Can HRT cause acne, and what helps?

Acne after starting menopause HRT

Acne is a recognised side effect of progestogen, including the progestogen part of combined HRT. Testosterone prescribed for menopause can also cause acne, although this side effect is not common. Menopause itself can contribute to hormonal acne, so a breakout after starting HRT does not automatically mean the prescription caused it.125

Progestogen side effects usually settle after a few weeks. If side effects are mild, continuing menopause HRT for at least 3 months gives them time to improve. Speak to your GP sooner for severe side effects, or if they continue beyond 3 months. Your GP can review the dose, hormone type or way you take HRT.1

Do not remove the progestogen from your prescription yourself. If you still have a womb and use systemic oestrogen, such as tablets, patches, gel or spray, progestogen helps protect against womb cancer. Low dose vaginal oestrogen is different and can be used without progestogen.2

Acne during gender affirming testosterone

Testosterone increases sebum, the oil your skin produces, and can increase inflammation. Breakouts often affect the lower face, chest, upper arms and back. They can begin within months of starting testosterone and often appear within the first 2 years. Not everyone develops acne, but it can persist rather than simply settle as your body adjusts.3

A dermatologist can treat acne while you continue testosterone at your prescribed dose. Reducing the dose does not necessarily clear acne, and changing it without medical guidance can interfere with your gender affirmation goals. Tell your dermatologist about planned surgery because it can affect the acne treatment plan.3

What can you do for mild breakouts?

1. 1Wash gently with a mild, nondrying cleanser once or twice daily, including after exercise. Remove makeup before bed.
2. 2Choose water based or noncomedogenic cosmetics and skin creams. Noncomedogenic means formulated and tested to avoid clogging pores in most people.
3. 3For mild acne, consider an acne product containing adapalene, benzoyl peroxide or salicylic acid. Follow its directions carefully and apply sparingly.
4. 4Avoid scrubbing, repeated washing and picking pimples. Picking can slow healing and cause scarring.

A cleanser's job is gentle cleaning, not making the bathroom sound like a military operation.6

Water based or noncomedogenic formulas are useful shopping criteria, unlike a product name that appears to have hired its own publicity department.6

Acne products can cause redness, dryness or excessive peeling. Benzoyl peroxide can also bleach towels and clothing. If you are pregnant or could become pregnant, discuss treatment with your clinician before choosing an acne medicine; topical retinoids and isotretinoin should be avoided during pregnancy.56

How long should you wait, and when should you get help?

Expect improvement over weeks, not days: hormonal acne treatment can take 4 to 6 weeks to show improvement, while acne treatment responses can take 6 to 8 weeks. Testosterone related acne sometimes needs longer ongoing treatment. The 3 month menopause HRT review is not a reason to leave painful or worsening acne untreated.356

See a clinician for deep painful lumps, cysts, worsening acne, scarring or emotional distress. Also seek help if pharmacy treatment has not helped after several months. Prescription options include topical medicines, antibiotics and, for severe acne, isotretinoin with close monitoring. Treatment should fit your hormone therapy, acne severity and pregnancy potential.456