The good thing about your doctor’s approach to treating you is that it’s evidence-based, unlike most holistic treatments.You might find this article interesting: Oral Spironolactone in Post-teenage Female Patients with Acne Vulgaris
Because of the complexity of acne, unlike say, liver damage, which can be pretty definitively identified using blood work etc, it’s extremely difficult to identify a cause from blood work. For example, even hormonal female acne doesn’t always show abnormally high circulating androgen levels (mine was completely normal), but certain types of tissue androgen may still be too high. So even if the tests come back negative, it doesn’t mean that your acne isn’t hormonally related, and it’s therefore still useful to try spironolactone. This could explain why he/she’s prescribing it before the results are back. Hormonal acne tends to be most severe on the lower part of the face/upper neck, and is often a bit sore. So he/she may be using this as an indication of hormonal acne.
In terms of what your doctor should be testing for, this may explain why. As long as you don’t have a renal condition, you’re pretty much good to go:
“It is important to establish prior to initiating therapy with spironolactone that there is no history of renal disease, that the patient does not utilize salt substitutes (many contain potassium in place of sodium), and is not utilizing potassium supplements, other potassium-sparing diuretics (i.e., amiloride, triamterene), ACE inhibitors, or ARBs. Many clinicians do not obtain baseline laboratory testing, including serum electrolytes, in young healthy female patients with AV with no medical problems who are not on any medication that may put them at risk for hyperkalemia when combined with spironolactone. Nevertheless, obtaining a complete blood cell count and chemical profile (including serum electrolytes) is a prudent approach to establish a baseline and to exclude some potential unexpected concerns in the given patient, such as pre-existing hyperkalemia or impaired renal function. After starting spironolactone for AV, clinical monitoring every 4 to 6 weeks, with adjustment of dose based on clinical response and assessment of side effects, is recommended until stabilization occurs.35 Laboratory monitoring in general is not essential overall, but some clinicians choose to test for hyperkalemia during the initial three months of treatment and periodically thereafter (Table 4).35 Serum potassium level monitoring and other testing, if applicable, can always be incorporated based on clinical judgment for individual patients who exhibit certain risk factors, such as older individuals and those on OCs containing DROSP.34 It is uncommon to experience hyperkalemia from spironolactone in healthy individuals; however, new-onset muscle cramps or weakness can be important clinical clues.”
If you’re worried about potential risks of spironolactone, here’s a study looking at the effects over a 8 year period:Long-term safety of spironolactone in acne: results of an 8-year followup study. http://www.ncbi.nlm....pubmed/12219252
Hope this helps.