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).
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)
. Guy has no acne gets on t his levels are sky high and he has pimples and your going to say it's genetic ? It has nothing to do with his free t levels through the roof ? I know when my levels are high I get pimples in my scalp and on my arms. If I keep my levels in range I don't get them. Very simpleI 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.