I read a lot here but rarely post. I know so many of you have tried lots of things for hormonal acne, so I thought I'd ask for some advice.

I've had face and back acne for over 20 years. I am 34. Tried BP, AHA, Accutane (2 rounds), some antibiotics topically and orally, birth control. Nothing clears me up 100% (or even 75%) except for Accutane, but only for a year or so. I have tried making adjustments to my diet and reducing stress, but I see no difference and can't really stick with it. I tried a combo of NPC and DIM for 6 weeks and had a crazy breakout and stopped. My skin waas looking brighter when I was on them, before the breakout. It seems I get a big breakout in the later half of my cycle.

My face is ok these days - 1-2 pimples cysts a month around my chin/mouth/jawline, with many more healing, but lots of blackheads and oil. My back is awful - 5-10 huge active cysts at any time, probably 30-40 at various stages of healing, and scarring. I also have dark chin hairs and thinning hair on my crown. No fertility issues. My cycle is regularish. I am thin and don't tend to gain weight. I am and on again, off again smoker. I have a very high stress job and that won't change.

My hormonal blood tests were all normal although I don't have the numbers. My 17-OH- progesterone was high so I went for a ACTH test to rule out Congenital adrenal hyperplasia, which I don't have. The endocrinologist thinks I am just androgen-sensitive. She has prescribed spiro.

I am so so sick of having acne and always covering my back. I just don't know what to do next. Spiro? inositol? natural anti-androgens? estrogen (because the first half of my cycle is always clearer)? NPC (don't think low progesterone is my issue)? I am willing to commit several months to something, but I just don't know what to try because I don't know exactly what the problem is. I am thinking of just trying spiro but if i can find something cheaper and not a pharmaceutical, I would like that.

Help?