Body Acne -- Caused by DHT or E2?

[captain_j]

I've been dealing with horrible acne all over my chest, shoulders, and back for about 4 months now. I started TRT back in October of last year (2019), but it took a while for the acne to develop.

Everywhere I look, I get conflicting reports on what causes body acne in men on TRT. Half the time I hear that it's DHT, and the other half of the time, I hear that it's caused by high estrogen.

Some methods I have tried to crush the acne have been a 30 day run of doxycycline, daily use of Fabior foaming retinol cream, showering twice a day, introducing an AI to lower my estrogen since my physician believes that my E2 level of 55 was the cause of acne, etc. My physician is also hesitant to introduce finasteride to lower DHT at the moment, since it would further complicate the protocol. But I am getting to a point where I am desperate to find relief. I have a trip to the beach at the beginning of August, and I already know there's no way it'll be cleared up by then.

The physician also mentioned that while we didn't test for SHBG, he noticed my ratio of free testosterone to total testosterone is pretty high, which is a sign of low SHBG. He said that in guys with low SHBG, they'll notice a similar ratio with their E2, meaning that my total E2 was tested at 55, but my free E2 would also be proportionally above range just like the free test.

Does anyone know the real truth as to what causes body acne? Could it really be that it's E2 in some guys, and DHT in others? Or are half of the people wrong when they say it's one of those over the other? I will say that lowering my E2 so far has not seemed to provide much improvement in the acne, so I'm about ready to go against my physician and start running finasteride (I have some left over from an old script).

My protocol:
20 mg test cyp daily
2 mg exemestane daily (vodka solution microdose)
140 IU HCG EOD

Latest Labs 2020-6-5 (taken before I went back on an AI):
Estradiol Ultrasensitive -- 55 pg/mL (<29)
Testosterone, Total, MS -- 1140 ng/dL (250-1100)
Testosterone, Free -- 275.9 pg/mL (35-155)
DHT, LC/MS/MS -- 47 ng/dL. (12-65)

 

[fifty]

Could it be that your FreeT is nearly double the top range?

Finasteride for this is highly questionable.

Less sh*t. Not more.

 

[captain_j]

Could be? But that would now be another theory to throw into the pot. I haven't heard anywhere else that the testosterone itself causes acne. Just DHT or estradiol.

 

[fifty]

The body of knowledge on hormone replacement isn’t exactly complete.

 

[lemonflavor]

I think it's safe to say that testosterone is the main cause. E2 and DHT would be way down the list, pertaining to some people. As far as treating it, there are threads here of things to try, but seeing a dermatologist, or at least GP would be a good next step since it's so bad.

 

[TorontoTRT]

Neither your E2 or DHT is high. The more shit you add into the mix the more you complicate things. Just inject testosterone and don’t add anything else. No AI. Don’t even think about finasteride. Just take test alone and let your body balance out. I get bouts of acne and I figured out why. I have a soft spot for ice cream. Every time I indulge in ice cream for a few days straight I get acne. And I’m not even lactose intolerant. Drink pomegranate juice and take 3000 mg a day of CDG. Calcium d-glucarate.

 

[DS3]

I've been dealing with horrible acne all over my chest, shoulders, and back for about 4 months now. I started TRT back in October of last year (2019), but it took a while for the acne to develop.

Everywhere I look, I get conflicting reports on what causes body acne in men on TRT. Half the time I hear that it's DHT, and the other half of the time, I hear that it's caused by high estrogen.

Some methods I have tried to crush the acne have been a 30 day run of doxycycline, daily use of Fabior foaming retinol cream, showering twice a day, introducing an AI to lower my estrogen since my physician believes that my E2 level of 55 was the cause of acne, etc. My physician is also hesitant to introduce finasteride to lower DHT at the moment, since it would further complicate the protocol. But I am getting to a point where I am desperate to find relief. I have a trip to the beach at the beginning of August, and I already know there's no way it'll be cleared up by then.

The physician also mentioned that while we didn't test for SHBG, he noticed my ratio of free testosterone to total testosterone is pretty high, which is a sign of low SHBG. He said that in guys with low SHBG, they'll notice a similar ratio with their E2, meaning that my total E2 was tested at 55, but my free E2 would also be proportionally above range just like the free test.

