A Case of Hidradenitis Suppurativa Responsive to Testosterone Replacement Therapy

This case study describes a 36-year-old female with Hidradenitis Suppurativa (HS) who experienced significant improvement after starting testosterone replacement therapy as part of a female-to-male gender transition. Despite previous treatments with antibiotics, intralesional steroids, and biologics like adalimumab and tildrakizumab, the patient continued to suffer from recurrent lesions. However, after commencing intramuscular testosterone, the patient reported complete resolution of groin lesions within 8 weeks, and no new lesions have appeared for 20 weeks without the need for biologics. The study suggests that exogenous testosterone may suppress endogenous hormone production, reducing the availability of pro-inflammatory 5-DHT, thus improving HS symptoms. This case highlights the potential role of sex hormones in HS management, although further research is needed to confirm these findings.