Nodular acne on back out of nowhere, is it dietary or the TRT? HELP!

[Unlockable]

In 2018 I started getting crazy nodular acne on my back, this is the deep stuff that is not poppable and does not have a head on it. I had started lifting in 2017 at 34.5 and was starting to increase calories as to not be a skeleton anymore. Somewhere along the way my skin revolted, salicylic acid and benzoyl peroxoide didnt work, neither did things like head and shoulders shampoo. It took me awhile to do an elimination diet and I found peanut butter and dairy of ANY sort were a no go. This was pre TRT with lower t, free t and e2.

Mid last year I go on TRT, I got a few initial minor "normal" zits here and there, easily demolished by BP. I was doing .236ml generic Sun Pharma t cypionate from CVS in cottonseed oil on MWF for the first three weeks, had issues with it burning subq, switched to Hallandale compounded in GSO. No acne issues except occasional stray nodular if I consumed something heavy on milk, which is super rare. I decided to try Lactaid chocolate whole milk as getting enough calories to stay in a surplus is difficult, no issues for MONTHS. I did start to drink more and more as I was getting stronger and it was easy to stay in a surplus, I added in an organic dark chocolate granola, more cereal etc, tried almond butter but had to drop it as I got acne immediately but it calmed down quickly.

I ran oxandralone at 24mg for almost 10 weeks with no issues and along the way I switched to EOD dosing at .2ml subq, then switched to shallow IM, a month after coming off of the oxandralone, and 2.5 weeks after having switched back to the Sun Pharma t I had a crazy break out of 10 big painful nodular spots on back, then more would show up and it's still happening now, after breaking out January 31st. I dropped the milk immediately, but since I am bulking I am still consuming all kinds of things that could be inflammatory I suppose, but no dairy, at all, yet the zits persist. I shower 2-3 times a day, and I use hibiclens on my back, but it's not even affecting this stuff at this point.

Hallandale Subq .236ml done on injection day before injection back at end of Sept
T - 931 (264-916)
Free T - 24 (8.7-25.1)
E2 Sensitive 36 (8.0-35)
SHBG 20 (16.5-55.9)
IGF1 - 261 (90-278)
DHT 50 (30-85) A month earlier

Hallandale Shallow IM .2ml on injection day before injection in Jan
T - 1030
Free T - 24
E2 labcorp's dumbasses didnt do it

Sun Pharma Shallow IM .2ml 3 weeks after blood work in Jan
T - 1145
Free T - 26.6
Sensitive E2 - 43
SHBG 29
IGF1 221
DHT 51

I don't know if it's the cottonseed oil in the t, the shallow IM along with the sun pharma obviously being stronger making my numbers higher, or if it's just dietary (bread, sunflower oil, too many high glycemic carbs around lifting and a huge insulin response?), having come off of the oxandralone and I am just fucked now as I have seen other people say that, but nothing in my blood work looks extreme enough to cause this.

One thing, derm looked at it a couple of weeks ago, this spot on my neck wont go away, he says it's a sebaceous cyst and will take a long time to go away. Would that point to overproduction of oil vs inflammatory response? My back is quickly getting ruined and I do not know what to do, nodular acne is one of the hardest to treat. This sucks.

 

[madman]

In 2018 I started getting crazy nodular acne on my back, this is the deep stuff that is not poppable and does not have a head on it. I had started lifting in 2017 at 34.5 and was starting to increase calories as to not be a skeleton anymore. Somewhere along the way my skin revolted, salicylic acid and benzoyl peroxoide didnt work, neither did things like head and shoulders shampoo. It took me awhile to do an elimination diet and I found peanut butter and dairy of ANY sort were a no go. This was pre TRT with lower t, free t and e2.

Mid last year I go on TRT, I got a few initial minor "normal" zits here and there, easily demolished by BP. I was doing .236ml generic Sun Pharma t cypionate from CVS in cottonseed oil on MWF for the first three weeks, had issues with it burning subq, switched to Hallandale compounded in GSO. No acne issues except occasional stray nodular if I consumed something heavy on milk, which is super rare. I decided to try Lactaid chocolate whole milk as getting enough calories to stay in a surplus is difficult, no issues for MONTHS. I did start to drink more and more as I was getting stronger and it was easy to stay in a surplus, I added in an organic dark chocolate granola, more cereal etc, tried almond butter but had to drop it as I got acne immediately but it calmed down quickly.

