From the Guidelines
Treatment for high testosterone levels and acne in females should prioritize combined oral contraceptives (COCs) containing estrogen and progestin, such as drospirenone/EE, as they have been shown to reduce testosterone production and improve acne symptoms. According to the most recent guidelines 1, COCs are recommended for acne treatment based on moderate certainty evidence, and they yield net antiandrogenic properties, reducing ovarian androgen production, increasing sex hormone-binding globulin, and reducing free testosterone.
Hormonal Management
- COCs, such as Yaz, Yasmin, or Ortho Tri-Cyclen, are first-line treatments for hormonal management, as they reduce testosterone production and increase sex hormone binding globulin, which binds free testosterone 1.
- Spironolactone at doses of 50-200 mg daily is another effective option that blocks androgen receptors and reduces sebum production, and may be used off-label for acne treatment 1.
Acne Treatment
- Topical treatments, such as benzoyl peroxide (2.5-10%) to kill bacteria, retinoids like adapalene 0.1% gel to normalize skin cell turnover, and antibiotics such as clindamycin 1% to reduce inflammation, can be used in conjunction with hormonal therapy.
- For moderate to severe cases, oral antibiotics like doxycycline (100 mg twice daily for 3 months) may be prescribed alongside hormonal therapy.
Lifestyle Modifications
- Lifestyle modifications, including a low-glycemic diet, regular exercise, stress management, and a gentle skincare routine with non-comedogenic products, are also important for improving acne symptoms.
- Treatment typically requires 3-6 months for significant improvement, and regular follow-up with healthcare providers is essential to monitor hormone levels and adjust treatment as needed 1.
From the FDA Drug Label
1 INDICATIONS AND USAGE
- 3 Acne Drospirenone and ethinyl estradiol tablets are indicated for the treatment of moderate acne vulgaris in women at least 14 years of age, who have no known contraindications to oral contraceptive therapy and have achieved menarche.
The treatment for high testosterone level and acne in a female may involve the use of drospirenone and ethinyl estradiol tablets, as they are indicated for the treatment of moderate acne vulgaris in women.
- The patient must have no known contraindications to oral contraceptive therapy and have achieved menarche.
- The use of drospirenone and ethinyl estradiol tablets for acne treatment is recommended only if the patient desires an oral contraceptive for birth control 2.
- However, the label does not directly address the treatment of high testosterone levels.
From the Research
Treatment Options for High Testosterone Level and Acne in Females
- Hormonal therapies, such as anti-androgen agents, can be effective in treating acne in women with high testosterone levels 3, 4.
- Isotretinoin, a vitamin A derivative, can decrease androgen levels, including testosterone, and improve acne symptoms 5.
- However, isotretinoin may also increase levels of dehydroepiandrosterone (DHEA), a hormone that can contribute to acne pathogenesis, highlighting the potential need for co-administration of an anti-androgenic agent 5.
- Topical androgen receptor antagonists, such as clascoterone, have shown promise in reducing acne lesions and may be a useful treatment option for women with acne and high testosterone levels 6.
- Combination oral contraceptives can help reduce circulating androgen levels and are often used as a primary treatment modality for acne in women 4.
- Androgen receptor blockers, such as spironolactone, can be used in combination with oral contraceptives to achieve optimal results in selected women 4.
Key Considerations
- The treatment of acne in women with high testosterone levels should be individualized and based on the severity of symptoms and the presence of other hormonal imbalances 3, 4.
- Hormonal therapies should be used under the guidance of a healthcare professional, as they can have potential side effects and interactions with other medications 7.
- Further research is needed to fully understand the role of androgens in women and to develop effective and safe treatment options for acne and other androgen-related disorders 7.