 3x a week, but this is rare. In fact, UM ran his own low dose course of Accutane (again, definitely not medical advice, do not do this) because it can be effective for people with mild to severe cystic acne with minimal side effects. With this option, the risk of permanently dry skin is near zero, and UM only experienced dry lips. You may want to show the study linked above to your dermatologist and have a discussion about whether a low dose of Accutane may be right for you.
If you try the B5/l-carnitine protocol, you can continue using salicylic acid or benzoyl peroxide as active ingredients in your normal skin routine. However, if you’re running Accutane, you’re better off just opting for just a gentle cleanser with no active ingredients, moisturizer, and facial SPF in the mornings. This is because Accutane is so drying that you’ll want to be as gentle with yourself as possible otherwise.
Closing Notes:
If you try any of these protocols, be sure to take progress pictures! I’d love it if you’d share them with me via DM on Twitter as well.
Dr. Loon is a cardiologist that provides blood work interpretation services via his website. Be sure to keep him in mind!
Aaaand finally, please make sure to give my team a follow on Twitter as well! Both Loon and UM are brilliant in their respective fields, and I could not have synthesized this information without them.
That’s all for now! Happy Skincare!
Note: you can now book consultations with me! Check it out here or DM me on Twitter to book with ETH.
