From the Guidelines

Acne and testosterone are closely linked, as fluctuations in testosterone levels can contribute to the development of acne.

To manage acne related to testosterone, it is recommended to consult a dermatologist or healthcare provider for personalized advice 1.
In cases where hormonal imbalance is suspected, particularly in women with polycystic ovary syndrome (PCOS), anti-androgen medications like spironolactone (25-50 mg twice daily) may be prescribed to help regulate hormonal balances and reduce acne severity 1.
Combined oral contraceptives (COCs), which contain estrogen and progestin, can also be effective in treating acne by reducing ovarian androgen production and increasing sex hormone-binding globulin, thereby reducing free testosterone 1.
For mild to moderate acne, topical retinoids such as adapalene (0.1% or 0.3%) or tretinoin (0.025% or 0.05%) may be prescribed for a duration of at least 3-6 months 1.
In more severe cases, oral antibiotics like doxycycline (50-100 mg twice daily) or minocycline (50-100 mg twice daily) may be considered for 3-6 months 1.
Isotretinoin, a powerful oral retinoid, may be considered for severe, resistant, or nodulocystic acne, but its use requires careful monitoring due to potential side effects, with a typical dose of 0.5-1 mg/kg/day for 4-6 months 1.

The association between acne severity and androgen levels remains unclear, with some studies showing positive associations while others showed no associations 1.
Routine endocrinologic testing is not indicated for most patients with acne, but may be warranted for patients presenting with clinical signs or symptoms of hyperandrogenism, such as hirsutism, oligomenorrhea, or androgenic alopecia 1.
It is essential to work closely with a healthcare provider to determine the best course of treatment for acne related to testosterone fluctuations, given the potential for hormonal therapies to have significant side effects 1.

From the Research

The relationship between acne and testosterone levels is well-established, with higher free testosterone levels contributing to increased sebum production, a key factor in the development of acne vulgaris 2, 3.
Testosterone is converted to dihydrotestosterone (DHT) in the skin, which stimulates the sebaceous glands and leads to acne formation 3.
Studies have shown that women with acne tend to have higher levels of total testosterone, lower levels of sex hormone-binding globulin (SHBG), or both, resulting in higher free testosterone levels 2, 4.
Elevated serum androgen levels, including testosterone, have been associated with acne, particularly in women with hirsutism or irregular menstrual cycles 5, 4.

Hormonal imbalance, including elevated testosterone levels, can contribute to the formation of acne vulgaris lesions 6.
Other hormones, such as prolactin, luteinizing hormone (LH), and follicle-stimulating hormone (FSH), may also play a role in the development of acne 6.
Lipid abnormalities, including high triglyceride levels and low high-density lipoprotein (HDL) levels, have also been linked to acne formation 6.

Evaluation of hormonal and lipid abnormalities may be helpful in the diagnosis and treatment of acne vulgaris 6.
Hormonal therapies, such as oral contraceptives, may be effective in reducing acne symptoms by decreasing free testosterone levels and inhibiting the conversion of testosterone to DHT 2, 5.