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What is hormonal therapy? Do I need to have my hormones evaluated?

Hormonal therapy is an excellent option for women with acne (i.e. moderate to severe acne or in women with late-onset acne. To know more about different types of acne, please refer to this page), more so if oral contraception is also desired. In fact, hormonal therapy implies oral contraceptives, either alone or in conjunction with other hormone treatments for undesirable increased of hair growth on our face or other parts of our body, excessive hair loss from the scalp, irregular menstrual periods, and other conditions as well.

Generally, hormonal therapy is useful for women with endocrine abnormalities and for women who are nonresponsive to or unable to tolerate those conventional acne therapies, i.e. oral antibiotics, topical antibiotics, and retinoids along with benzoyl peroxide. Nevertheless, hormonal therapy is proven effective when used in conjunction with other antiacne therapies/conventional acne therapies (i.e. oral or topical acne antibiotics, topical retinoids, azelaic acid, salicylic acid, and benzoyl peroxide). For those with concerns about the reduced effectiveness of contraception when oral contraceptive pills are used in conjunction with oral acne antibiotics, recent evidence suggests that their effectiveness in contraception should not be reduced.

Studies show that hormonal therapies work best in adult women and sexually active teens with persistent, painful, deep, inflammatory papules and nodules, and often comedones on the forehead and chin, though the skin may or may not be oily in this case.

How hormonal therapy works to treat acne is to block the effects of androgens (i.e. a class of hormones that cause the sebaceous gland to enlarge and produce more serum, which is an important factor in the causation of acne) on our sebaceous gland (i.e. oil-producing glands located in the deeper layers of our skin, and are attached to the hair follicle and the oil can travel up to the surface of our skin. We may want to read here for the details of human skin structure) and the skin cells that are lining our pores. It accomplishes this with the use of estrogens (i.e. female sex hormone) or a class of drugs known as antiandrogens (i.e. androgen receptor blockers such as cyproterone acetate, chlomadinone acetate, desogestrel, drospirenone, flutamide and spironolactone) or by agents designed to reduce our body's production of androgens by the ovary or adrenal gland, example of this included oral contraceptives, low-dose glucocorticoids, cyproterone acetate, estrogens, or gonadotropin-releasing hormone agonists.

An evaluation of hormones done by an endocrinologist is usually required for women with acne who have proven resistant to conventional acne treatments or if there is a sudden, severe onset of acne. Other cases in which an endocrine evaluation is required:
  • Women with acne who have irregular menstrual periods or increased hair growth in the face and abdomen (called hirsutism, which is generally caused by increased androgens, a common sign of polycystic ovary syndrome);

  • Women who relapse shortly after oral isotretinoin therapy

Hormonal screening tests (such as DHEAS, total testosterone, free testosterone, luteinizing hormone/follicle-stimulating hormone ratio, prolactin, 17-hydroxyprogesterone) shall involve a physical exam by the doctor and a series of blood tests to measure specific levels of hormones in the blood that are timed to correlate with a certain phase of women menstrual cycle. These tests are designed to help us pinpoint the source of our increased androgen production so that appropriate therapy can be instituted. It is no surprise to know that though women with acne are more likely to have abnormalities in hormonal evaluations than women without acne, however, most women with acne who are evaluated for hormonal abnormalities have androgen levels that are within normal limits.

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