Testosterone and acne in FTM transition: what TikTok gets wrong

What did @ashtonjamescolby actually say?

The creator, nine and a half years into testosterone therapy, told a follower that acne from T is normal, temporary, and manageable with a basic skincare routine. Their core advice: "just start with the basics, a gentle cleanser, a gentle moisturizer," then add a toner spray. They also said testosterone is an anabolic steroid and that acne is a side effect of "going through a second puberty." They applied the same toner logic to chest and back acne. They also linked a recent acne flare to a dose increase and rising estrogen, and credited hydration and stabilized hormone levels with improvement over time.

This is peer support content from someone with nearly a decade of lived experience, not a dermatologist. That context matters when evaluating what they get right and what they miss.

Does the science back this up?

On the big picture, yes. Testosterone therapy is well-documented to cause or worsen acne, particularly in transmasculine individuals. The skincare ingredients mentioned, including hyaluronic acid and gentle cleansers, have solid evidence behind them for barrier support.

A 2019 study by Connelly et al. in the Journal of the American Academy of Dermatology found acne was one of the most common dermatologic concerns in transmasculine patients on testosterone, affecting the face, chest, and back. The mechanism is real: androgens stimulate sebaceous gland activity and increase sebum production, which feeds Cutibacterium acnes. The "second puberty" framing is a simplification, but it is not wrong in spirit. Testosterone surges during cisgender male puberty cause the same sebum spike.

On toners specifically, the evidence is less dramatic than the creator suggests. Most dermatologic literature supports gentle cleansing and moisturizing as the foundation. Toners with active ingredients like niacinamide or salicylic acid have actual data behind them. A plain hydrating toner? Less so. The game-changer framing oversells it.

What did they get wrong (or right)?

They got the fundamentals right. Barrier-focused skincare, gentle cleansing, and moisturizing are exactly what dermatologists recommend for androgen-induced acne before escalating to actives or prescription treatments. Hydration advice is sound. The observation that acne "leveled out" after hormone stabilization is consistent with clinical reports.

The toner-as-game-changer claim is where things get shaky. The creator says "when I started adding the toner, that is when you change the game for me." That is personal experience, not a controlled variable. They were also changing multiple products simultaneously and adjusting hormone doses, so attributing improvement to the toner specifically is attribution error.

Calling testosterone "an anabolic steroid" in the context of acne is technically accurate but the framing is a bit blunt for clinical purposes. Testosterone is both an anabolic steroid and an endogenous hormone. The acne mechanism is androgenic, not just anabolic.

The CBD lotion mention is a throwaway but worth flagging. Evidence for topical CBD in acne management is preliminary at best. A 2014 study by Olah et al. in the Journal of Clinical Investigation showed cannabidiol inhibited lipid synthesis in sebocytes in vitro, which is interesting, but in vitro data does not translate directly to a face lotion recommendation.

What should you actually know?

Testosterone-induced acne is a real, common, and treatable condition. The creator is right that patience and skincare basics help, but there is a clinical ladder here that this video skips entirely. Mild acne responds to over-the-counter actives like salicylic acid (0.5-2%) or benzoyl peroxide. Moderate or persistent acne may need topical retinoids or antibiotics prescribed by a dermatologist. Severe or cystic acne, especially on the chest and back, may warrant isotretinoin, and transmasculine patients are absolutely candidates for this if needed.

The creator's framing of "let it level out, let your body do its thing" is reasonable advice for mild breakouts in the first year or two. It is not appropriate advice if someone is developing scarring, nodular acne, or significant psychological distress from their skin. That warrants a real clinical conversation, not a wait-and-see approach.

Rising estrogen prompting a testosterone dose adjustment is a real clinical scenario. Aromatization of testosterone to estradiol does occur and is monitored in hormone therapy. But the management of that, including dosing decisions, should happen with a prescriber, not through skincare changes alone.