I've always been prone to acne. Got my first zits when I was around 10 or 11 years old. Then it was bad but not "needing medical care" -kind of bad throughout my teens. It calmed down a bit when I was around 18-19 but still got some acne every day. Then I started T at age 21 and the acne got just as bad as it was before again. Then I was off T for a while before I got on it again (for unrelated reasons), and not until I had been on it for about 2-3 years after starting it the second time the acne calmed down again. By then I was around 26 years old. Now a month shy of 29.
Since then and now I still get acne but it's fairly little/mild. Like 2-3 zits a day, on average. Usually on my face, but on rare occasion I get some on my back, chest, arms, stomach or even legs. Like wherever. If I'm stressed it gets worse. It's never been completely gone. I haven't gotten it diagnosed but I suspect I have some form of cystic/adult acne. My mother still gets zits too and she's 58, so it's likely hereditary for me. I have tried several different treatments but nothing has worked. Most treatments I tried made it worse. Nowadays I just wash my face about once a week and moisturise when needed cause I have dry skin too. Yes I have dry skin and acne, which makes the acne more difficult to counter cause most acne treatments dry out the skin, and a lot of moisturisers tend to worsen the acne or even cause flare ups. Also it's a lot worse in my beard for the same reason with the additional lack of oxygen in there. So that sucks. On occasion I put makeup (concealer/foundation) on it but usually I don't. Only if it's really bad and I need to show my face outdoors on that particular day.
As far as I know, testosterone is likely to cause acne, especially if you had it during first puberty. But it may not cause acne for those who did not get that during their first puberty. Testosterone is more likely to cause acne than estrogen. I expected to get acne from T and did get it. It sucks, but for me the pros of taking T still outweigh the cons. Also, if you get acne from it it's likely just gonna stay/be bad for the first year or so, but can last longer if you have acne for other reasons as well like I likely do.
I don't really care that much about my own acne nowadays, like it doesn't bring me down, unless it's hurting and itching at the same time. That drives me crazy. But otherwise I'm okay with it, and the scarring I got from it doesn't bother me. I know it doesn't make me ugly or anything, and other people don't judge me for it. Unless they're jerks, but why would I listen to the opinions of jerks anyway.