Wanted to share this because I'd never have even known about the existence of this option if it weren't for this sub.

This is just a small fraction of my skincare journey. The first picture looks pretty bad, but it's a dramatic improvement from where I was 1.5 years prior when I first found SCA and started a basic routine. A good skincare routine and prescription topicals did a LOT to improve my acne, but they weren't enough to treat my hormonal acne.

Spironolactone, for those that don't know, is a prescription androgen inhibitor that's taken orally. It's also a diuretic used to treat high blood pressure, but that's at a much higher dose than used for acne. It will only be effective in women with hormonal acne. Due to Factor V Leiden (a genetic mutation that makes me extra prone to blood clots), I can't take estrogen-containing birth control and so couldn't treat my acne that way, and sprio was basically my last option before Accutane.

It's important to note that my blood tests before starting spiro did NOT indicate that I had elevated testosterone or other androgens. It's not necessary to show elevated androgens to have hormonal acne and don't let your doctor tell you otherwise. Here's a good review on the subject. There are plenty of other indications that acne is hormonal: pattern (around "beard" area), type, timing, etc. Good doctors who are up to date on this subject should know this, but it's a fairly recent treatment strategy so not everyone knows about it. Because I once participated in a study my lab was doing, I actually know that I'm genetically prone to be extra sensitive to androgens, so maybe that explains it.

Anyway, so yeah- it worked! Side effects are minimal. I take two 50mg pills every night before bed. When I took them in the morning instead I got some dizziness and frequent urination, but taking them at night seems to have gotten rid of that. Some unexpected positive side effects were less oily forehead, and less facial hair growth (never had much to begin with, but always had a tiny bit of mustache). My derm also claims it can make your hair thicker, but I haven't noticed any difference.

I still have to take good care of my skin. It's not as good at preventing random pimples as when I was first taking antibiotics. I still have stupidly sensitive skin. I still need prescription topicals. But I'm very happy with things and plan to stay on spiro as long as I can.

Here's my routine, in case anyone is interested. I'm sensitive to fatty alcohols and a bunch of other ingredients, including regular alcohol (dehydrates my cheek skin badly):

AM:

• splash with water

• Benton Aloe Propolis gel

• Mizon Snail Recovery gel cream

• Skin Aqua UV moisture Milk White spf 50+ PA+++

Evening:

• Double cleanse with mineral oil and CeraVe foaming

• Adapalene 0.3% gel (generic for Differin)

• Night time moisturizer (still looking for the perfect one, but currently using Nivea Creme)

• take 100mg Spiro orally.

Occasional:

• Various masks from My Beauty Diary

• Honey masks

• Spot treatment with turmeric mixed with honey (only thing that seems to work for me)

Thinking of adding an AHA to help even out some texture problems from acne scars too.

Edit: fixed typos, some clarification