If you can post lab range numbers I can take a look. I've been reading labs a long time. Sometimes the "norm" isn't normal as some doctors believe. Before I was diagnosed with what I had, I had to go through this.

If you can post lab range numbers I can take a look. I've been reading labs a long time. Sometimes the "norm" isn't normal as some doctors believe. Before I was diagnosed with what I had, I had to go through this.

Thanks Pee yew. Unfortunately I don't actually have the numbers, they just told me they were all normal I don't know if they'd give me them if I rang up, but the receptionist is usually kinda unfriendly so I'm thinking probably not! Why do doctors say they're normal if they're not? I just don't understand, it's so frustrating!

Yeah I have the same thing - all normal results for androgens but acne, facial hair and no period whatsoever. As my endo explained, hormones can happen in the skin and not the blood. However, my estrogen is NOT normal - it is very low, like menopause ranges. I also have diminished ovarian reserve (low egg count, fertility problems). You didn't mention estrogen - did you have this tested?

Yeah I have the same thing - all normal results for androgens but acne, facial hair and no period whatsoever. As my endo explained, hormones can happen in the skin and not the blood. However, my estrogen is NOT normal - it is very low, like menopause ranges. I also have diminished ovarian reserve (low egg count, fertility problems). You didn't mention estrogen - did you have this tested?

Ah right, I didn't realise hormones could happen in the skin as well as the blood. They didn't test my estrogen but from a developmental perspective I would imagine it's probably not that high (I'm 21 but regularly get mistaken for about 14). They tested my growth hormone levels but never got back to me with the results... not sure if that's relevant or not. Sorry I find all this hormone stuff so confusing!

a saliva test sounds like a good alternative for you.

from everything i've read, they seem to be far more accurate than blood tests when measuring hormones.

a saliva test sounds like a good alternative for you.

from everything i've read, they seem to be far more accurate than blood tests when measuring hormones.

Oh that's interesting! I wasn't offered/asked for a saliva test. Do doctors generally do those for testing hormones?

This interests me as well... I have a gyno appointment coming up *shivers*, but I guess the only "good" thing about having that is, that I want to have my hormone levels tested. I would love to know once and for all if my acne is hormonal. I don't get the typical cheek and jawline acne that is generally categorized as hormonal. My problem areas are my forehead and chin/mouth area. My acne doesn't worsen around my cycle (which is and always has been severely irregular, thanks to osteopenia)... or when it does, it's like a single zit. Which could be completely coincidental.

What I would love to know is, when I get my hormones tested what should I be looking for? If my acne is hormonal what would the test read like? From what I've read, I think that if my acne was hormonal, my testosterone level would be out of whack. Obviously, I'm not completely sure. Can anyone provide some insight?

I am also interested in this post. I have also the same problem, I am 43 years old, suffering with cystic acne since I was teen. And every time I get my blood tested, the doctor says to me that my hormonal levels are normal. And I have been also taking diane35 for 5 years. I still have acne, but not so severe.

But the last time I had my blood tested, my doctor said that my estrogen levels were very low, the levels for estrogen were <5 (I dont know if the levels in your country are the same) because of the menopause. I would like to ask michi31 that said at her posts that her estrogen levels were low, how did you manage with the problem of low estrogen levels? Because I am currently taking Diane35, and I think this medication should provide enough estrogen. And do you think my low estrogen levels can cause my cystic acne ?

I am also interested in this post. I have also the same problem, I am 43 years old, suffering with cystic acne since I was teen. And every time I get my blood tested, the doctor says to me that my hormonal levels are normal. And I have been also taking diane35 for 5 years. I still have acne, but not so severe.

But the last time I had my blood tested, my doctor said that my estrogen levels were very low, the levels for estrogen were <5 (I dont know if the levels in your country are the same) because of the menopause. I would like to ask michi31 that said at her posts that her estrogen levels were low, how did you manage with the problem of low estrogen levels? Because I am currently taking Diane35, and I think this medication should provide enough estrogen. And do you think my low estrogen levels can cause my cystic acne ?