I ran oxandralone at 24mg for almost 10 weeks with no issues and along the way I switched to EOD dosing at .2ml subq, then switched to shallow IM, a month after coming off of the oxandralone, and 2.5 weeks after having switched back to the Sun Pharma t I had a crazy break out of 10 big painful nodular spots on back, then more would show up and it's still happening now, after breaking out January 31st. I dropped the milk immediately, but since I am bulking I am still consuming all kinds of things that could be inflammatory I suppose, but no dairy, at all, yet the zits persist. I shower 2-3 times a day, and I use hibiclens on my back, but it's not even affecting this stuff at this point.

Hallandale Subq .236ml done on injection day before injection back at end of Sept
T - 931 (264-916)
Free T - 24 (8.7-25.1)
E2 Sensitive 36 (8.0-35)
SHBG 20 (16.5-55.9)
IGF1 - 261 (90-278)
DHT 50 (30-85) A month earlier

Hallandale Shallow IM .2ml on injection day before injection in Jan
T - 1030
Free T - 24
E2 labcorp's dumbasses didnt do it

Sun Pharma Shallow IM .2ml 3 weeks after blood work in Jan
T - 1145
Free T - 26.6
Sensitive E2 - 43
SHBG 29
IGF1 221
DHT 51

I don't know if it's the cottonseed oil in the t, the shallow IM along with the sun pharma obviously being stronger making my numbers higher, or if it's just dietary (bread, sunflower oil, too many high glycemic carbs around lifting and a huge insulin response?), having come off of the oxandralone and I am just fucked now as I have seen other people say that, but nothing in my blood work looks extreme enough to cause this.

One thing, derm looked at it a couple of weeks ago, this spot on my neck wont go away, he says it's a sebaceous cyst and will take a long time to go away. Would that point to overproduction of oil vs inflammatory response? My back is quickly getting ruined and I do not know what to do, nodular acne is one of the hardest to treat. This sucks.

Sounds like you are genetically prone to acne and the more aggressive form nodular/cystic which is difficult to treat.

Usually treated with Accutane depending on the severity.

Hormones play a big role and the use of exogenous T can easily cause oily skin/inflammatory state leading to acne especially when FT levels get too high.

To what degree depends on the individual/genetics.

Doubtful it is the carrier oil let alone diet as the sole cause and although you stated..... I have seen other people say that, but nothing in my blood work looks extreme enough to cause this.

I would think twice on that one.

Although TT is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

First off you used the piss poor direct immunoassay which is known to be inaccurate to test your FT and I would put money on it that your trough FT is much higher than you think.

Unfortunately too many are still caught up in using/relying upon such.

Many have no clue where their FT level truly sits.

The only way to know where your FT level truly sits is to have it tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best)

On your most recent set of labs, you are hitting a very high trough TT 1145 ng/dL with an SHBG 29 nmol/L which would most likely have your trough FT 41 ng/dL (very high).

Even then you tested 3 weeks in which is too early and your trough TT/FT levels would be even higher as you need to wait 4-6 weeks for blood levels to stabilize when using TC/TE.

Clear as day that your trough FT is going to be absurdly high!

FT 5-10 ng/dL is low.

FT 16-31 ng/dL (top-end) is healthy.

 

[Unlockable]

Sounds like you are genetically prone to acne and the more aggressive form nodular/cystic which is difficult to treat.

Usually treated with Accutane depending on the severity.

Hormones play a big role and the use of exogenous T can easily cause oily skin/inflammatory state leading to acne especially when FT levels get too high.

To what degree depends on the individual/genetics.

Doubtful it is the carrier oil let alone diet as the sole cause and although you stated..... I have seen other people say that, but nothing in my blood work looks extreme enough to cause this.

I would think twice on that one.

Although TT is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

First off you used the piss poor direct immunoassay which is known to be inaccurate to test your FT and I would put money on it that your trough FT is much higher than you think.

Unfortunately too many are still caught up in using/relying upon such.

Many have no clue where their FT level truly sits.

The only way to know where your FT level truly sits is to have it tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best)

On your most recent set of labs, you are hitting a very high trough TT 1145 ng/dL with an SHBG 29 nmol/L which would most likely have your trough FT 41 ng/dL (very high).

