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Acne Incidence and Severity in Transgender Individuals
Courtney A Smith1, Oumaima Kaabi2, Amita K Manatunga3
1Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.
JAMA Dermatology
|January 21, 2026
Summary
Transgender individuals, particularly those on hormone therapy, experience distinct acne incidence patterns. Transmasculine individuals on testosterone show higher acne risk, while transfeminine individuals on estradiol may also develop acne.
Area of Science:
- Dermatology and Endocrinology
- Transgender Health Research
- Population Health Studies
Background:
- Acne is a common concern for transgender individuals undergoing gender-affirming hormone therapy (GAHT).
- Limited population-level data exist on acne incidence in transgender populations receiving GAHT.
- Understanding these patterns is crucial for comprehensive transgender healthcare.
Purpose of the Study:
- To compare acne incidence in transgender individuals, including those on GAHT, with matched cisgender individuals.
- To assess the incidence of moderate to severe acne in these groups.
- To analyze acne care utilization based on transgender status.
Main Methods:
- Retrospective matched cohort study using electronic health record data from Kaiser Permanente.
- Included individuals without baseline acne, transmasculine, and transfeminine individuals matched with cisgender controls.
- Follow-up up to 5 years; analyses conducted between November 2024 and November 2025.
Main Results:
- Cumulative 5-year acne incidence was 15.8% in transmasculine individuals vs. 3.8% in cisgender men and 10.5% in cisgender women.
- Acne risk in transmasculine individuals was highest in the first year post-testosterone initiation (HR 8.29 vs. cisgender men).
- Transfeminine individuals showed higher acne risk post-estradiol initiation compared to cisgender men (HR 1.56) but lower than cisgender women (HR 0.53).
Conclusions:
- Distinct acne incidence patterns exist between transgender and cisgender individuals.
- Close monitoring and treatment of acne are recommended for transmasculine individuals starting testosterone, especially within the first year.
- Clinicians should be aware of potential acne development in transfeminine individuals initiating estradiol therapy.
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