Well as of now I am on Spiro 100mg for 7 months and minocycline 50mg and I'm clear - but I'm so scared I will break out when I go off the mino as I am still oily. Anyway, it's interesting that you say you are on Diane and estrogen levels still low. I specifically asked my doctor if I go on birth control, will the estrogen in the pill be measurable in the blood and he said yes. So not sure if this is untrue or if your levels are STILL that low including the estrogen from the pill. I am planning to go on hormone replacement therapy - such as people do after menopause. I'll let you know how that goes. I do think low estrogen is connected - when I was in my third trimester and had sky high estrogen levels I was completely clear and not oily at all.

I am also interested in this post. I have also the same problem, I am 43 years old, suffering with cystic acne since I was teen. And every time I get my blood tested, the doctor says to me that my hormonal levels are normal. And I have been also taking diane35 for 5 years. I still have acne, but not so severe.

But the last time I had my blood tested, my doctor said that my estrogen levels were very low, the levels for estrogen were <5 (I dont know if the levels in your country are the same) because of the menopause. I would like to ask michi31 that said at her posts that her estrogen levels were low, how did you manage with the problem of low estrogen levels? Because I am currently taking Diane35, and I think this medication should provide enough estrogen. And do you think my low estrogen levels can cause my cystic acne ?

Well as of now I am on Spiro 100mg for 7 months and minocycline 50mg and I'm clear - but I'm so scared I will break out when I go off the mino as I am still oily. Anyway, it's interesting that you say you are on Diane and estrogen levels still low. I specifically asked my doctor if I go on birth control, will the estrogen in the pill be measurable in the blood and he said yes. So not sure if this is untrue or if your levels are STILL that low including the estrogen from the pill. I am planning to go on hormone replacement therapy - such as people do after menopause. I'll let you know how that goes. I do think low estrogen is connected - when I was in my third trimester and had sky high estrogen levels I was completely clear and not oily at all.

I would be careful before supplementing estrogen. You could have had high estrogen levels in your third trimester but your progesterone levels are also insanely higher during the third trimester too, which might have actually been enough to counter the estrogen and was what actually cleared your skin. The increase in progesterone is what some say gives people that pregnancy "glow".

This interests me as well... I have a gyno appointment coming up *shivers*, but I guess the only "good" thing about having that is, that I want to have my hormone levels tested. I would love to know once and for all if my acne is hormonal. I don't get the typical cheek and jawline acne that is generally categorized as hormonal. My problem areas are my forehead and chin/mouth area. My acne doesn't worsen around my cycle (which is and always has been severely irregular, thanks to osteopenia)... or when it does, it's like a single zit. Which could be completely coincidental.

What I would love to know is, when I get my hormones tested what should I be looking for? If my acne is hormonal what would the test read like? From what I've read, I think that if my acne was hormonal, my testosterone level would be out of whack. Obviously, I'm not completely sure. Can anyone provide some insight?

Can anyone answer the above questions? ^^

Mitchi31, It,s very interesting as you said in your post that my estrogen levels are so low, considering that I have been taking Diane35 for 5 years. I had my blood tested 1 month ago, and yesterday, my doctor gave me the results: 6.1 estradiol and he says its very low for a person at my age ( 43 years). The blood test was done the first day of my period. The last time I had my blood tested the results of estradiol was <5 estradiol ( I don`t know if in your country its the same ).

It,s also very interesting that you are going to start hormone therapy replacement. How old are you? Have you decided to do this on your own? What,s your level of estrogen?. Please let me know how it,s going. I thought of taking soya isoflavones. Have you ever taking them?

But I think you should be very careful as hearts says.

My doctor says that hormone therapy replacement is a mistake but he cant explain why I have my estradiol so low if I am currently taking 2 mg of estradiol every day.

Endocrine Evaluation

While androgens are essential to the development of acne, routine screening of women with acne or hirsutism usually reveals normal levels of androgens. The serum level of DHEAS, testosterone, and DHT in women with acne ranges from high to normal. Several hypotheses exist about why women with acne can have normal androgen levels. One possibility relates to the intracrine relationship of androgens and sebaceous glands, namely, there is increased local production of androgens in patients with acne. Another theory is that the sebaceous glands of patients with acne are more sensitive to androgens effects. Nonetheless, there is evidence for the successful use of hormonal therapy in women with and without elevated androgen levels.

