312 Risk factors for acne development in the first two years of initiating masculinizing testosterone therapy among transgender men

Abstract

Acne is known to correlate with masculinizing testosterone (T) therapy use in female-to-male transgender men. However, the timing of acne onset and acne risk factors in this population have not been well-studied. In this retrospective study, we explored the combined effects of T therapy and biological factors on acne development in a population of transgender men that have initiated and maintained therapy for at least two years. We identified 55 transgender men aged ≥18 who received care between January 1, 2008 - December 31, 2017 at Boston Medical Center, MA. Data from routine care were extracted from electronic medical records and patients were identified as having acne if they received an ICD-10 acne diagnosis and/or prescribed medication for acne after starting therapy. A multivariate logistic regression model was used to examine the impact of potential acne risk factors. Among the sample of transgender men, the median age was 25 years (Range:18-75); 74.6% (n=41) were white; and the median serum T level was 647 ng/dL (Range:118-1758). In the first two-years following T initiation, 20 transgender men (41.8%) developed acne, with a mean onset of 9.25 (SD:8.33) months. After adjusting for race, age, BMI, smoking status, and alcohol history in the regression model, serum T levels above 630 ng/dL were associated with a 5.64 increased odds of acne in the study group (95% CI:1.19-26.77, p<0.03). The adjusted model also revealed that an increased BMI was associated with an increased prevalence of acne (OR:1.13; 95% CI:1.02-1.26, p<0.03) and that the risk of acne decreased with increased age (OR:0.92; 95% CI:0.86-0.98, p<0.02). These findings suggest that T can lead to an increased acne incidence in the first two years of therapy, and that this risk is elevated in the setting of an increased BMI and younger age. Acne treatment guidelines do not currently exist for transgender men, which limits medical providers ability to optimally counsel patients and devised treatment plans. Future studies assessing long-term acne treatment outcomes is needed for the transgender male population.