Using a testosterone-blocking drug to reduce the hormone levels responsible for activating oil production is controversial; it’s also an approach to treating acne and oily skin that is not very well-researched. The most frequently prescribed hormone blocker is known as spironolactone (brand name Aldactone). It is an option only for women, however, because without testosterone men start to develop female characteristics such as enlarged breasts and softer skin. But because testosterone can be one of the primary causes of acne, curtailing its presence in the body may have positive results—namely, acne clears up and oil production slows.
What kind of results can you expect? A study described in the Journal of the American Academy of Dermatology (September 2000, pages 498-502) looked at “85 women with acne
treated consecutively with spironolactone Results: Clearing of acne occurred in 33% of
patients treated with low doses of spironolactone; 33% had marked improvement, 27.4% showed partial improvement, and 7% showed no improvement. The treatment regimen was well tolerated, with 57.5% reporting no adverse effects.” Another study, reported in the Archives of Dermatology (September 1998, volume 134, number 9), reviewed “38 patients: 4 with severe acne (with cystic lesions), 32 with moderate acne, and 2 with mild acne. Improvement in acne, defined as a lessening in severity of acne classification, was observed in 32 (97%) of 33 patients who continued to follow up while receiving therapy. Of the 32 patients with improvement in their acne, all 4 patients with severe acne improved to moderate acne, 26 of 27 patients with moderate acne improved to mild acne and in 2 the acne disappeared, and both patients with mild acne experienced complete resolution. One patient had no improvement in her acne.”
While those statistics aren’t exciting, they may be of interest for women who have not responded well to other treatments. But the side effects of Aldactone are as daunting as those for Accutane. The list of adverse effects includes abdominal cramping, nausea, diarrhea, headache, reduced sexual drive (libido), dry mouth, excessive thirst, unusual tiredness, unusual muscle weakness, skin rash, deepening of voice, irregular or no menstrual periods, and slowed heart rate, plus enlarged breasts in men, and breast tenderness in women.
Moreover, hormone blockers require long-term use to effectively treat acne. When you stop taking them, the testosterone returns and so can the acne. Because hormone blockers require repetitive, continuous use, at least for treating acne, I strongly recommend trying Accutane before trying hormone blockers. Although Accutane’s side effects can be more serious than those of the hormone-blocking drugs, use of Accutane is very short term, involving only a few months, and it can be a permanent cure.