When should an endocrine disorder be suspected? Hyperandrogenism should be considered if a woman presents with acne that is severe, associated with hirsutism, or irregular menstrual periods. Other signs include cushingoid features, increased libido, presence of acanthosis nigricans, and androgenetic alopecia. Further tests and referrals are appropriate since these women may have insulin resistance with resultant development of diabetes and cardiovascular disease. Screening tests include serum DHEAS, total and free testosterone, and luteinizing hormone/follicle stimulating hormone (LH/FSH) ratio. These tests should be obtained during the two weeks prior to the onset of menses to avoid the LH surge associated with ovulation. In addition, if the patient is on oral contraceptives, these should be stopped 4 to 6 weeks before the endocrine evaluation.

When interpreting the results of an endocrine evaluation, remember there are three sources of androgen production in women: the ovary, the adrenal gland, and within the skin itself. The first parameter to evaluate is DHEAS. An elevation indicates an adrenal source of the androgens. DHEAS levels >8000ng/mL (normal: <3500ng/mL) indicates an adrenal tumor. If the level is 4,000 to 8,000ng/mL, consider congenital adrenal hyperplasia. The next parameters to interpret are total and free testosterone. Elevation in testosterone, while not precluding an adrenal abnormality, commonly indicates an ovarian source of the androgens. Free testosterone is elevated in all forms of hyperandrogenemia, but can be useful if there is a SHBG dysfunction. Total testosterone >150 to 200ng/dL (normal range: 20 to 80ng/dL) indicates an ovarian tumor. Mild elevation suggests polycystic ovary syndrome (PCOS). Further findings in PCOS include an elevated LH/FSH ratio greater than 2 to 3, in addition to irregular menstrual periods, reduced fertility, obesity, hirsutism, and insulin resistance. If PCOS is diagnosed, ultrasound is indicated and the patient should be referred to a gynecologist for further evaluation.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2923944/pdf/jcad_2_12_16.pdf

I am also interested in this post. I have also the same problem, I am 43 years old, suffering with cystic acne since I was teen. And every time I get my blood tested, the doctor says to me that my hormonal levels are normal. And I have been also taking diane35 for 5 years. I still have acne, but not so severe.

But the last time I had my blood tested, my doctor said that my estrogen levels were very low, the levels for estrogen were <5 (I dont know if the levels in your country are the same) because of the menopause. I would like to ask michi31 that said at her posts that her estrogen levels were low, how did you manage with the problem of low estrogen levels? Because I am currently taking Diane35, and I think this medication should provide enough estrogen. And do you think my low estrogen levels can cause my cystic acne ?

Well as of now I am on Spiro 100mg for 7 months and minocycline 50mg and I'm clear - but I'm so scared I will break out when I go off the mino as I am still oily. Anyway, it's interesting that you say you are on Diane and estrogen levels still low. I specifically asked my doctor if I go on birth control, will the estrogen in the pill be measurable in the blood and he said yes. So not sure if this is untrue or if your levels are STILL that low including the estrogen from the pill. I am planning to go on hormone replacement therapy - such as people do after menopause. I'll let you know how that goes. I do think low estrogen is connected - when I was in my third trimester and had sky high estrogen levels I was completely clear and not oily at all.

I would be careful before supplementing estrogen. You could have had high estrogen levels in your third trimester but your progesterone levels are also insanely higher during the third trimester too, which might have actually been enough to counter the estrogen and was what actually cleared your skin. The increase in progesterone is what some say gives people that pregnancy "glow".

It is interesting - I have always thought progesterone was the culprit of my horrendous first trimester breakouts as I was supplementing heavily with progesterone at that time. But as they go up together throughout pregnancy, I suppose I'll never know. Also estrogen is the anti-androgen where progesterone has androgenic effects - which is why women breakout right before their period and why you get a pregnancy "glow" aka oily skin.

