Could my hormone therapy be causing my skin problems?

Question

Hello doctor,

I would like to ask something. I have been on TRT and GH replacement because I have hypogonadism and hypopituitarism. Over the years, my skin barrier has become damaged.

Every night, I start to itch, and the skin feels soft, which makes the itchiness worse. Then oozing starts, and I keep scratching until I bleed and feel a lot of pain. This happens every day, and I have it all over my arms and legs, and it keeps repeating. I need help. My current medications are testosterone and growth hormone.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

The pattern you are describing sounds extremely uncomfortable and distressing. With your history of hypogonadism, hypopituitarism, and long-term TRT (testosterone replacement therapy) and GH (growth hormone) replacement, your skin barrier may have become fragile and more reactive over time. The cycle you experience every night, like intense itching, softening or moisture, oozing, scratching, and then bleeding, suggests a combination of factors.

You may have chronic eczema or dermatitis, which is a condition affecting the skin barrier. With long-term hormone deficiency, dry and thin skin is common. Once the skin barrier is damaged, even minor irritation can trigger severe itching and inflammation.

The oozing and repeated bleeding also raise concern for a mild secondary bacterial infection, often caused by Staphylococcus, which worsens itching and delays healing. The itch-scratch cycle exacerbates the issue because once itching begins at night, it becomes increasingly complex to resist scratching, which in turn leads to further skin damage.

To help restore the skin barrier, use a thick, fragrance-free ointment or barrier repair cream such as petroleum jelly or other thick emollient creams. Apply them generously twice daily and especially before bed.
To help control nighttime itching, you may need short-term medical treatment, such as a moderate topical steroid to reduce inflammation or a non-steroid medication like Tacrolimus or Pimecrolimus, if long-term steroids are a concern.
Taking an oral antihistamine at night, such as Cetirizine, Hydroxyzine, or Fexofenadine, can also help reduce itching and break the cycle.
If there is a possible infection, you may require a topical antibiotic, such as Mupirocin, and in more severe cases, an oral antibiotic.

A doctor needs to examine your skin to confirm this. It is also essential to check your hormone levels. Even with TRT and GH replacement, under-replacement or over-replacement can affect the skin. Low cortisol, low thyroid, low estrogen or testosterone imbalance, or GH fluctuations can worsen skin health. A blood panel that includes a complete blood count (CBC), cortisol, ACTH (adrenocorticotropic hormone), thyroid tests, testosterone, and IGF-1 (insulin-like growth factor) can help ensure proper balance.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.