Hormonal acne can be an issue on and off HRT. However, this will not be equal to all of us. Some patients will have zero to trivial problems, and others like me will have to deal with them, but we have options to manage them.
My acne issues started somewhere in 2017. At first, no big deal. In time, acne appeared on my back only and not visible with a shirt or a tank top. After that, they moved to my shoulders and finally down to my arms.
I am the face of Dad Bod Transformation and my medical clinic, and I cannot allow myself to keep covering or retouching my body acne. Or keep explaining to folks at the gym what’s going on with my shoulders, which was why I stopped wearing a tank-top or my favorite cut-off shirt.
Anti-Bacterial, zinc, and sulfur soaps did work for a bit, and my skin stopped responding to them all. Tanning was helping and probably in the most efficient way; however, even tan wasn’t doing its job. And at some point, it might even make things worse.
Changing shirts daily, bed sheets regularly, lukewarm water while showering, and color-safe bleach for my clothes to kill the colonial bacteria did not make too much difference.
What is Spironolactone
Spironolactone is an aldosterone receptor antagonist approved by the FDA for acne treatment in the 1980s. In the beginning, studies included female participants only.
Bethanee J. Schlosser, MD, Ph.D., of Northwestern University, said here at the American Academy of Dermatology summer meeting. Though many dermatologists widely use Spironolactone to treat acne, the application remains off-label.
Dermatologists used a fixed-dose topical agent, isotretinoin, and Spironolactone to treat acne. I can tell you first-hand that isotretinoin is one nasty drug and with many side effects. Not to mention that isotretinoin can create irreversible side effects because this medication will alter the DNA.
How does it work
When your adrenal glands produce too much of a hormone called aldosterone, this creates many issues, such as water retention, high blood pressure, and stress on your kidneys. They’re unable to regulate water and salt balance.
If aldosterone is high, your circulating, under the skin androgen is too, and we would want to calm the side effects of too much androgen, which is where Spironolactone comes in handy. Spironolactone will not do much for your testosterone levels because you’re on therapy, and the same can apply even if you’re not—excessive means out of control.
So far, I am pretty happy with it, and I’ve seen a difference within a week. My acne flared out for a couple of days, and all of a sudden, they started “drying” out and disappearing one by one. Another patient experience was pretty similar. However, there was a second flare out, and after that, all acne calmed down.
Tanning can aggravate acne while on Spironolactone; at least, that’s my experience with it. Lukewarm water still implies, and hot will do what tanning does.
Spironolactone is also dieretic, and there will be plenty of urination. We could use this to our advantage to get rid of the excess water from our bodies.
Do not alter your dose in any way. Please don’t stop your treatment before talking to your provider. Spironolactone is a medication that we should not quit cold turkey.
Hydrate and drink more water than usual. Electrolytes are essential, but watch your potassium intake because this medication can raise it.
Besides being an acne medication and a diuretic, Spironolactone is for high blood pressure treatment and an extra thing to look after.
You should also read the Healthline link listed below.