From the Guidelines

Androgens play a significant role in the development of acne.

Androgens, such as testosterone and dihydrotestosterone (DHT), are known to contribute to the pathogenesis of acne by increasing sebum production, which can lead to clogged pores and inflammation 1.
The evidence suggests that androgens, particularly DHT, can stimulate the sebaceous glands to produce more sebum, leading to acne lesions 1.
Additionally, androgens can also increase the production of keratin, a protein that can contribute to the formation of comedones (blackheads and whiteheads) 1.
The relationship between androgens and acne is further supported by the fact that treatments that target androgen receptors, such as spironolactone, can be effective in reducing acne lesions 1.

The diagnostic accuracy of androgen measurement in polycystic ovary syndrome (PCOS) has been evaluated in several studies, which suggest that total testosterone (TT) and calculated free testosterone (cFT) are the most accurate androgen measurements for diagnosing biochemical hyperandrogenism in PCOS 1.
The use of liquid chromatography-tandem mass spectrometry (LC-MS/MS) is considered the reference standard for assessing steroids, including androgens, due to its high accuracy and sensitivity 1.

Topical photodynamic therapy (PDT) has been shown to be effective in reducing acne lesions by targeting the sebaceous glands and reducing sebum production 1.
PDT can also reduce the production of porphyrins, which are naturally produced by Propionibacterium acnes, a bacterium that contributes to the development of acne 1.
Other treatments that target androgen receptors, such as spironolactone, can also be effective in reducing acne lesions, particularly in women with PCOS or other conditions characterized by hyperandrogenism 1.

From the Research

Androgens play a significant role in the development of acne vulgaris, with higher androgen levels found in patients with acne compared to controls 2, 3, 4, 5.
The skin contains enzymes that convert precursor hormones to more potent androgens, such as testosterone and dihydrotestosterone, allowing for local regulation of androgen synthesis 2, 4.
Androgens stimulate sebum production, which is necessary for the development of acne, and may lead to a diagnosis of functional hyperandrogenism, such as polycystic ovary syndrome or nonclassical 21-hydroxylase deficiency 3, 4, 5.
The goal of hormonal therapy in acne is to oppose the effects of androgens on the sebaceous gland, with antiandrogens, such as cyproterone acetate or aldactone, being useful in severe acne 3, 5.

The sebaceous gland is the main site of hormone biosynthesis, especially for androgens, and acne is the classical androgen-mediated dermatosis 4, 5.
The androgen receptor-dependent genomic effect of dihydrotestosterone on sebocytes is confirmed, and genetic studies indicate that regulation of the androgen receptor is an important factor in severe acne 4, 5.
Androgens not only regulate embryology and lipogenesis/sebum synthesis in sebocytes but also influence inflammation in acne 4, 5.

While many arguments support the role of androgens in the aetiology of acne, their part in determining the severity of the disease is not well established 6.
A study found no positive correlation between the grade of acne severity and any of the clinical or laboratory markers of androgenicity assessed, suggesting that the severity of acne manifestation in adult women is not determined by androgen production 6.