Systemic Testosterone Induces Structural, Immunological, and Sex Steroid Receptor Changes in Human XX Skin

This study investigated the effects of systemic testosterone on XX skin, particularly in transgender individuals undergoing gender-affirming hormone treatment. Analyzing discarded skin samples from surgeries, researchers found that testosterone-treated skin showed a 2.77-fold increase in androgen receptor-positive cells, elevated estrogen and progesterone receptor-positive cell counts, a 43% reduction in CD45 positive immune cells, and a 2.93-fold increase in collagen density in the dermis. In the epidermis, there was a reduction in progesterone receptor-positive cells and increased fibronectin expression. These changes suggest that testosterone-treated XX skin develops characteristics similar to male skin, driven by altered sex steroid receptor expression, immune cell infiltration, and structural organization. The study emphasizes the need for further research to understand the mechanisms of testosterone-induced skin remodeling and its impact on surgical outcomes.