Does anyone know the real truth as to what causes body acne? Could it really be that it's E2 in some guys, and DHT in others? Or are half of the people wrong when they say it's one of those over the other? I will say that lowering my E2 so far has not seemed to provide much improvement in the acne, so I'm about ready to go against my physician and start running finasteride (I have some left over from an old script).

My protocol:
20 mg test cyp daily
2 mg exemestane daily (vodka solution microdose)
140 IU HCG EOD

Latest Labs 2020-6-5 (taken before I went back on an AI):
Estradiol Ultrasensitive -- 55 pg/mL (<29)
Testosterone, Total, MS -- 1140 ng/dL (250-1100)
Testosterone, Free -- 275.9 pg/mL (35-155)
DHT, LC/MS/MS -- 47 ng/dL. (12-65)

Your TT is pretty high and you Free T is very high. This are not necessarily bad. However, I have to ask the question...have you tried to lower the dosage of T to say 15 mg EOD and see if you acne resolves? DHT in your assay isn’t remarkable nor is your E2.

 

[ajax31]

The first thing I would do if I were you is to try a low carb diet. In particular, avoid insulinogenic foods such as milk, soft drinks, whey protein, white flour, etc.

I don't have anything to add to the testosterone/dht vs. estrogen debate. No one has ever been able to adequately explain why some men never get acne in spite of running high total and free T. Or even on steroids. All arguments boil down to "it's genetics."

My adult acne disappeared after I began donating platelets at the blood bank's request. I started out as a whole blood donor to keep my hemoglobin in a healthy range. Even though platelets aren't the root cause of acne, they are involved in the inflammatory process. All I can say is that my skin cleared after I began donating platelets and has remained free from acne and blemishes ever since.

Conclusion. Platelet counts and mean platelet volume significantly decreased following isotretinoin [Accutane] treatment. Since the decrease of platelet counts and the mean platelet volume was seen concomitantly, it is concluded that the effect of isotretinoin was through the suppression of bone marrow.

Effects of Isotretinoin on the Platelet Counts and the Mean Platelet Volume in Patients with Acne Vulgaris

<i>Aim</i>. The aim of this study was to evaluate the platelet counts and the mean platelet volume in patients who received isotretinoin for the treatment of acne vulgaris. <i>Method</i>. A total of 110 patients were included in this retrospective study. Complete blood count parameters were...

www.hindawi.com

 

[DS3]

The first thing I would do if I were you is to try a low carb diet. In particular, avoid insulinogenic foods such as milk, soft drinks, whey protein, white flour, etc.

I don't have anything to add to the testosterone/dht vs. estrogen debate. No one has ever been able to adequately explain why some men never get acne in spite of running high total and free T. Or even on steroids. All arguments boil down to "it's genetics."

My adult acne disappeared after I began donating platelets at the blood bank's request. I started out as a whole blood donor to keep my hemoglobin in a healthy range. Even though platelets aren't the root cause of acne, they are involved in the inflammatory process. All I can say is that my skin cleared after I began donating platelets and has remained free from acne and blemishes ever since.

Conclusion. Platelet counts and mean platelet volume significantly decreased following isotretinoin [Accutane] treatment. Since the decrease of platelet counts and the mean platelet volume was seen concomitantly, it is concluded that the effect of isotretinoin was through the suppression of bone marrow.

Effects of Isotretinoin on the Platelet Counts and the Mean Platelet Volume in Patients with Acne Vulgaris

<i>Aim</i>. The aim of this study was to evaluate the platelet counts and the mean platelet volume in patients who received isotretinoin for the treatment of acne vulgaris. <i>Method</i>. A total of 110 patients were included in this retrospective study. Complete blood count parameters were...

www.hindawi.com

If his diet hasn’t changed since starting TRT and the only changed variable is the addition of Test, HCG, and Adex, he would logically look to modify those variables before dabbling in dietary modifications or platelet donations.

 

[captain_j]

I think it's safe to say that testosterone is the main cause. E2 and DHT would be way down the list, pertaining to some people. As far as treating it, there are threads here of things to try, but seeing a dermatologist, or at least GP would be a good next step since it's so bad.

I actually am already seeing a dermatologist. They have me on Fabior foaming retinol cream once daily, and I'm about 32 days into a 60 day doxycycline regiment. The doxy doesn't seem to of had much of an effect on my body acne, but it did clear my face up really well (I only had very slight acne on my face, nothing to really worry about).

