From the Guidelines
Treatment for high testosterone levels and acne in females should typically involve spironolactone, an anti-androgen medication, at doses of 50-200 mg daily, as it has been shown to be effective in reducing acne severity and improving quality of life. According to a study published in the Journal of the American Academy of Dermatology in 2019 1, spironolactone has antiandrogenic properties, which decrease testosterone production and competitively inhibit binding of testosterone and dihydrotestosterone to androgen receptors in the skin.
Some key points to consider when treating high testosterone levels and acne in females include:
- Spironolactone may be used as monotherapy or in combination with other treatments, such as topical retinoids or oral antibiotics, to achieve optimal results 1.
- The use of combined oral contraceptives (COCs) may also be beneficial in reducing acne severity, as they have antiandrogenic properties and can help regulate hormonal imbalances 1.
- Lifestyle modifications, such as a low-glycemic diet, regular exercise, and stress management, may also help manage acne and reduce testosterone levels 1.
- Regular follow-up with a healthcare provider is essential to monitor hormone levels, adjust treatment as needed, and minimize potential side effects 1.
It's worth noting that while COCs can be effective in reducing acne severity, they may not be suitable for all patients, particularly those with certain medical conditions or taking certain medications 1. Spironolactone, on the other hand, has been shown to be effective and well-tolerated in many patients, making it a viable treatment option for high testosterone levels and acne in females 1.
From the FDA Drug Label
The combination of EE and DRSP increases sex hormone binding globulin (SHBG) and decreases free testosterone, Drospirenone is a spironolactone analogue with anti-mineralocorticoid and antiandrogenic activity. Acne vulgaris is a skin condition with a multifactorial etiology including androgen stimulation of sebum production
Treatment for high testosterone level and acne in a female:
- Drospirenone and ethinyl estradiol tablets may be used for the treatment of moderate acne vulgaris in women at least 14 years of age.
- The antiandrogenic activity of drospirenone may help decrease free testosterone levels, which can contribute to acne.
- However, the relationship between the changes in sex hormone binding globulin (SHBG) and free testosterone and the decrease in the severity of facial acne has not been established. 2 2 2
From the Research
Treatment Options for High Testosterone Level and Acne in Females
- Spironolactone is a synthetic aldosterone receptor antagonist that has antiandrogenic properties, making it suitable for treating diseases caused by excess androgen production, including acne and hirsutism 3.
- Estrogen-progestin oral contraceptives, antiandrogens, and insulin sensitizers are effective treatments for hirsutism, with antiandrogen monotherapy being similar in efficacy to the combination of oral contraceptives and antiandrogens 4.
- The combination of spironolactone, norgestimate, and estrogen is an effective and well-tolerated treatment for hirsutism in women with polycystic ovary syndrome (PCOS), with a favorable influence on lipids and indices of low-grade inflammation 5.
Hormonal Therapies for Acne
- Androgens play a pivotal role in the development and severity of acne, and hormonal therapies such as androgen receptor blockers, adrenal androgen production blockers, and ovarian androgen production blockers can be effective treatments 6.
- Spironolactone, cyproterone acetate, chlormadinone, and flutamide are examples of androgen receptor blockers that can be used to treat acne and hirsutism 6, 7.
- The choice of treatment depends on the individual patient's needs and medical history, and may involve a combination of medications and lifestyle changes.
Mechanism of Action
- Antiandrogens such as spironolactone and cyproterone acetate work by competitively inhibiting androgen binding at the receptor level, as well as suppressing androgen secretion and/or production 7.
- The combined mode of action of these agents makes them effective in treating diseases caused by excess androgen production, including acne and hirsutism.