Acne in Men: Why It Happens and What Works

Acne in men is driven by the same factors as acne generally — excess sebum, clogged follicles, bacteria, inflammation — but the hormonal environment is different. Testosterone directly stimulates sebaceous glands, which is why men tend to have oilier skin and often worse or later-onset acne than women.

Why men get acne

• High androgen levels: testosterone converts to DHT (dihydrotestosterone) in sebaceous glands, directly stimulating oil production. This is why acne spikes in male puberty and why anti-androgens are used in female acne treatment but not typically in men.
• Sweat and occlusion: exercise, helmets, and close-fitting clothing trap heat and moisture against skin — a breeding ground for acne-causing bacteria.
• Shaving irritation: disrupting the follicle opening during shaving can trigger inflammatory acne, particularly on the neck and jaw.
• Diet: men tend to consume more high-GI foods and dairy on average than women in most dietary surveys — both linked to acne.

What actually works

• Benzoyl peroxide (2.5–5%): kills Cutibacterium acnes bacteria and unclogs pores. The most effective OTC acne treatment. Start at 2.5% — the lower concentration is as effective as 10% with far less dryness.
• Salicylic acid (2%): oil-soluble, penetrates pores, dissolves the debris that causes blackheads and whiteheads. Good for blackhead-prone areas like the nose and forehead.
• Niacinamide (5%): reduces sebum production and calms redness. Well tolerated, no adjustment period needed.
• Retinoids: prescription tretinoin is the most effective topical treatment for acne overall. Worth requesting from a GP if OTC options plateau.
• Oral options: a GP can prescribe antibiotics (short-term), or refer for isotretinoin if acne is severe. Oral zinc (30mg elemental) has evidence for mild-to-moderate acne as a non-antibiotic option.