WOMEN’S HEALTH

TESTOSTERONE TRUTH

Dr Ginni Mansberg examines what science says about testosterone and the skin, separating evidence from trends

TESTOSTERONE AND THE SKIN

Skin is not a passive bystander in androgen biology. It contains androgen receptors across multiple cell types including fibroblasts, keratinocytes, and sebaceous gland cells, and actively metabolises testosterone and DHT.1

The most clinically visible effect of androgens in skin is on the sebaceous glands. Testosterone and DHT stimulate sebaceous gland proliferation and sebum secretion, which is why puberty brings increased skin oiliness and acne in the majority of adolescents.2 This relationship is dose-dependent and receptor-mediated.2

The relationship with collagen is more nuanced. At a cellular level, androgens can stimulate fibroblast activity and collagen I production in vitro.3 However, in vivo wound-healing data suggest that androgens may impair cutaneous repair. Ashcroft and colleagues demonstrated that testosterone delays wound healing by prolonging the inflammatory phase and impairing collagen deposition in the wound bed.4 These contradictory findings likely reflect the complexity of androgen signalling, with effects differing according to tissue state, local hormonal milieu, and whether the primary driver is testosterone or its conversion products.

Skin thickness is greater in men than women, correlating with androgen exposure, though oestrogen and growth hormones. Male skin has a thicker dermis and higher collagen density than female skin, differences that appear to be partly androgen-dependent.3

DECLINING TESTOSTERONE

Whether declining testosterone has clinically meaningful skin effects is mostly unknown. In men, the skin changes attributed to the gradual decline in testosterone with age include reduced dermal thickness and altered sebum production, though distinguishing androgen effects from the concurrent decline in growth hormone and IGF-1 is challenging.3

In women, the evidence that declining female testosterone independently causes skin ageing is limited, and the Endocrine Society and other major bodies have not endorsed testosterone for skin-related indications in women.4

Some data suggest androgens may contribute to maintaining skin thickness. Brincat et al. found a 48% increase in skin collagen content in women treated with combined oestradiol and testosterone for two to ten years compared with untreated controls, though whether the benefit was attributable to testosterone, oestradiol, or the combination remains unclear.6

SYSTEMIC TESTOSTERONE THERAPY

For men, a 2026 scoping review published in Sexual Medicine Reviews synthesised findings from 10 studies on the dermatological effects of TRT.7 The findings were sobering for those hoping for a cosmetic dividend: acne was the most common skin-related adverse effect, affecting 0.6–9.1% of participants, with the highest rates in injectable formulations. Pruritus, rash, and abnormal hair growth were also reported.8 The review found no studies reporting skin rejuvenation or anti-ageing outcomes as a primary endpoint.

For women, the picture is similarly dominated by adverse effects rather than benefits. Acne and hirsutism are the most frequently reported cutaneous side effects, though at female-appropriate doses the risk is considerably lower than in supraphysiological use.4 The Endocrine Society 2019 position statement endorses testosterone therapy in post-menopausal women only for hypoactive sexual desire disorder and notes the absence of safety and efficacy data for other indications including skin.

In a meta-analysis of 35 studies, 7% of women developed acne and 10.7% hirsutism.8 A few small studies have examined combined oestrogen-testosterone HRT and skin outcomes in post-menopausal women.

These show mixed signals on collagen and skin thickness, are confounded by concurrent oestrogen use, and are uniformly underpowered. None compares testosterone with a retinoid, the established standard of care for skin ageing.6

TOPICAL TESTOSTERONE ON THE FACE

The current social media iteration sees influencers applying prescription testosterone gel to the skin as an anti-ageing intervention. The logic is simple: testosterone thickens skin, stimulates collagen, and firms the face. But the evidence for this is essentially non-existent. The closest data come from gender-affirming hormone therapy studies, which document increased skin oiliness and acne with topical testosterone, not the refined, firmed complexion promised online.7

The risks are meaningful and underdiscussed, ranging from acne, virilisation, facial hair growth, menstrual disruption and voice deepening in women, as well as unintended exposure to children through skin-to-skin contact.9 Testosterone has a genuine and complex relationship with skin biology, but the evidence does not support its use as an anti-ageing treatment.

If a patient has symptoms that might reflect androgen deficiency, Scan for references: appropriate assessment and supervised hormone therapy through a qualified clinician is the correct pathway.