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Wife Makes a Big Deal About Acne

“My wife had a lot to say about how horrible the acne on my back was, and that it was all because of the T therapy. She’d use any excuse to get me to quit taking testosterone, but I have to admit that the acne does look pretty bad.”

For some guys, taking testosterone therapy means feeling like a teenager again. But not in a good way.

Adult man squeezes the pimple on his face looking in the mirror

Acne can be one of the unpleasant side effects of T therapy. For most men, it’s a minor inconvenience, but for a few, the acne can get pretty bad. It’s especially difficult when you have a wife who’s not supportive of you taking T therapy in the first place, and then goes on to give you a hard time about ‘having teenage zits’.

So, what’s going on with that, and what can you do about it?

Testosterone metabolizes into a few different components, including estrogen and DHT (dihydrotestosterone). It’s DHT that’s actually the culprit in acne because it revs up your sebaceous (oil) glands and increases their output of sebum (oil secretion). This eventually clogs the hair follicles and allows bacteria to grow, resulting in acne.

It might seem logical, then, to simply decrease DHT levels to solve your acne problem, either by decreasing overall testosterone levels or by preventing the conversion of testosterone into DHT, and that’s certainly an option. Not so fast, though, because in addition to causing acne, DHT is also responsible for some pretty good stuff.

Several times more potent than testosterone, DHT contributes to a healthy libido and ease of orgasm as well as producing quality erections. In addition, DHT can boost mood and cognitive function, muscle growth and energy. So while decreasing DHT may cure your acne, you’re probably not going to like what it does to the rest of your body.

So, now what? Are you just stuck in teenage wasteland?

There are actually quite a few ways to treat acne, some of them fairly straight-forward, some a little more complicated. Let’s start with the easy ones first.

Get some sunshine. Make sure not to burn as that can exacerbate acne down the road, but moderate amounts of sunshine to the affected areas can help.

Eliminate dairy from your diet. This is a huge help for some people.

Supplement with fish oil. Some studies have shown a benefit from this, although the results have been inconsistent. Fish oil has a number of other health benefits, so it’s an overall good idea to supplement.

Supplement with zinc, 50 mg daily (plus 3 mg of copper). Evidence suggests that zinc has antibacterial and anti-inflammatory effects and that it may decrease sebum production. Zinc picolinate and zinc methionine seen to have the best bio-availability, so are probably your best options. Make sure to limit your zinc intake to 50 mg/day, as more than this may irritate the gut.

Use Nizoral shampoo on acne-affected areas. Nizoral shampoo is a dandruff shampoo whose active ingredient is an anti-fungal called ketoconazole. There are some studies that indicate that ketoconazole can be effective in clearing up certain types of acne, and there is a lot of anecdotal evidence out there that indicates the same. Ketoconazole also blocks DHT at the local site, thus mediating its effects on the sebaceous glands.

Nizoral is available in a 1% formulation without a prescription, and there are also generics available. For a 2% formulation, you’ll need a prescription from your doctor. It’s a fairly cheap fix, so there’s not much to lose by trying it.

Try the usual acne treatments containing benzoyl peroxide or salicylic acid. They are often effective.

Monitor your testosterone levels and keep them within optimal range. If they’re super high, decreasing your dose may improve acne.

Supplement with Vitamin B5 + L-Carnitine. Dr. Jeffrey Dach, a well-regarded doctor in the anti-aging field, is getting good results in his patients from the use of Vitamin B5 and L-Carnitine, an amino acid produced in the body involved in the metabolism of fatty acids. There are negligible side effects at these doses, so this is worth a shot.

Try prescription antibiotics if none of the other options work for you. While antibiotics like minocycline and doxycycline can be quite effective at treating acne, they are one of my last choices because antibiotics kill good bacteria as well as bad bacteria, and we need good bacteria in order to be healthy.

If you do end up using a prescription antibiotic, make sure to also take probiotics to replenish your good bacteria. It needs to be a good quality probiotic that can survive long enough to get to the lower gut where it’s needed. Theralac is a good one that I personally use.

Try Isotretinoin (Accutane) only as a last resort. An oral medication normally prescribed after other alternatives have been exhausted, isotretinoin has numerous troubling side effects such as extremely dry skin, depression, a link to Crohn’s disease, possible liver damage, and severe birth defects if a woman takes it while pregnant. Roche, the manufacturer of Accutane pulled it off the market in 2009, but generic versions are still available in some areas.


Okay, so there you have it. Some simple and some not-so-simple treatments for acne. Go forth and zap those zits.