Hi guys. I went to see my endocrinologist today to check up on my blood pressure/electrolytes with Spiro. I have basically been obsessed with hormones and how they effect the skin lately, so I thought I would ask him all my questions. He has been a very good doctor and he went to Harvard med school so I trust in what he has to say. So here are some Q and A's for anyone who is interested.
Q: I'm afraid that Spiro won't work because my testosterone is so low and so Spiro will make it worse.
A: Well we don't know what's happening at the skin level. There could be higher levels of testosterone and DHT in the skin that don't show up in the blood. Spiro would compete with these to block the androgen receptors in the skin. We just don't know though and have to wait and see.
(This is good news - but wouldn't this ALWAYS be the case for women with acne whose testosterone levels are normal - or low? If so, why wouldn't Spiro work for ALL women?)
Q: But what if it's not that I have higher levels of testosterone and DHT in the skin, but rather my androgen receptors are just really sensitive to low amounts?
A: This would be extremely rare, and a genetic fluke.
Q: What if the problem is that my estrogen is too low?
A: You would have elevated FSH and you don't. Also you were able to carry a pregnancy which shows your body isn't in premenopause or something. (He didn't say or something, I just can't remember how he finished that thought)
Q:What if my progesterone is too low?
A: Again, you were able to carry a pregnancy.
Q:What about the theory of estrogen dominance, that there is bad estrogen due to low progesterone?
A: This is "fringe thinking". There just hasn't been any work done to prove that or how it would effect the skin.
Q: Why do women have an initial outbreak? Why does the pill work for some and not others?
A: There are many variations that have not been studied, many genetic variations. No one has looked at this. There has to be the money so someone can study what happens in the skin. We just do not know.
(Freaking UNBELIEVABLE! Are you KIDDING me that no one has wanted to study how variations in the skin are impacted by hormones? I feel like this is gender discrimination or something. I mean, I've seen clinical trial with rat skin and what not but maybe that's not the same thing or they didn't puruse it enough. Ok, rant over)
Q: Why does Spiro take so long to work?
A: No one knows. But it takes 6-9 months. Although adverse effects would probably be seen sooner.
I find this stuff super interesting. If anyone else has these types of conversations with doctors please fee free to share! I'd love to hear what others have to say.