Understanding Mental & Skin Health While Transitioning

Acne is bound tightly to mental health, influencing our confidence, self love and sociability. Growing awareness of this direct relationship has helped so many receive the care needed to treat their condition and regain a sense of self. However, for those who are undergoing hormone replacement therapy (HRT), regaining a sense of self may feel more difficult, as receiving comprehensive and informed care addressing trans health needs lags behind. Provider education around HRT and skin health is necessary today, not only because all identities deserve care but because no population should suffer silently out of fear of being mistreated and misunderstood.

For those unfamiliar with hormones here is a brief lesson:

  1. we all got em’

  2. they heavily influence our skin

  3. they heavily influence our hair (which can influence our skin)

  4. they play a key role in homeostasis (stable internal state of the body)

So, when an individual transitions and has HRT, their body’s homeostasis is greatly impacted, consequently influencing skin, hair health and appearance. Understanding this chain of effect not only offers clarity, but more importantly, a sense of urgency to become clinically and culturally informed to invite and treat individuals pursing HRT.

Some things to understand about HRT; acne most commonly appears among female-to-male persons. Similar to those assigned female-at-birth and cis-women who experience adult hormonal acne, persons transitioning from female-to-male by undergoing HRT, experience the effects of higher testosterone levels which often trigger acne. What is commonly referred to as “T-acne” (short for testosterone acne), earns its name by the hormone’s influence on our sebaceous glands, encouraging an increase in sebum (oil) production leading to clogged follicles (acne occurs in our hair follicles), which trap bacteria and cause infection.

There is no stage in life where acne is easy. The challenge though, when facing acne brought on by HRT, is the intricate way this side effect influences one’s gender confirmation journey. Severe acne may cause setbacks in certain treatments, only increasing the discomfort and sense of urgency to define oneself.

Practitioners from clinical to cosmetic, must hold each other and themselves accountable for being informed, especially when it comes to skin conditions related to hormones no matter how a person identifies. As a cis-woman, I speak only from what I have learned from conversations with friends and clients, and educational resources for practitioners offered by organizations such as the Gay and Lesbian Medical Association.

This piece is meant to initiate the conversation around acne and HRT, and to bring attention to treating individuals pursuing gender confirming treatments. As the trans community raises their voice, we as practitioners must also speak up in support, and act as allies, as we can greatly support all parts of their transition.

Resources for Providers & Practitioners

WHAT DO I NEED TO KNOW ABOUT TRANSITIONING

Tetracyclines & Acne

Understanding Topicals