Even then you tested 3 weeks in which is too early and your trough TT/FT levels would be even higher as you need to wait 4-6 weeks for blood levels to stabilize when using TC/TE.

Clear as day that your trough FT is going to be absurdly high!

FT 5-10 ng/dL is low.

FT 16-31 ng/dL (top-end) is healthy.

Well I had these same nodular acne with a t level below the mid 300's and free t at 6, and e2 at 8. I doubt my free t was super high no matter the lab test at the time.

I never had acne in my teens or 20's, now I'll be 40 this year and its worse than when I was 15 and was lucky if I showered more than once every two days while eating all kinds of garbage and being super active and sweaty OFTEN.

Even if you are not a fan of the direct free t, I had no issues at a level of 24, I had no issues when I started TRT which is when hormones swing the wildest, I had no issues on oxandrolone. So that's why this is so confusing.

 

[madman]

How long after donating blood before changes in HCT and Ferritin is noticed on blood work

Yes, morning blood markers did not go down much at all. However, I had been high Am before and only slightly high PM hct with normal RBC and hemoglobin before. Didnt check PM numbers after donation. I drink A LOT of water before going in, but must not be absorbing it, may try to add some pink...

www.excelmale.com

This is why I asked you to post labs!

Now you know why you are struggling with elevated RBCs/hemoglobin/hematocrit and are caught up on that most likely never-ending donating blood merry-go-round due to running too high a trough FT level.


My reply from a previous thread:

As you can see your RBCs/hemoglobin/hematocrit is elevated which is a common side-effect when using exogenous T, especially when running higher FT levels let alone peak--->trough levels can have a significant impact.

Keep in mind smoking/sleep apnea can also drive up hematocrit.


Regarding those struggling with high hematocrit here is my reply from another thread:

When using exogenous T RBCs/hemoglobin/hematocrit will increase within the 1st month and can take up to 9-12 months to reach peak levels.

T formulation, the dose of T, genetics (polymorphism of the AR), age all play a role in the impact a trt protocol will have on blood markers (RBCs/hemoglobin/hematocrit).

Other factors such as sleep apnea, smoking can have a negative impact on hematocrit.

Injectable T has been shown to have a greater impact on increasing HCT compared to transdermal T.

3–18% with transdermal administration and up to 44% with injection.

In most cases when using injectable T high supra-physiological peaks post-injection and overall T levels (running too high TT/FT level) will have a big impact on increasing HCT.

Manipulating injection frequency by injecting more frequently using lower doses of T resulting in minimizing the peak--->trough and maintaining more stable levels may lessen the impact on HCT but it is not a given.

As again running very high TT/FT levels will have a stronger impact on driving up HCT.

Although injectables have been shown to have a greater impact on HCT you can see even when using a transdermal formulation that maintains stable serum concentrations that the impact it has on HCT is DEPENDANT ON THE DOSE AND SERUM LEVEL OF T.

Using higher doses of transdermal T and achieving higher TT/FT levels will have a great impact on HCT levels.

How high an FT level you are running is critical.

It is a given that most men on trt struggling with elevated RBCs/hemoglobin/hematocrit are running too high an FT level.

Sure some men are more sensitive than others as they may still struggle with elevated blood markers when running lower T levels but it is far from common and many may already have an underlying health issue contributing to such.

If you are struggling with such blood markers then in most cases finding the lowest FT level you can run while still maintaining the beneficial effects may very well be the solution.

Easier said than done as many men on trt tend to do better running higher-end FT levels within reason.

Mind you some are lucky and never have an issue or levels tend to stabilize over time.

Others will continue to struggle until the cows come home.

Unfortunately too many are caught up in running absurdly high trough FT levels due to the herd mentality spewed on the bro forums and gootube!

 

[Unlockable]

You are overlooking I had high AM hematocrit long before TRT. Sure it went up a few points, it's going to on exogenous test. Everybody uses the same free t test for the most part and most guys with similar t levels to me are in the high 20's to mid 30's on the same total t level. Oddly enough my SHBG has went up 9 Points recently. Going from 941 to 1145 barley budged my free t.

 

[madman]

Well I had these same nodular acne with a t level below the mid 300's and free t at 6, and e2 at 8. I doubt my free t was super high no matter the lab test at the time.

