BRIEF REPORT: Skin Quality for Transsexuals on Hormone Treatment

Note: Brief reports are features which highlight specific studies or small groups of studies on transgender topics. They are not intended to be given the same weighting as comprehensive reports (such as on the Transgender Brain or Quality of Life in Treated Transsexuals, q.v.) Please use caution when interpreting or drawing conclusions from the results, and never attempt any changes in your medication or health care without consulting your physician first.

Most transsexuals notice significant changes in the quality of their skin as a result of hormone therapy. For transsexual women these changes include softening, thinning, less oil production, and sometimes the appearance of sun freckles (which may become permanent). Transmen tend to notice the opposite effects, with their skin becoming tougher and more oily, and a reduction in freckles. However, there is a wide variation in results. Most changes in skin quality occur over a 1-3 year period, but it is vital that as you read these reports, you understand that your results may not align with the results which are discussed.

Transwomen

One study with good management of the test subjects and controls examined the change in skin oil production and acne affliction in transsexual women and men. There were 21 transwomen (all Caucasian, from age 20-44) who underwent an assessment of skin oil production on their forehead, nose, chin, and back, as well as a judgment of the changes in their acne affliction on their face and back. All subjects were tested before starting hormone therapy, and at 4-month intervals up to one year from the start of hormones. Over the 12-month period transwomen saw significant decreases in skin oil production, which occurred rapidly within the first 4 months on hormone therapy. Oil levels on the forehead decreased by more than 75%, by a third on their nose, by two-thirds on their chin, and nearly 100% on their back. Acne was eliminated for all subjects within 4 months, but this result cannot be considered significant due to the small number of subjects with acne. (Giltay)

Transmen

In the study by Giltay and Gooren there were 17 transmen (all white, from age 18-37) who underwent an assessment of skin oil production on their forehead, nose, chin, and back, as well as a judgment of the changes in their acne affliction on their face and back. All subjects were tested before starting hormone therapy, and at 4-month intervals up to one year from the start of hormones. Over the 12-month period transmen saw significant and gradual increases in skin oil production, with increases being the least for the chin and nose. Forehead oil production increased by about one-third, and back oil production doubled. Significant increases in acne were seen on the face and back, with almost all subjects suffering from facial acne by the end of the 12-month period. One interesting effect (which was not seen in transsexual women in the study) was a change in skin temperature, with the mean skin temperature increasing from 91.2 °F to 92.7 °F. (Giltay)

Another study examined 20 transmen who had never taken testosterone, and compared them with 50 transmen who had taken it an average of 9.9 years and undergone SRS, to focus on the skin effects of hormone therapy on both a short and long-term basis. At the start of the study 7 of the 20 pre-hormone transmen suffered from facial acne, and 3 of the 20 suffered from back acne. After just 6 months of testosterone therapy more than 80% of the transmen had facial acne, and nearly 90% had back and upper chest acne. Acne levels decreased by 12 months, but still afflicted more than half of the transmen. Acne was much lower in the 50 experienced transmen than among the group of 20 new transmen. (Wierckx)

Conclusions

Transsexual women and men on hormone therapy can expect to see significant changes in skin quality within one year of treatment. Transsexual women should notice a rapid decrease in skin oil production, and transsexual men a gradual increase in skin oil production. Transsexual men should expect to see significant increases in acne on their face and back.

Giltay, E.J. and Gooren, J.G. “Effects of Sex Steroid Deprivation/Administration on Hair Growth and Skin Sebum Production in Transsexual Males and Females” The Journal of Clinical Endocrinology & Metabolism 85.8 (2000): 2913-2921.

Wierckx, Katrien et al. “Short- and Long-Term Clinical Skin Effects of Testosterone Treatment in Trans Men” Journal of Sex Med 11 (2014): 222-229.