Mikito - My estrogen has fluctuated between 11 and 30. I'm sorry I don't have the units in front of me, but this is well below normal. It is consistent with post-menopause and I could never ovulate at these levels. The weird thing is my FSH is not elevated, so I am not technically in menopause. My endo wants me to supplement with estrogen because as you know, low estrogen leads to bone deterioration and osteoporosis already runs in my family. He thinks it's a major problem especially since I have such low estrogen at such a young age (I'm 32). why is your doc against it? It does have to be counterbalanced with progesterone to avoid the cancerous side effects, so it is much like the pill.

Mitchi31, It,s very interesting as you said in your post that my estrogen levels are so low, considering that I have been taking Diane35 for 5 years. I had my blood tested 1 month ago, and yesterday, my doctor gave me the results: 6.1 estradiol and he says its very low for a person at my age ( 43 years). The blood test was done the first day of my period. The last time I had my blood tested the results of estradiol was <5 estradiol ( I don`t know if in your country its the same ).

It,s also very interesting that you are going to start hormone therapy replacement. How old are you? Have you decided to do this on your own? What,s your level of estrogen?. Please let me know how it,s going. I thought of taking soya isoflavones. Have you ever taking them?

But I think you should be very careful as hearts says.

My doctor says that hormone therapy replacement is a mistake but he cant explain why I have my estradiol so low if I am currently taking 2 mg of estradiol every day.

Why i think estrogen is good from the link that was just posted:

Endocrine Evaluation

While androgens are essential to the development of acne, routine screening of women with acne or hirsutism usually reveals normal levels of androgens. The serum level of DHEAS, testosterone, and DHT in women with acne ranges from high to normal. Several hypotheses exist about why women with acne can have normal androgen levels. One possibility relates to the intracrine relationship of androgens and sebaceous glands, namely, there is increased local production of androgens in patients with acne. Another theory is that the sebaceous glands of patients with acne are more sensitive to androgens™ effects. Nonetheless, there is evidence for the successful use of hormonal therapy in women with and without elevated androgen levels.

When should an endocrine disorder be suspected? Hyperandrogenism should be considered if a woman presents with acne that is severe, associated with hirsutism, or irregular menstrual periods. Other signs include cushingoid features, increased libido, presence of acanthosis nigricans, and androgenetic alopecia. Further tests and referrals are appropriate since these women may have insulin resistance with resultant development of diabetes and cardiovascular disease. Screening tests include serum DHEAS, total and free testosterone, and luteinizing hormone/follicle stimulating hormone (LH/FSH) ratio. These tests should be obtained during the two weeks prior to the onset of menses to avoid the LH surge associated with ovulation. In addition, if the patient is on oral contraceptives, these should be stopped 4 to 6 weeks before the endocrine evaluation.

When interpreting the results of an endocrine evaluation, remember there are three sources of androgen production in women: the ovary, the adrenal gland, and within the skin itself. The first parameter to evaluate is DHEAS. An elevation indicates an adrenal source of the androgens. DHEAS levels >8000ng/mL (normal: <3500ng/mL) indicates an adrenal tumor. If the level is 4,000 to 8,000ng/mL, consider congenital adrenal hyperplasia. The next parameters to interpret are total and free testosterone. Elevation in testosterone, while not precluding an adrenal abnormality, commonly indicates an ovarian source of the androgens. Free testosterone is elevated in all forms of hyperandrogenemia, but can be useful if there is a SHBG dysfunction. Total testosterone >150 to 200ng/dL (normal range: 20 to 80ng/dL) indicates an ovarian tumor. Mild elevation suggests polycystic ovary syndrome (PCOS). Further findings in PCOS include an elevated LH/FSH ratio greater than 2 to 3, in addition to irregular menstrual periods, reduced fertility, obesity, hirsutism, and insulin resistance. If PCOS is diagnosed, ultrasound is indicated and the patient should be referred to a gynecologist for further evaluation.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2923944/pdf/jcad_2_12_16.pdf

Thanks biggs881 that was really informative! The first paragraph kind of explains why my hormone tests may have come out "normal" but I do also wonder if it's something to do with them doing the tests when I was already on Dianette as well. They didn't tell me not to take it or to stop taking it but I did wonder at the time whether that might skew the results. I don't actually have a record of my results and wouldn't really have the first clue how to interpret them anyway so I'm still not much wiser in terms of my own case but thankfully the Dianette seems to be helping for the moment at least!

