Anyone else dealing with hormonal acne WELL INTO hrt?

I was in the exact same boat - cystic acne in my teens that only evolved as I got older and went on HRT. Nothing topical ever cleared my skin fully, so last year I bit the bullet on Accutane and I couldn’t be happier with the results! I’ve been off it for about three or four months now and my skin has never been so clear. Accutane really isn’t as scary as it seems. I was afraid to start it because I’d heard horror stories but I felt the side effects were very manageable (YMMV of course). I would at least ask your dermatologist/doctor about it when you can because they would be the best person to determine whether you’d be a good candidate for it or not based on the health history you described.

I don't have any advice on treating the acne, but I live with 2 cis men who are in their 30's and they continually have acne. Sometimes it's bad, sometimes it's not.

I know that having bad acne isn't fun. I hope you can find something to treat it.

Oh man, I feel for you. I had horrible acne for probably the first 3yrs on T, then pretty bad acne for the next 3yrs and it really cleared up this last year #6. So I think there’s still hope!

I did see a derm and she suggested that it could be partly diet related. I did several very strict (3-4 weeks each) separate elimination diets of certain foods that can be irritating to the system and fortunately (or not so fortunately) quitting dairy helped significantly. It was not perfect, I still had breakouts, but it helped a lot and I would do it again in a heartbeat. Now it’s been about 4yrs dairy free and I’m so used to it now, I really only miss pizza sometimes, haha. You have to fully fully quit though. The only dairy I have is milk baked into bakery products and sometimes butter (very low milk proteins in butter). I check all packaging and ask at every restaurant. It has just been so worth it to me, I am fine with the extra effort. I was willing to do anything, I was so bothered by the acne.

I will also add that hydration does help a lot too. I stopped using all kinds of medicated creams and stuff and just did gentle soap washing. I still change my pillowcase every night, use a clean towel every day and I put acne patches on zits if I pop them (tho you shouldn’t) to absorb the bacteria and not have it spread to surrounding skin.

I have so so much compassion for you, it sucks soo much! Look at your diet!

Hey, pal. I'm in my late 40's dealing with it too. Ha ha. Yeah, about 4 years in and still... Doctor said he could try me on acutane for a couple months and it should end it, but it's so weird to me because it comes and goes. Nothing for a month, and then my whole face seems to erupt at once. I keep thinking it will stop, but it doesn't.

I took accutane pre-T for persistent cystic acne through my 20s (diagnosed hormonal, and they offered me spiro, but it's an androgen blocker so I said no), and it did what it was supposed to do. When I started T I got some breakouts and still deal with adult acne, but it's nowhere near what it was before accutane.

Accutane is very safe. I was on it for over a year (with regular blood tests) and would absolutely do it again. I have a history of depression but I didn’t relapse with it. Now I maintain my skin with tazorac.

do you have insurance? i’ve been on everything you’ve tried and the only thing so far that worked for me is this new one called twyneo. if you have insurance, you can run it and then they have a manufacturers coupon. i think i paid $20 maybe?

there’s also versions of spiro (pills that they give cis women for acne/also trans women) but the oral kind is a dht blocker. the topical kind however is relatively new and works really well for some people. it didn’t for me, but worth looking into bc it does for a lot. called winlevi. made for cis men, so safe for us too.

also re tret, have you tried sandwiching it? putting lotion on, waiting a few minutes, then tret, then lotion. i only started to see results with 0.1% didn’t get anything with the 0.025 or 0.05

I’ve also tried the BP/clindamycin/tretinoin and also using CeraVe products. I’m having some luck with an added oral antibiotic (I’m taking Seysara which is expensive, but there are other less expensive options). I just started topical spiro and it’s not covered by my insurance but my derm is sending it to a compounding pharmacy so I can afford it. A good doctor or derm can help you navigate costs. Hibiclens has also been somewhat effective for body acne for me, you just can’t put it on your face.

Yep, not nearly as bad as it used to be though. What are your T levels at? Mine were around 1000 when I was having the bad issues and I've lowered my dose quite a bit and now I usually have 1-3 noticeable zits at a time.

I’m only nearly a year and a half on T, but the hormonal acne hit pretty hard for me within the first few months of starting T. It took a big hit to my confidence and after trying lots of different skincare I realized I needed some prescription strength stuff and medical advice. I found this service called Nurx, they do lots of medical telehealth type stuff but a big part of what they do is helping folks deal with acne.

You basically take a bunch of pics and put in some info about your acne and they assign you a dermatologist who then reviews your info and creates a plan for you - including cleansers and such you can get over the counter and prescribed acne meds. I’ve been on a cycle of clindamycin and Tretenoin for about 8 months and my acne finally started clearing up a few months ago. They can also prescribe you acne meds in pill form, but that’s not something that was in my specific plan so I don’t have experience with that. You can ask as many questions as you want to your dermatologist as well.

I think there was an initial fee to start and then you pay for the prescriptions. But it’s pretty cheap in my experience about $30 for both prescriptions and they are mailed directly to my house every few months. Just as a disclaimer - I did have to put in my gender assigned at birth in the initial paperwork, and you do have to disclose what medications you are on as well (so I had to put that I was on T). Just a head’s up on that.

