Rosacea, facial redness (acne?) on low dose compounded testosterone cream - can't figure out?

Thread starter #1
Hello, first post ever. I have been on and off trt for a few times unfortunately. Initially on Chlomid to see if can get my own test up, which did work a bit but made me very anxious and red faced. Then onto injections and finally on a cream. This course of treatment came about due to odd side effects of facial redness flushing. I am not looking for the exact answer here but maybe even a plan to help uncover what is happening. I have a solid doc and we have a plethora of lab tests. I will post some #'s below. However, I get this red facial flushing w/ bumps -not sure if it would be considered acne - almost thickening of the skin on temples each side of face. The redness is odd in lower cheek areas in that it is very stark - like a line between flesh tone and rosacea along lower cheek and sort of red acne bumps sides of eyes / temple area - like skin is thicker. I suspect I have have a DHT Alpha 5 reductase reaction that is not common. My last blood work while on .05 dose of compounded DHEA 100MG / 150MG Testosterone Cream Per ML showed:

DHEA Sulfate 301 ug/dL - normal range
DHEA Serum 652 ng/dL - normal range
Hematocrit 40 - normal range
Testosterone Serum 887 ng/dL - 5-HIAA Qn, Random URINE normal range (maybe high side for me)
Free Testosterone 25.5 pg/mL - HIGH
Androsterone 29 - HIGH
DHT, Free 11.88 - shown as HIGH but no unit of measure on labcorp print out
Estradiol 5-HIAA, Urine 2.6 Normal range
Estradio 5-HIAA Qn, Random Ur 2.8 Normal Range
Estradiol Serum MS 14 - says normal - no unit of measure shown


I have many other values from LABS which came in normal - I think the above are likely what most would want to see. Without going into too much history I have been told before my 5 alpha reductase enzyme is quite active in turning my TRT into DHT. That said, I am now on a lower dose of the cream - around .02-.03mL which is so low I wonder how helpful that can really be? I am starting to suspect my own TRT is not turning off. Before I started therapy I was:

DHEA Sulfate 226 ug/dL
DHEA Serum 156 ng/dL (large difference now)
Testosterone Serum 283 ng/dL - LOW 348-1197 ng/dL range
Free Test 7.2 pg/mL
Dihydrotestosterone 23 (no unit of measure on labcorp print out but says reference is LOW)
Hematocrit 40.7
Sex Binding Glob 33.7 mol/L Normal
Estradiol 11 - Normal

I get some results in the gym at age 48 and very active. However, even when I upped my dose pretty high I did not feel stronger, more energetic or have higher libido. Maybe low dose is ok? If the dose is so low it is meaningless, I'd rather not supplement at all?
 
Thread starter #3
Thanks for the link I will do some research. My rosacea on cheeks not certain it is actually acne but there are some bumps. Looks sort of like I've been boozing a lot. Some on temples maybe acne sort of thick skin - no zits but red rough skin. Mostly red on cheeks rosacea sort of thing. If I'm in the sun, it's like I get a super tan. Sort of crazy - neither are a look I'm really excited about. E2 is fine per blood tests. DHT maybe it but I have a feeling it's something related to cortisol or stress type reaction...just a hunch. Open to any feedback as I've been trying to figure this out with my Doc for over a year now.
 
#4
Hi mlongtin,

I am not on TRT, but I am getting labs to see if I need it. So far all I know is that my total testosterone is in the 200-range.

At age 45 I was diagnosed with "adult onset rosacea." I get easy flushing in my cheeks and great acne on my forehead. As I understand it the symptoms for each person are slightly different.

As I've learned, there is basically no treatment and no cure beyond "figure out your own triggers and then avoid them." For me alcohol is a mild trigger but heat is a major one. And by "heat" I mean like sitting in a sauna or steam room for 20 minutes kind of heat stress. Occasionally I'll get other food-related triggers like hot peppers or very sugary or acidic foods, but I am still after a year trying to sort it out.

I think hormone imbalances might play into it a little, but if it was that simple there would have been a cure discovered for rosacea by now. There are many sub-types and it sounds like you are experiencing "Phymatous rosacea: Skin thickens and has a bumpy texture." This from a Rosacea site:

Learn what triggers your rosacea[FONT=&quot]. Many everyday things can cause rosacea to flare. These include sunlight, stress, and many foods and beverages. [/FONT]

[FONT=&quot]What causes one person’s rosacea to flare may not trigger a flare-up for another person. This is why dermatologists recommend that patients with rosacea learn what triggers their flare-ups. Avoiding these triggers can reduce flare-ups.