I never had acne in my teens or 20's, now I'll be 40 this year and its worse than when I was 15 and was lucky if I showered more than once every two days while eating all kinds of garbage and being super active and sweaty OFTEN.

Even if you are not a fan of the direct free t, I had no issues at a level of 24, I had no issues when I started TRT which is when hormones swing the wildest, I had no issues on oxandrolone. So that's why this is so confusing.

Hard to say what contributed in the past and all I can say is that there is a good chance that your absurdly high trough FT level is a big part of the problem.

The direct FT is a piss poor assay known to be inaccurate and should not be used/relied upon for testing FT.

With a trough TT of almost 1200 ng/dL and SHBG 29 nmol/L your trough FT would be absurdly high.

 

[madman]

You are overlooking I had high AM hematocrit long before TRT. Sure it went up a few points, it's going to on exogenous test. Everybody uses the same free t test for the most part and most guys with similar t levels to me are in the high 20's to mid 30's on the same total t level. Oddly enough my SHBG has went up 9 Points recently. Going from 941 to 1145 barley budged my free t.

It's an inaccurate assay!

Even if your pre-trt hematocrit was on the higher end it was driven up much further due to your absurd trough FT.

 

[Unlockable]

Using a free t calculator based off of albumin, t and shbg shows 28 at trough

 

[Unlockable]

It's an inaccurate assay!

Even if your pre-trt hematocrit was on the higher end it was driven up much further due to your absurd trough FT.

It was driven up a few points. 51-52 to 54-55. That's a standard increase for exogenous testosterone.

 

[madman]

Using a free t calculator based off of albumin, t and shbg shows 28 at trough

TruT Free Testosterone Calculator by FPT

Free testosterone calculator by FPT. Improved accuracy of free T calculations.

tru-t.org

 

[madman]

Using a free t calculator based off of albumin, t and shbg shows 28 at trough

My Most Recent Labs.

My protocol, 16 mg of testosterone cypionate daily, 500 iu of hcg twice weekly and no AI. Pregnenolone 10 mg and 25 mg of DHEA. My last injection before labs, about 28 hr.s. Labs are from LabCorp. Testosterone, Serum 1319 ng/dL range 264-916 Free Testosterone 47.9 ng/dL range...

www.excelmale.com

Get back to me on that one when you test your trough FT using an accurate assay!

070038: Testosterone, Free, Equilibrium Ultrafiltration With Total Testosterone, LC/MS-MS | Labcorp

Labcorp test details for Testosterone, Free, Equilibrium Ultrafiltration With Total Testosterone, LC/MS-MS

www.labcorp.com

 

[Unlockable]

So now you're against all free test calculators and only use random ones you deem worthy. You have a tendency to come into thread and derail them on these tangents and try to play this superiority game. I DONT CARE ABOUT MADMAN's opinion on free t testing. You frequently ignore data from people posting that doesn't align with your agenda.

DEFY treats 10's of thousands of patients and have an idea of what number they like to see on this very test, regardless of whatever that number may be on some
Other test at some other lab.

Now back to the topic at hand or don't bother replying. You're a moderator right? Be moderate.

 

[madman]

You are overlooking I had high AM hematocrit long before TRT. Sure it went up a few points, it's going to on exogenous test. Everybody uses the same free t test for the most part and most guys with similar t levels to me are in the high 20's to mid 30's on the same total t level. Oddly enough my SHBG has went up 9 Points recently. Going from 941 to 1145 barley budged my free t.

post #29

How long after donating blood before changes in HCT and Ferritin is noticed on blood work

Yes, morning blood markers did not go down much at all. However, I had been high Am before and only slightly high PM hct with normal RBC and hemoglobin before. Didnt check PM numbers after donation. I drink A LOT of water before going in, but must not be absorbing it, may try to add some pink...

www.excelmale.com

Which was it 47/48/49/50?

I'm not sure how much a minor lowering of dose can really make, especially if hematocrit was high beforehand. Of course I don't know what my mid day hematocrit was pre TRT. It may have been high normal. Lowest I ever saw was 47-49 but plenty in the 50's

I do think I've been a bit more fatigued lately but could be from pushing it harder and harder at the gym.

 

[Unlockable]

My Most Recent Labs.

