Dermatological adverse effects of testosterone replacement therapy: a scoping review of the literature

While testosterone replacement therapy (TRT) is generally effective in restoring testosterone levels and improving quality of life, its dermatological adverse effects are underreported compared to cardiovascular and oncologic risks.

This review aims to synthesize existing evidence on cutaneous complications associated with TRT to better inform clinical practice.

A scoping review was conducted using PubMed, Scopus, and Cochrane databases to identify studies reporting dermatologic adverse events related to TRT in adult men. Inclusion criteria focused on original studies documenting skin-related side effects in TRT recipients. Ten studies met eligibility: eight prospective clinical trials and two retrospective chart reviews published between 2006 and 2025. Data were extracted and summarized narratively.

Across all included studies, dermatologic adverse events were consistently reported. Acne was the most frequent, affecting 0.6%-9.1% of participants, with the lowest incidence in oral formulations. Pruritus occurred in up to 10.0%, rashes in up to 5.3%, and abnormal hair growth in up to 5.3%. Injectable formulations were generally associated with higher rates of acne and systemic reactions than topical or oral preparations. Despite the prevalence of these effects, most studies lacked standardized reporting or detailed management strategies.

Dermatologic side effects of TRT, though often considered non-severe, can significantly impact patient satisfaction, adherence, and quality of life. Acne and other cutaneous reactions vary by delivery method and patient susceptibility, emphasizing the need for clinician awareness, patient counseling, and better adverse event reporting. Future research should standardize dermatologic outcome measures and explore effective prevention and management strategies to improve the safety and tolerability of TRT.