[/FONT]
Hope this helps, rosacea sucks man.
 
Thread starter #5
Thanks for the tips I will look into this ...For me, it was never a problem until I started TRT. So that is my trigger. The dose I take is directly related to the redness. Problem is as I lower the dose, I begin to wonder if the treatment is worth while? I feel good on lower dose but have heard mixed reviews. Doc prescribed Finasteride to lower DHT which I think would work for me but really don't want to be on that stuff long term.
 
#6
As discussed there are a variety of triggers. My dermatoligist said the retinol-A cream as a restorative therapy, would help and I think it does, but I do not use it much because it is expensive and is contraindicated when your are going to be out in the sun afterword. So what I have actually found the most useful is a product called Prosacea, and its available at Walgreens or Walmart. But I think the best price is from Amazon. Here is a link if you want to check it out.
 
#7
mlongtin,

Damn, I injected for the first time ever today and what do you know, facial flush. It feels like niacin flush except not as intense. My face is visibly red It is exactly 4 hours since I injected, and the redness is in my cheeks and forehead, exactly the places rosacea flares. Dang.

My gut instinct is that this has nothing to do with the testosterone itself, but maybe the solvent is the culprit. Quick google says that test cypionate contains benzyl alcohol and benzyl benzoate.

https://www.webmd.com/drugs/2/drug-77581/benzocaine-benzyl-benzoate-topical/details/list-sideeffects

The link lists so-called INFREQUENT side effects, specifically:

Giant Hives
Hives
Itching
Rash
Redness Of Skin
Skin Inflammation Due To A Topically Applied Medication
Stinging Of Skin

I have lots of different allergies and so maybe this is just part of the genetic cards we were dealt. I wonder if a compounding pharmacy can blend the testosterone without these compounds, or just with alternate compounds that I'm not allergic to?
 
Last edited:
#8
mlongtin,

Damn, I injected for the first time ever today and what do you know, facial flush. It feels like niacin flush except not as intense. My face is visibly red It is exactly 4 hours since I injected, and the redness is in my cheeks and forehead, exactly the places rosacea flares. Dang.

My gut instinct is that this has nothing to do with the testosterone itself, but maybe the solvent is the culprit. Quick google says that test cypionate contains benzyl alcohol and benzyl benzoate.

https://www.webmd.com/drugs/2/drug-77581/benzocaine-benzyl-benzoate-topical/details/list-sideeffects

The link lists so-called INFREQUENT side effects, specifically:

If experienced, these tend to have a Severe expression


Giant Hives
Hives
Itching
Rash
Redness Of Skin
Skin Inflammation Due To A Topically Applied Medication
Stinging Of Skin

I have lots of different allergies and so maybe this is just part of the genetic cards we were dealt. I wonder if a compounding pharmacy can blend the testosterone without these compounds, or just with alternate compounds that I'm not allergic to?
I would give it many more injections before you make any changes or make a final decision. My rosacia is better now that I am on TRT. Not saying it is not the cause, just get some more data points.
 
#9
Hi mlongtin,

I am not on TRT, but I am getting labs to see if I need it. So far all I know is that my total testosterone is in the 200-range.

At age 45 I was diagnosed with "adult onset rosacea." I get easy flushing in my cheeks and great acne on my forehead. As I understand it the symptoms for each person are slightly different.

As I've learned, there is basically no treatment and no cure beyond "figure out your own triggers and then avoid them." For me alcohol is a mild trigger but heat is a major one. And by "heat" I mean like sitting in a sauna or steam room for 20 minutes kind of heat stress. Occasionally I'll get other food-related triggers like hot peppers or very sugary or acidic foods, but I am still after a year trying to sort it out.

I think hormone imbalances might play into it a little, but if it was that simple there would have been a cure discovered for rosacea by now. There are many sub-types and it sounds like you are experiencing "Phymatous rosacea: Skin thickens and has a bumpy texture." This from a Rosacea site:

Learn what triggers your rosacea. Many everyday things can cause rosacea to flare. These include sunlight, stress, and many foods and beverages.

What causes one person’s rosacea to flare may not trigger a flare-up for another person. This is why dermatologists recommend that patients with rosacea learn what triggers their flare-ups. Avoiding these triggers can reduce flare-ups.

Hope this helps, rosacea sucks man.
I agree with this. For me, my dermatologist has his own brand of face cleanser so cutting out soap has been a big help. For me, spicy food, coke, certain sun screens, wind and heat are triggers. It has been good lately though.
 