I am also interested in this post. I have also the same problem, I am 43 years old, suffering with cystic acne since I was teen. And every time I get my blood tested, the doctor says to me that my hormonal levels are normal. And I have been also taking diane35 for 5 years. I still have acne, but not so severe.

But the last time I had my blood tested, my doctor said that my estrogen levels were very low, the levels for estrogen were <5 (I dont know if the levels in your country are the same) because of the menopause. I would like to ask michi31 that said at her posts that her estrogen levels were low, how did you manage with the problem of low estrogen levels? Because I am currently taking Diane35, and I think this medication should provide enough estrogen. And do you think my low estrogen levels can cause my cystic acne ?

Well as of now I am on Spiro 100mg for 7 months and minocycline 50mg and I'm clear - but I'm so scared I will break out when I go off the mino as I am still oily. Anyway, it's interesting that you say you are on Diane and estrogen levels still low. I specifically asked my doctor if I go on birth control, will the estrogen in the pill be measurable in the blood and he said yes. So not sure if this is untrue or if your levels are STILL that low including the estrogen from the pill. I am planning to go on hormone replacement therapy - such as people do after menopause. I'll let you know how that goes. I do think low estrogen is connected - when I was in my third trimester and had sky high estrogen levels I was completely clear and not oily at all.

I would be careful before supplementing estrogen. You could have had high estrogen levels in your third trimester but your progesterone levels are also insanely higher during the third trimester too, which might have actually been enough to counter the estrogen and was what actually cleared your skin. The increase in progesterone is what some say gives people that pregnancy "glow".

It is interesting - I have always thought progesterone was the culprit of my horrendous first trimester breakouts as I was supplementing heavily with progesterone at that time. But as they go up together throughout pregnancy, I suppose I'll never know. Also estrogen is the anti-androgen where progesterone has androgenic effects - which is why women breakout right before their period and why you get a pregnancy "glow" aka oily skin.

Why i think estrogen is good from the link that was just posted:

While testosterone and DHT have clear roles in acne

pathogenesis, research continues on the role of estrogen.

Estrogen is known to suppress sebum production when

given in sufficient amounts. Other mechanisms for

estrogens effect include direct opposition effect on

testosterone and inhibition of testosterone secretion.6,15 In

addition, through the metabolization of estrogen in the

liver, estrogen increases sex hormone-binding globulin

(SHBG).16 SHBG has a high affinity for testosterone and

will bind to it preferentially over estrogen. Since

testosterone and its conversion to DHT are the primary

androgens in acne, increased SHBG leads to improvement

in acne.17

Everyone has their opinions... obviously I have a different one here. Progesterone is not androgenic from both my research and from personal experience. It actually inhibits the 5 alpha-reductase process (which converts testosterone to DHT.) It has been shown to be anti-androgenic and can even reduce sebum production. Everything you quoted from that link actually sounds like progesterone to me, not estrogen. Women can break out before their period because of the spike in estrogen at ovulation if they don't have enough progesterone to combat this.

I wonder what kind of progesterone you were taking when you were in your first trimester... If it was from your doctor, it was most likely a synthetic progestin. In which case it doesn't surprise me that you would have had unwanted side effects. I've been using natural progesterone for almost a year now and I have had amazing results (not only relating to acne) with zero side effects.

I understand that you're going to do what you want and that's totally fine. I would still be careful... supplementing estrogen has shown to increase in endometrial and breast cancers and also heart disease among many other side effects. However, above all else I do hope that you find what works for you, since we are all different. Good luck, and I wish you the best.

I am also interested in this post. I have also the same problem, I am 43 years old, suffering with cystic acne since I was teen. And every time I get my blood tested, the doctor says to me that my hormonal levels are normal. And I have been also taking diane35 for 5 years. I still have acne, but not so severe.

