Although daily TRT injections are often promoted as “optimal,” acne is driven by what happens locally in the skin rather than average serum testosterone levels, and facial skin in particular has high 5-alpha reductase activity and androgen receptor density. Daily injections create constant micro-peaks of testosterone that provide a steady substrate for local DHT conversion in facial sebaceous glands, leading to continuous stimulation, excess oil production, and inflammation, even if blood levels appear stable. In contrast, injecting two or even one time per week allows more time below the skin’s acne-trigger threshold, reducing persistent androgen signaling despite higher systemic peaks. Daily injections can also suppress SHBG more, increasing free testosterone available to skin cells, further worsening acne. This explains why acne may appear only on the face and resolve completely when injection frequency is reduced, showing that injection frequency—not total dose—can be the key factor, and that “optimal” protocols are highly individual rather than universal.
Bottom line: This doesn’t happen to everyone, but in men who are acne-prone or already have low-normal SHBG, daily injections can push free androgen exposure high enough to trigger facial acne, while less frequent dosing keeps it below that threshold.
