Tretinoin and Sexual Function: What the Evidence Actually Shows

What the Renova label describes

Renova (tretinoin cream) 0.02% is approved only as an adjunct, alongside a comprehensive skin care and sunlight avoidance program, for mitigation (palliation) of fine facial wrinkles. Its label says it does not eliminate wrinkles, repair sun-damaged skin, reverse photoaging or restore more youthful skin [1]. In the double-blind, vehicle-controlled studies behind that label, 339 patients applied Renova 0.02% to their faces. Almost all reported one or more local reactions, and about 4% discontinued because of adverse reactions [1].

Topical tretinoin and oral isotretinoin are different products

Oral isotretinoin and topical tretinoin cream are different products; the Renova label describes a topical cream [1]. The hormone and mood studies below used oral isotretinoin, not topical tretinoin, and say nothing about topical tretinoin.

A 2011 study of 47 acne patients treated with isotretinoin for 3 months found significant decreases in free T3, thyroid-stimulating hormone, luteinising hormone, prolactin, total testosterone, morning cortisol and ACTH. The authors concluded that isotretinoin causes mild suppression of pituitary hormone levels [2]. That study measured hormones, not sexual function.

A 2017 meta-analysis of 31 studies found that isotretinoin treatment did not appear to be associated with an increased risk of depression, and mean depression scores fell from baseline. The authors noted that no randomized controlled trials were reviewed [3].

How much tretinoin gets through the skin

The Renova label reports that transdermal absorption of tretinoin from various topical formulations ranged from 1% to 31% of the applied dose, depending on whether it was applied to healthy skin or inflamed skin [1]. With a 0.05% cream in healthy men, absorption was less than 2% after a single application. Bioavailability was lower after 28 days of daily application, and there was no significant difference in the body's own tretinoin concentrations between single and repeated dosing [1]. The label states that no percutaneous absorption study was conducted with Renova 0.02% in human volunteers [1].

Skin irritation

The label calls Renova a dermal irritant and says topical use may cause severe local redness, itching, burning, stinging and peeling at the application site. It adds that larger amounts than recommended have not been shown to give faster or better results, and marked redness, peeling or discomfort may occur [1].

What the Renova label can and cannot tell you

The outcomes the label reports are skin effects and drug exposure. It does not report libido, erectile function or sexual satisfaction, so it cannot answer whether tretinoin changes them.