But the last time I had my blood tested, my doctor said that my estrogen levels were very low, the levels for estrogen were <5 (I dont know if the levels in your country are the same) because of the menopause. I would like to ask michi31 that said at her posts that her estrogen levels were low, how did you manage with the problem of low estrogen levels? Because I am currently taking Diane35, and I think this medication should provide enough estrogen. And do you think my low estrogen levels can cause my cystic acne ?

Well as of now I am on Spiro 100mg for 7 months and minocycline 50mg and I'm clear - but I'm so scared I will break out when I go off the mino as I am still oily. Anyway, it's interesting that you say you are on Diane and estrogen levels still low. I specifically asked my doctor if I go on birth control, will the estrogen in the pill be measurable in the blood and he said yes. So not sure if this is untrue or if your levels are STILL that low including the estrogen from the pill. I am planning to go on hormone replacement therapy - such as people do after menopause. I'll let you know how that goes. I do think low estrogen is connected - when I was in my third trimester and had sky high estrogen levels I was completely clear and not oily at all.

I would be careful before supplementing estrogen. You could have had high estrogen levels in your third trimester but your progesterone levels are also insanely higher during the third trimester too, which might have actually been enough to counter the estrogen and was what actually cleared your skin. The increase in progesterone is what some say gives people that pregnancy "glow".

It is interesting - I have always thought progesterone was the culprit of my horrendous first trimester breakouts as I was supplementing heavily with progesterone at that time. But as they go up together throughout pregnancy, I suppose I'll never know. Also estrogen is the anti-androgen where progesterone has androgenic effects - which is why women breakout right before their period and why you get a pregnancy "glow" aka oily skin.

Why i think estrogen is good from the link that was just posted:

While testosterone and DHT have clear roles in acne

pathogenesis, research continues on the role of estrogen.

Estrogen is known to suppress sebum production when

given in sufficient amounts. Other mechanisms for

estrogens effect include direct opposition effect on

testosterone and inhibition of testosterone secretion.6,15 In

addition, through the metabolization of estrogen in the

liver, estrogen increases sex hormone-binding globulin

(SHBG).16 SHBG has a high affinity for testosterone and

will bind to it preferentially over estrogen. Since

testosterone and its conversion to DHT are the primary

androgens in acne, increased SHBG leads to improvement

in acne.17

Everyone has their opinions... obviously I have a different one here. Progesterone is not androgenic from both my research and from personal experience. It actually inhibits the 5 alpha-reductase process (which converts testosterone to DHT.) It has been shown to be anti-androgenic and can even reduce sebum production. Everything you quoted from that link actually sounds like progesterone to me, not estrogen. Women can break out before their period because of the spike in estrogen at ovulation if they don't have enough progesterone to combat this.

I wonder what kind of progesterone you were taking when you were in your first trimester... If it was from your doctor, it was most likely a synthetic progestin. In which case it doesn't surprise me that you would have had unwanted side effects. I've been using natural progesterone for almost a year now and I have had amazing results (not only relating to acne) with zero side effects.

I understand that you're going to do what you want and that's totally fine. I would still be careful... supplementing estrogen has shown to increase in endometrial and breast cancers and also heart disease among many other side effects. However, above all else I do hope that you find what works for you, since we are all different. Good luck, and I wish you the best.

Thanks! Yeah it was Crinone suppository - which I think is natural but I'm not sure. It's really hard to know what was the cause, it was like the second I was pregnant I broke out in cysts. Maybe it was the HCG since that goes up at first and then goes back down - who the heck knows. What kind of natural progesterone are you on? Do you know where I can read more about it's anti-androgenic effects? I have never seen that. I do hope we all find what works.