I’ve had a good experience with it, I can answer any questions you have about it based on my experience.

I've been on T for about 2 and a half years and I'm still dealing with cystic acne, I've had it since I hit first puberty and it calmed down as an adult, but since starting hrt it's been a free for all on my face and jawline particularly. I went to a dermatologist with the intent to do anything but accutane because I also do not like the potential side effects and possible liver damage.

I was put on a low dose oral antibiotic (doxycycline) and told to use certain Cerave products, and it worked! But I also didn't want to be on long term antibiotics so when I got off that, some of the acne returned, but not as full force as it had been previously.

So now my routine is in the morning, wash my face with the Cerave for normal to oily skin cleanser, Dr Thayers toner (unscented), Cerave Daily moisturizer with spf. Then at night in the shower I use the Cerave with benzoyl peroxide (it can bleach fabric so I use it in the shower so it gets rinsed off completely), out of the shower I use tretinoin only a couple of times a week since my skin is very sensitive to it, in between that I'll use Dapsone gel (generic for Aczone) and it's much gentler on my skin, and I'll top it off with the Cerave nighttime moisturizer. I try to keep my facial hair visible but shorter to lessen to oiliness on my face and I do my best to not touch my face as much.

If you're supplementing vitamin B12 (or a multivitamin that contains it), consider stopping it, at least temporarily. I found out last year that that's what was causing my cystic acne miseries.

I'm also immunosuppressed bc of meds I take for a chronic illness, so the cysts that formed, even if they never surfaced or became visible, would hurt in place under the skin for MONTHS before they'd finally resolve -- in the meantime of course, new ones would have formed. UGGH.

I was looking at the oral stuff (Accutane, etc) before I figured it out and was 100% ready to go that route. The efficacy/safety/satisfaction ratio seems to balance out fine, especially the older one gets.

Topical spiro and easing your way into tret. Start with a mild retinol, then differin, then 0.25% tret, etc. also, really make sure your cleanser and moisturizer agree with you. They should not burn or make your skin feel tight.

My routine is water only wash in the morning, then sunscreen. I prefer Asian sunscreens, US sunscreens use old filters that don’t provide as much protection. Current fave is Anessa.

PM is removing sunscreen with squalene and a cotton round, then washing face with a gentle cleanser like Bioderma micellar gel cleanser of LRP hydrating cleanser. Then I will do a few different things, kind of alternating between them.

Some days I use The Ordinary Glycolic Acid. Still on the fence about this one.

Then Bioderma hyaluronic serum.

Other days I use Apostrophe spiro/.25 tret.

Then a moisturizer. I like Bioderma products but they’ve discontinued my favorites. TheAveeno oatmeal one is good too. Then, an occlusive like aquaphor.

I went thru a LOT of products to find ones that didn’t burn my skin.

I've been on T for 6 years this month, and cystic acne has been my bane. I've finally cleared up my skin through using multiple retinol products and some dietary supplements.

I start with a cleanser, right now it's Banila Clean It Zero foam cleanser, which uses fruit acids to clear pores. This is a variable, I can use most any cleanser that isn't too stripping, no Clean and Clear or anything for teenage acne. Those are too harsh for my skin, and too harsh for anyone over 20, I think.

Then, toner. I swear by Paula's Choice Skin Perfecting 2% BHA Liquid Exfoliant. This is my holy grail. It's intense and I had to build up to using it daily, now morning and night. It's about $30 a bottle and I get 6 weeks out of one. This product saved my skin.

Then, a thin layer of Paula's Choice Skin Perfecting 8% AHA Gel Exfoliant. This I can skip if I've gotten too much sun or I've shaved (do not apply after a wet shave, dear Lord). It goes for around $30 a bottle, and the current one I'm using has lasted 4 months thus far.

Lastly, I apply moisturiser. I prefer I Dew Care's Chill Kitten moisturiser, it's oil free and soothing. If it's daytime, add some sun cream, because retinols make for sun-sensitive skin and I live in the Deep South. Sun cream and hats are necessary. I add in bronzer, too, because I get no tan anymore.

I also drink a goodly dose of chlorophyll in my daily water to combat inflammation and keep hydrated. It is the Deep South. I can tell when I don't have it, the acne on my back is infinitely worse. It sounds woo, but it's minty and makes water green, and I've consumed worse stuff that's done less, but your mileage may vary.

I don't have to do a lot of additional treatments unless I've had to wear a mask all day or some such. I either use some masks from I Dew Care or a Zinc one from The Ordinary, but those vary depending on what's going on.

It's not cheap. But being unable to access a dermatologist, this is what I've found that works for my cystic acne. I also switched to Turkish towels and silk pillowcases, which have been kinder to my skin. I'm still finding the right shaving products, though aftershave with willow bark has done me well thus far. But those are the big changes I made.

It's probably your diet. Do you eat dairy, meat, fried foods, excess salt, and/or added sugar?

I've had shitty skin since I was 10. Once I started watching what I eat my skin improved dramatically. I haven't experienced any acne since starting T. I don't use any sort of special face wash, serums, lotions, etc. I use a gentle, non scented body wash and lotion. I usually wash my face once a day but sometimes I don't even bother with that. I now only start getting pimples if I don't wash my face for days.