Trenbolone Hexahydrobenzylcarbonate and the Skin: Acne and Oiliness

Trenbolone hexahydrobenzylcarbonate, known under the former trade name Parabolan, is one of the most potent androgens found on the illegal market. Among its most noticeable side effects are changes in the skin: oily shine, enlarged pores, breakouts on the back and shoulders. The editorial team explains where "steroid acne" comes from, why it can be severe, and what is known about it from the scientific literature.

The sebaceous glands as a target of androgens

The sebaceous glands are small organs in the dermis that produce skin oil (sebum). Most of them are on the face, in the upper part of the back, on the chest, and on the shoulders. It is these areas that are the first to react to any fluctuations in the androgen background, which is clearly seen in the example of adolescence: with the onset of puberty the skin becomes oilier, and many people develop pimples.

The cells of the sebaceous glands — sebocytes — have androgen receptors. When an androgen binds to the receptor, sebocytes divide more actively, increase in size, and accumulate more lipids. As a result, the gland grows, and the amount of sebum on the surface of the skin increases. This process is dose-dependent: the stronger and longer the androgen signal, the more pronounced the reaction.

An excess of sebum in itself is not yet a disease, but it creates conditions for acne. The composition of the skin oil changes, the follicle ducts more often become clogged with keratinized cells, and microcomedones form. In such an environment the bacterium Cutibacterium acnes (formerly Propionibacterium acnes) actively multiplies, which triggers inflammation.

Dermatologists describe four key links in the pathogenesis of acne: overproduction of sebum, impaired keratinization in the follicle duct, bacterial colonization, and inflammation. Androgens directly "switch on" the first link and intensify the second, so any exogenous androgen is potentially capable of provoking breakouts even in a person who has never had skin problems.

Why trenbolone is especially "hard" on the skin

Trenbolone is a derivative of 19-nortestosterone with three double bonds in the steroid skeleton. According to the review work of Yarrow and colleagues (2010), it binds to the androgen receptor significantly more strongly than testosterone. High affinity for the receptor means that even a relatively small amount of the substance gives a potent androgen signal in tissues, including the skin.

Unlike testosterone, trenbolone is not converted to dihydrotestosterone and is not aromatized into estrogens. Sometimes a false conclusion is drawn from this that it is "mild" on the skin. In fact, the molecule is already a strong receptor agonist in itself, so it does not need enhancement via 5-alpha-reductase to stimulate sebocytes.

The hexahydrobenzylcarbonate ester makes the release of the active substance from the oil depot longer than that of the acetate. For the skin this means prolonged androgen stimulation without "dips." Moreover, trenbolone is rarely used in isolation: in the cases described in the literature it is usually combined with other androgens, and the total load on the sebaceous glands increases.

The review by Melnik and colleagues (2007) calls acne in bodybuilders who use anabolic steroids an underestimated problem. The authors emphasize that it is precisely in this group that severe forms of the disease, which are rarely seen in ordinary dermatological practice, occur disproportionately often.

Forms of involvement: from oiliness to acne fulminans

The mildest manifestation is seborrhea, that is, noticeably oily skin of the face and the hairy part of the head. A person notices that the face is shining within a few hours after washing, the hair "gets greasy" faster, and enlarged pores appear. These changes are cosmetically unpleasant but in themselves leave no marks.

The next stage is comedonal and papulopustular acne: blackheads and whiteheads, red inflamed nodules, pustules. The characteristic localization for androgen-induced acne is the back, shoulders, and chest, while the face may suffer less. Such "topography" often helps the dermatologist to suspect exogenous androgens.

The most severe forms are nodulocystic acne (acne conglobata) and acne fulminans. In the first case, deep painful nodules and cysts form, which merge with each other and heal with scars. Acne fulminans is a rare but dangerous condition, when a sudden flare-up of breakouts is accompanied by fever, joint pain, and changes in blood tests. Descriptions of such cases in users of anabolic steroids have been published repeatedly in the medical literature.

It is of decisive importance that severe acne almost always leaves consequences: atrophic or hypertrophic scars, keloids, post-inflammatory pigmentation. Their correction requires long and expensive procedures, and it is not always possible to completely eliminate the scars.