Neither your E2 or DHT is high. The more shit you add into the mix the more you complicate things. Just inject testosterone and don’t add anything else. No AI. Don’t even think about finasteride. Just take test alone and let your body balance out. I get bouts of acne and I figured out why. I have a soft spot for ice cream. Every time I indulge in ice cream for a few days straight I get acne. And I’m not even lactose intolerant. Drink pomegranate juice and take 3000 mg a day of CDG. Calcium d-glucarate.

I've decided against the finasteride for now, since I do agree with you and others that it would only complicate things now. I'm also cutting out whey protein to see if that gives an improvement. Is there evidence online that shows pomegranate juice and CDG will help body acne? If I'm trying to reduce insulin spikes (since others have suggested this could cause acne), then a sugary fruit juice may not be the best thing.

Your TT is pretty high and you Free T is very high. This are not necessarily bad. However, I have to ask the question...have you tried to lower the dosage of T to say 15 mg EOD and see if you acne resolves? DHT in your assay isn’t remarkable nor is your E2.

I am currently considering lowering my daily dose from 20 mg down to 18 mg, and sticking there for about 2 weeks to let my body adjust. See how that goes, and if I need to, drop down to 16 mg for 2 weeks, reassess, etc. I've lowered my dose in the past, and I remember it kinda sucked for a while when my body was adjusting.

The first thing I would do if I were you is to try a low carb diet. In particular, avoid insulinogenic foods such as milk, soft drinks, whey protein, white flour, etc.

...

My adult acne disappeared after I began donating platelets at the blood bank's request. I started out as a whole blood donor to keep my hemoglobin in a healthy range. Even though platelets aren't the root cause of acne, they are involved in the inflammatory process. All I can say is that my skin cleared after I began donating platelets and has remained free from acne and blemishes ever since.

I think I can handle reducing carbs by upping protein and fat, but not sure I'd go complete "low carb" right away. But I am definitely going to be cutting out most sugars, even fruits. I already don't eat a lot of sugar, but I'd like to reduce even further.

If his diet hasn’t changed since starting TRT and the only changed variable is the addition of Test, HCG, and Adex, he would logically look to modify those variables before dabbling in dietary modifications or platelet donations.

I agree, I don't think I want to make drastic diet changes at the moment. I'd rather be able to stick to a regular, balanced diet, and change the protocol to reduce side effects. As I said above, I'm considering gradually dropping my daily test dose, and I've even considered dropping HCG temporarily. But I do notice greater sensitivity and orgasms when I'm running HCG, so it sucks to have to give that up.

 

[DS3]

I actually am already seeing a dermatologist. They have me on Fabior foaming retinol cream once daily, and I'm about 32 days into a 60 day doxycycline regiment. The doxy doesn't seem to of had much of an effect on my body acne, but it did clear my face up really well (I only had very slight acne on my face, nothing to really worry about).



I've decided against the finasteride for now, since I do agree with you and others that it would only complicate things now. I'm also cutting out whey protein to see if that gives an improvement. Is there evidence online that shows pomegranate juice and CDG will help body acne? If I'm trying to reduce insulin spikes (since others have suggested this could cause acne), then a sugary fruit juice may not be the best thing.



I am currently considering lowering my daily dose from 20 mg down to 18 mg, and sticking there for about 2 weeks to let my body adjust. See how that goes, and if I need to, drop down to 16 mg for 2 weeks, reassess, etc. I've lowered my dose in the past, and I remember it kinda sucked for a while when my body was adjusting.



I think I can handle reducing carbs by upping protein and fat, but not sure I'd go complete "low carb" right away. But I am definitely going to be cutting out most sugars, even fruits. I already don't eat a lot of sugar, but I'd like to reduce even further.



I agree, I don't think I want to make drastic diet changes at the moment. I'd rather be able to stick to a regular, balanced diet, and change the protocol to reduce side effects. As I said above, I'm considering gradually dropping my daily test dose, and I've even considered dropping HCG temporarily. But I do notice greater sensitivity and orgasms when I'm running HCG, so it sucks to have to give that up.

Same here with the HCG. Much deeper orgasms and penile sensitivity but it does have some side effects in me that I don’t like.

 

[sokaiya]

I love how people go back and forth, "it's dairy" "it's testosterone" "it's E2" blah blah blah. The bottom line is that it's GENETIC. End of story. You want to fix it? Get on Accutane. You won't regret it.

