@theskinandlashlady's HRT acne claims need context

What did @theskinandlashlady actually say?

Amy, a licensed esthetician, is telling women who develop acne on hormone replacement therapy that their testosterone is the culprit and that her options are limited. Her core advice: either "remove the culprit" by stopping testosterone entirely or go back to your prescriber for a lower dose. She also mentions clients who quit testosterone and were "left with acne scarring." The framing is sympathetic but leans heavily toward discontinuation as the obvious fix.

To be fair, she does tell people to loop in their practitioner. That part is correct. But the overall message that stopping testosterone is the logical conclusion, and that there is little else to do, deserves more scrutiny than a 60-second TikTok provides.

Does the science back this up?

Partially. Androgens including testosterone do drive sebaceous gland activity, and acne is a documented side effect of testosterone therapy in women. But "remove the culprit" is a significant oversimplification of what the evidence actually supports.

Testosterone-related acne in women on HRT is real and documented. A 2019 review by Glintborg and colleagues in the journal Current Opinion in Endocrinology, Diabetes and Obesity confirmed that androgenic side effects, including acne and oily skin, occur in a subset of women using testosterone, particularly at supraphysiologic doses. But the same literature makes clear that dose optimization, not automatic discontinuation, is the first clinical step. Dermatological interventions, including topical retinoids, benzoyl peroxide, and in some cases spironolactone, can be effective alongside or instead of stopping testosterone. Spironolactone, an androgen receptor blocker, is specifically used to manage androgen-driven acne without requiring someone to abandon their hormonal therapy entirely. The idea that estheticians are the ceiling of available help is simply not true.

What did they get wrong (or right)?

She got the mechanism right. Testosterone increases sebum production via androgen receptors in the skin, which can trigger or worsen acne, especially in women who are sensitive to androgenic effects. That part checks out.

What she got wrong, or at least incomplete, is the claim that there is "very little" she or anyone else can do short of stopping the hormone. That framing ignores a whole category of medical dermatology options. Spironolactone has decades of evidence for androgen-driven acne. A 2017 randomized controlled trial by Santer et al. published in BMJ demonstrated meaningful acne reduction with low-dose spironolactone in adult women. Topical tretinoin and combination oral therapies also have strong support. Dose reduction of testosterone is a legitimate first move, but it is one option among several, not the final word. Framing discontinuation as "just what it is" could push someone off a therapy that has real benefits for their quality of life, libido, energy, and bone health.

What should you actually know?

If you are a woman on testosterone therapy and developing acne, this is a conversation for your prescribing clinician first, not your esthetician. Estheticians are skilled at topical skincare and aesthetic treatments, but they are not licensed to manage hormonally driven skin conditions or adjust your medication strategy.

Your prescriber can evaluate whether your testosterone levels are within an appropriate physiologic range for women, typically 15 to 70 ng/dL, and whether a dose adjustment is warranted. They can also refer you to a dermatologist who may recommend spironolactone, topical retinoids, or other evidence-based options. Discontinuing testosterone may be the right call for some people, but it should come after a clinical evaluation, not a TikTok. The acne scarring Amy mentions in her clients is a real risk, which is actually a reason to act faster with a dermatologist, not slower while waiting to see if quitting testosterone solves it.

One more thing worth saying plainly: acne from HRT is not inevitable and it is not untreatable. The research does not support the fatalistic framing that once hormones cause breakouts, you are stuck choosing between clear skin and your therapy.