My protocol, 16 mg of testosterone cypionate daily, 500 iu of hcg twice weekly and no AI. Pregnenolone 10 mg and 25 mg of DHEA. My last injection before labs, about 28 hr.s. Labs are from LabCorp. Testosterone, Serum 1319 ng/dL range 264-916 Free Testosterone 47.9 ng/dL range...

www.excelmale.com

Get back to me on that one when you test your trough FT using an accurate assay!

070038: Testosterone, Free, Equilibrium Ultrafiltration With Total Testosterone, LC/MS-MS | Labcorp

Labcorp test details for Testosterone, Free, Equilibrium Ultrafiltration With Total Testosterone, LC/MS-MS

www.labcorp.com

No. I won't. You're not that important. At all.

Either offer help or go away. It's simple.

 

[Unlockable]

post #29

How long after donating blood before changes in HCT and Ferritin is noticed on blood work

Yes, morning blood markers did not go down much at all. However, I had been high Am before and only slightly high PM hct with normal RBC and hemoglobin before. Didnt check PM numbers after donation. I drink A LOT of water before going in, but must not be absorbing it, may try to add some pink...

www.excelmale.com

Which was it 47/48/49/50?

I'm not sure how much a minor lowering of dose can really make, especially if hematocrit was high beforehand. Of course I don't know what my mid day hematocrit was pre TRT. It may have been high normal. Lowest I ever saw was 47-49 but plenty in the 50's

I do think I've been a bit more fatigued lately but could be from pushing it harder and harder at the gym.

47 was YEARS AGO. in modern times it was over 50 every single time. You know, the relevant data.

 

[madman]

So now you're against all free test calculators and only use random ones you deem worthy. You have a tendency to come into thread and derail them on these tangents and try to play this superiority game. I DONT CARE ABOUT MADMAN's opinion on free t testing. You frequently ignore data from people posting that doesn't align with your agenda.

DEFY treats 10's of thousands of patients and have an idea of what number they like to see on this very test, regardless of whatever that number may be on some
Other test at some other lab.

Now back to the topic at hand or don't bother replying. You're a moderator right? Be moderate.

No agenda here.

Out to lunch on that one bro search the numerous threads!

The direct immunoassay is known to be inaccurate plain and simple.

Harmonized reference ranges for Total and Free T levels

Accurate Measurement and Harmonized Reference Ranges for Total and Free Testosterone Levels (2022) Ravi Jasuja, Ph.D., Karol M. Pencina, Ph.D., Liming Peng, MSc, Shalender Bhasin, MB, BS* INTRODUCTION A central tenet of endocrinology is that the hormones secreted by the endocrine glands...

www.excelmale.com

 

[madman]

No. I won't. You're not that important. At all.

Either offer help or go away. It's simple.

I'm telling you your trough FT is going to be very high!

If you want to be in denial go nuts.

Not trying to bust your balls just trying to kick some sense.

 

[madman]

You never heard it from me.

Might want to sit back and think deeply on that one when it comes to testing your free testosterone!

Again as I stated many have no clue where their FT level truly sits as they are caught up on using/relying upon those known to be inaccurate piss poor direct immunoassays.

You know the one all those T-mill clinics let alone some of the more reputable clinics are recommending lol!

Gotta love it when people claim their FT is that that or the other yet they are the same ones using/relying upon inaccurate assays.....go figure.




post#3/4/5

Improving Diagnostic Accuracy and Treatment Decisions in Men with Hypogonadism

www.excelmale.com

* most hospital labs will offer you a crappy tracer analog method for Free Testosterone




Methods for Assessing Free Testosterone Levels

TruT Free Testosterone Calculator by FPT

Free testosterone calculator by FPT. Improved accuracy of free T calculations.

tru-t.org

 

[Nelson Vergel]

One thing, derm looked at it a couple of weeks ago, this spot on my neck wont go away, he says it's a sebaceous cyst and will take a long time to go away. Would that point to overproduction of oil vs inflammatory response? My back is quickly getting ruined and I do not know what to do, nodular acne is one of the hardest to treat. This sucks.

I would read these posts since others have experienced your problem.

How to Treat Acne Caused by Testosterone Therapy

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.excelmale.com

TRT and Acne: Causes & Treatments

Are you wondering if TRT and acne correlate with each other? There are a handful of possible side effects of TRT (testosterone replacement therapy). While most side effects of TRT are manageable, if n

www.discountedlabs.com