 

[ajax31]

I love how people go back and forth, "it's dairy" "it's testosterone" "it's E2" blah blah blah. The bottom line is that it's GENETIC. End of story. You want to fix it? Get on Accutane. You won't regret it.

This is a dumb statement. If "it's GENETIC," then what's the underlying cause? No answer, just it's genetic.

I had severe cystic acne as a teen and took the maximum dosage of Accutane that caused severely elevated liver enzymes. That was two decades ago and I still had adult acne up until recently when I began donating platelets. The people in this thread don't seem to be interested in learning anything new. Go read the study I linked - one of Accutane's modes of action is to reduce platelet count by bone marrow suppression.

If the OP doesn't care about the wider picture or learning anything new, then just cut his T dose in half, inject every day, and eat a low carb diet to prevent insulin spikes.

BTW, among over things, insulin increases 5-alpha-reductase in tissue. It's a double whammy because not only are you getting more DHT, but it's being generated in the tissues where it can create the most havoc - male pattern baldness, acne, etc. The more insulin sensitive you are, the less problems you're going to have on TRT.

 

[sokaiya]

I love how people go back and forth, "it's dairy" "it's testosterone" "it's E2" blah blah blah. The bottom line is that it's GENETIC. End of story. You want to fix it? Get on Accutane. You won't regret it.

again it's genetic. It's about your sebaceous glands more than anything. It's quite stupid to pin it on dairy, this or that. If it were a high platelet count or whatever you are suggesting then everyone with that would have acne and they don't. And they don't have acne because once again it's genetic.

It's like saying, testosterone makes your hair fallout. Whey protein and creatine makes your hair fallout. NO, it's genetic. If you have a genetic predisposition to lose hair, then guess what? You are going to lose hair.

 

[captain_j]

I had severe cystic acne as a teen and took the maximum dosage of Accutane that caused severely elevated liver enzymes. That was two decades ago and I still had adult acne up until recently when I began donating platelets. The people in this thread don't seem to be interested in learning anything new. Go read the study I linked - one of Accutane's modes of action is to reduce platelet count by bone marrow suppression.

I actually donated blood a few weeks ago. Does that cause you to lose as much platelets as doing a targeted platelet donation?

 

[ajax31]

I actually donated blood a few weeks ago. Does that cause you to lose as much platelets as doing a targeted platelet donation?

They typically take 3 units of platelets during an apheresis session. It would take 5 whole blood donations to add up to one unit of platelets so the answer is no.

I donated whole blood 30 times and never saw any improvement in my skin until I started doing triple platelet donations. The only downside is that it takes two hours, but you can usually go in on Sunday and take your computer/tablet/phone and just chill.

 

[Stylo]

Alcohol and diet. If you don’t fix that... you will keep chasing cures.

 

[Ironhead]

I stopped HCG and take 1/2 tb of arimidex per week, acne cleared up! of course we're all different! Test cyp. 140 mg per week.

 

[Nelson Vergel]

I've been dealing with horrible acne all over my chest, shoulders, and back for about 4 months now. I started TRT back in October of last year (2019), but it took a while for the acne to develop.

Post a picture. What people call acne is usually folliculitis.

 

[Nelson Vergel]

Folliculitis pictures

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www.excelmale.com

TRT and Anabolic Steroid Side Effect Management Table

It is suggested that you talk to your physician about the need for proper blood tests before and during testosterone. Read this first since it is the most common testosterone side effect: High hematocrit Problem Solution and Comments Acne/oily skin Caused by Dihydrotestosterone (DHT)...

www.excelmale.com

Testosterone and Acne: What You Need to Know

Testosterone replacement therapy (TRT) is the prescribed treatment for men with low testosterone levels. It has become a widespread treatment--as many as 11 million men were undergoing TRT in 2013, a number that has grown significantly since. However, as with any treatment, there are a few...

www.testosteronewisdom.com

Anyone tried Sulfur Soap?

I use zinc soap for any acne I get and I'm very happy with the results. But another problem I have not related to TRT, is rosacea. I've read that sulfur soap, helps get rid of both acne and rosacea. ... I bought a bar of Sulphur Soap - Premium 10% Sulfur Advanced Wash. Hoping it will help.

www.excelmale.com

Anyone have a good solution for back acne?

Try using Nizoral shampoo with a scrub brush on your back. This is what Nelson had recommended.

www.excelmale.com