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Ok, so I feel I'm still confused about this in a way, and maybe I am not alone. I don't really get how Spiro works and maybe that's why I don't have high hopes on this drug.
So if we simplify the process, it is: Spiro blocks testosterone > skin produces significantly less oil > less breakouts form.
I do have elevated testosterone. This makes perfect sense.
Except that my skin is permanently DRY. Ok, in my teens it was an oily mess, but after Accutane I don't seem to produce a drop of oil and I still go 3-5 days without washing my hair (back then I had to every day). So how is it possible that I'm still breaking out in giant painful pustules? Why do I produce whiteheads on my face? If I had so much excess sebum, wouldn't that first show on my face, making it shiny and sticky etc?
Are there other factors in acne growth triggered by testosterone? Inflamation was mentioned, but how does testosterone contribute to the body's inflamation response?
Everybody talks about "oil decrease" first but my skin was and remains dry and inflamed. So if Spiro gets rid of the "excess" sebum in individuals who don't even have any, how would that stop breakouts from forming?
Or are skin receptors simply sensitive to any amount of testosterone and get irritated/overstimulated?
Sorry if I sound like a maniac, I really want to understand (so I could evaluate if it's worth to continue with Spiro). Would be good to hear some scientific facts!
:Puh:
This is a really good question. I definitely have oily skin triggered by testosterone/DHT in the skin itself. However, in my first trimester of pregnancy at some point my skin became very dry. However, the breakouts were fierce! So how is this possible? Dry skin, yet acne? If androgens are causing acne without producing oil, how are they doing it?
This phenomenon isn't really understood. The most popular theory of course is that excess oil = acne. I believe there are other components involved.
I have always had an oily T-zone (nose, forehead). DRY cheeks and chin. Where were my worst cysts? My cheeks and chin.
Going on spiro dried up my T-zone and my scalp considerably. Didn't seem to change my already dry areas. Yet the cysts on my dry skin areas are gone.
I don't know why that is. My speculation is
a) the oil theory is wrong (makes sense, otherwise why does Accutane fail so often?)
and/or
b) cysts come from oil trapped in deeper layers of the skin. precisely the reason I had more cysts in the dry areas was because the oil couldn't escape to the surface.
The second seems very likely. Also I read something about Spiro changing the consistency of the sebum. Maybe it becomes less sticky and doesn't get trapped that much 
Is that true that it helps to bring down the inflamation too?
I think Accutane helps with all aspects: inflamation, oil & skin cell shedding. So bizarre it still doesn't last.