Other skin manifestations and accompanying factors

Besides acne, the review by Walker and Adams (2009) describes in users of anabolic steroids a whole range of skin changes: striae (stretch marks) in the area of the pectoral and deltoid muscles due to rapid increase in volume, increased body hair growth, and, in predisposed people, accelerated balding of the head.

Separately, it is worth mentioning local reactions at injection sites. Oil solutions from dubious sources are often non-sterile, which can cause infiltrates, abscesses, and even phlegmon. Such complications require surgical treatment and antibiotics.

The condition of the skin is also affected by accompanying factors characteristic of this group of people: a high-calorie diet with a large amount of dairy products and fast carbohydrates, intense sweating during training, wearing synthetic clothing that does not let air through. Each of them individually has a moderate effect, but together they intensify the action of androgens.

• Striae— on the chest, shoulders, armpits; over time they fade but do not disappear completely.
• Seborrheic dermatitis— flaking and redness on the face and the hairy part of the head.
• Folliculitis— inflammation of the hair follicles, often on the back and buttocks.
• Reactions at injection sites— induration, redness, abscesses.

It is important to distinguish these conditions, because the treatment approach differs substantially. For example, folliculitis can be of fungal nature and does not respond to classic acne remedies, while seborrheic dermatitis is treated with entirely different drugs.

What to do: the medical view

The first and most effective step is stopping the action of the causative factor. Androgenic acne, as a rule, gradually decreases after discontinuation of anabolic steroids, although this process can last for months. A long-acting ester means that even after the last injection the androgen stimulation persists for some time.

Treatment of acne is the competence of a dermatologist. For mild forms, topical remedies with benzoyl peroxide, retinoids, or azelaic acid are used. For moderate and severe forms, the doctor may prescribe systemic antibiotics or isotretinoin. The latter has strict contraindications, requires monitoring of liver tests and lipids, and in combination with anabolic steroids the load on the liver and lipid metabolism increases.

Openness with the doctor is critically important. If the dermatologist does not know about the use of androgens, they may incorrectly assess the cause of the breakouts and choose an ineffective treatment. Medical confidentiality protects the patient, and the doctor's goal is to help, not to judge.

For supporting the skin, basic hygiene measures are useful: gentle cleansing twice a day, a shower immediately after training, non-comedogenic moisturizers, refraining from mechanically squeezing out elements. They do not eliminate the cause but reduce inflammation and the risk of infection.

Editorial conclusions

Trenbolone hexahydrobenzylcarbonate is a potent agonist of the androgen receptor, and the skin is one of the first organs to react to it. Oiliness, breakouts on the back and shoulders, and the risk of severe forms of acne are predictable consequences of its biological action, not an "individual intolerance."

The absence of conversion to DHT does not protect the skin: the molecule itself is strong enough to stimulate the sebaceous glands. The long-acting ester prolongs this effect over time.

The most severe forms of acne leave scars for life, so any breakouts that progress quickly, hurt, or are accompanied by fever are a reason for an urgent visit to a dermatologist.

We also recommend reading our materials on the effect of trenbolone on hair and the risk of androgenic baldness, on the body's recovery after its use, and on the drug's metabolism.

References

1. Melnik B, Jansen T, Grabbe S. Abuse of anabolic-androgenic steroids and bodybuilding acne: an underestimated health problem. J Dtsch Dermatol Ges. 2007;5(2):110–117.
2. Walker J, Adams B. Cutaneous manifestations of anabolic-androgenic steroid use in athletes. Int J Dermatol. 2009;48(10):1044–1048.
3. Yarrow JF, McCoy SC, Borst SE. Tissue selectivity and potential clinical applications of trenbolone (17β-hydroxyestra-4,9,11-trien-3-one): a potent anabolic steroid with reduced androgenic and estrogenic activity. Steroids. 2010;75(6):377–389.
4. Pope HG Jr, Wood RI, Rogol A, et al. Adverse health consequences of performance-enhancing drugs: an Endocrine Society scientific statement. Endocr Rev. 2014;35(3):341–375.
5. Kicman AT. Pharmacology of anabolic steroids. Br J Pharmacol. 2008;154(3):502–521.
6. Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74(5):945–973.