#10
If it is rosacea, try Nizoral. I have tried “everything” (dermatologists, Gen. doctors, beauty cliniques) and nizoral twice a week turnout to be a “miracle” deterrent of symptoms. Nixoral is a very strong shampoo tho, so be careful, it is really tough on the skin. Try it for a few weeks and see how it goes.

Ps, I used to get a red flush while boozing when I was on 120mil of cyp per week. Went down to 100 and it went away.
 
#11
I would give it many more injections before you make any changes or make a final decision. My rosacia is better now that I am on TRT. Not saying it is not the cause, just get some more data points.

Agreed.

The flush yesterday seemed to last for about 2 hours and then diminished. I exercised also and I think that might have helped me get over the hump.

At my next injection I think I'll experiment with a dose of benadryl beforehand just to see if an antihistamine is all that's needed. It is worth a shot anyway...
 
#12
If it is rosacea, try Nizoral. I have tried “everything” (dermatologists, Gen. doctors, beauty cliniques) and nizoral twice a week turnout to be a “miracle” deterrent of symptoms. Nixoral is a very strong shampoo tho, so be careful, it is really tough on the skin. Try it for a few weeks and see how it goes.

Ps, I used to get a red flush while boozing when I was on 120mil of cyp per week. Went down to 100 and it went away.
So, you put the nizoral shampoo directly on your face? For how long?
 
#13
One DR. recommended to just let the foam from washing my hair “rest” on my face for a few minutes (some sort of indirect application). Then I heard about applying directly (I leave it on my skin for a few minutes), and I think it worked great this way. Your face will get super dry, but after a few uses and a couple weeks, if you are lucky enough, your rosacea symptoms will decrease substantially.
You can also try Onrealta (Not sure the American name for this medication). Best cream I have tried. The result are ok tho. The redness kinda goes away, but your skin still looks odd. Worth a try tho!
 
Thread starter #14
Thanks I tried it. Does seem to help a little but really curious what the root cause is...my doc thinks it's high 5 alpha reductase causing DHT to rise. But the redness happens 1-2 hours after applying cream and is almost gone by the next day before it's time to apply again. Anyone have any other suggestions? Thanks in advance.
 
#15
Thanks I tried it. Does seem to help a little but really curious what the root cause is...my doc thinks it's high 5 alpha reductase causing DHT to rise. But the redness happens 1-2 hours after applying cream and is almost gone by the next day before it's time to apply again. Anyone have any other suggestions? Thanks in advance.
It's starting to sound like a reaction to the cream.
 
#16
My rosacea flushed 4 hours after my testosterone injection and I suspected an allergic reaction, so at my last injection I swallowed a Benadryl tablet after the shot, and what do you know no flushing.

I've been using the Nizoral shampoo on my face for about a week (every other day for 5-10 minutes) and I think my skin has been OK. The jury is still out. Red cheeks haven't flared up, but I don't think so far it has reduced my acne any.

Thanks I tried it. Does seem to help a little but really curious what the root cause is...my doc thinks it's high 5 alpha reductase causing DHT to rise. But the redness happens 1-2 hours after applying cream and is almost gone by the next day before it's time to apply again. Anyone have any other suggestions? Thanks in advance.
 
#17
I am totally like you. Testim has totally given me Rosacea. I cannot go out in sun without a huge flare up. I thought it was alcohol too, but stayed away for a month and rosacea was still there. My Dr's have been no help....I feel some sort of hormone imbalance maybe causing this due to the testim. Have you been prescribed anything that has helped?
Thanks.
 

captain

Active Member
#18
Lupus rash will flare up in the sun. I been having a rash on my face like ones seen in Lupus but tested negative. I asked my famous TRT doc and he sounded like sergeant Schultz where he said he knows nothing. He then stated 3 other guys had asked about a rash that same day. I would have thought that after 4 guys have the same problem that it may be connected but went nowhere with it. One connection to 4 guys would be getting the same meds from Empower. I have no Idea if that has anything to do with it but seeing this thread makes 5 guys with a rash.
 
#19
They thought it maybe Lupus with me too, but Rheumatologist said I had no other systems and is sending me back to skin DR who does not have a clue. TRT is definitely causing this. Anybody who has any suggestions how to clear this up I would be grateful too.
Thanks.
 

captain

Active Member
#20
For me cortisone cream clears it up as long as I keep using it. It comes back when I stop using it. I tried antifungal and it didn't do anything. I am trying Metrogel now but don't know yet if that is doing anything for it.
 
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