_{Hearts, I am also interested in the natural progesterone you are on. Could you please tell us the name of it and explain your experience with more detail? I am currently taking Diane35, and It has changed my acne from severe to mild acne, but I have never been clear from acne since I was teen. I was thinking of taking soy isoflavones, because I think that hormone replacement therapy is very dangerous.}

_{Mitchi31, my doctor says that replacement hormonal therapy is very dangerous, and It has been a mistake. Here in Spain, Doctor prescribed this therapy in the recent past, but actually most of them doesn't prescribe it for menopause for the reasons heart have explained ( increasement in breast and endometrial cancer). But as hearts says every one is diferent, and probably if your levels of estradiol are very low ( 32) probably in this cases you need this therapy to avoid osteoporosis.And I am not an expert but I think that 32 of estradiol is very low at your age.}

_{I have to point out that I have 6.2 of estradiol, but 5 years ago, my levels of estradiol were 115, and I also had acne. I don't know if estradiol is conected with acne. And I don,t know if my levels of progesterone are low or not.}

First of all, the "normal" range is too broad and you might still have an imbalance if you are within the normal range. For instance, you might be on the lower end of the "normal" range for progesterone, but for your body that might still be too low.

I had blood testing done too and the only hormone that was low was my progesterone, but they told me that everything else seemed normal. Blood testing is highly unreliable because they only draw blood once during your cycle, and so it's impossible to account for all the hormonal fluctuations that happen on various stages of your cycle. Also, the typical blood testing hormonal panel for acne/PCOS/hirsutism doesn't cover ALL hormones. This means they don't check for variants like free testosterone (only regular testosterone), estrogen dominance, and comprehensive thyroid testing. I happened to get tested during a time in my cycle where my skin always calms down, so no wonder they couldn't detect anything majorly off.

I'm getting a full hormonal panel test using saliva testing this time. Even though this isn't 100% accurate either, they have you submit a saliva sample during 3 or 4 times of your cycle so that they can give you a sense of how your hormones fluctuate throughout the course of a month. That might be an option for you if you want to figure out which hormones are causing your imbalance, so that you know exactly how to treat it. Standardized birth control/synthetic hormones don't benefit all women equally. They might fix one issue(e.g. the hormones causing the acne), but tip the scale towards other imbalances (e.g. weight gain) because they are not customized to your body's needs.

First of all, the "normal" range is too broad and you might still have an imbalance if you are within the normal range. For instance, you might be on the lower end of the "normal" range for progesterone, but for your body that might still be too low.

I had blood testing done too and the only hormone that was low was my progesterone, but they told me that everything else seemed normal. Blood testing is highly unreliable because they only draw blood once during your cycle, and so it's impossible to account for all the hormonal fluctuations that happen on various stages of your cycle. Also, the typical blood testing hormonal panel for acne/PCOS/hirsutism doesn't cover ALL hormones. This means they don't check for variants like free testosterone (only regular testosterone), estrogen dominance, and comprehensive thyroid testing. I happened to get tested during a time in my cycle where my skin always calms down, so no wonder they couldn't detect anything majorly off.

I'm getting a full hormonal panel test using saliva testing this time. Even though this isn't 100% accurate either, they have you submit a saliva sample during 3 or 4 times of your cycle so that they can give you a sense of how your hormones fluctuate throughout the course of a month. That might be an option for you if you want to figure out which hormones are causing your imbalance, so that you know exactly how to treat it. Standardized birth control/synthetic hormones don't benefit all women equally. They might fix one issue(e.g. the hormones causing the acne), but tip the scale towards other imbalances (e.g. weight gain) because they are not customized to your body's needs.

Thanks so much for all the info WishClean! I think I understand it all a little better now. When they did the blood test I'd already started on Dianette so I'm fairly sure that would have swayed the results. Before that there was definitely no way my hormones could be considered "normal". I don't know if I'd be able to get the saliva test done but I will look into it because it does sound like it takes a little more account of the variables. I do see what you mean about standard birth control not being tailored to an individual's hormonal imbalance but I'm not really sure what else you can do to adjust your hormone levels to something more normal. The Dianette has been helping the acne a bit I think (although I'm also on antibiotics and Epiduo so it's hard to know how much the birth control is helping on its own) but it does make me eat like a horse! It's not a bad thing at the moment because I was a bit underweight beforehand anyway but hopefully it won't become too much of a problem in the future. Thanks again for all the info and advice!

There are actually some ways to manage which hormones and what quantities you get for your body. It's called bioidentical hormone therapy, but it's definitely more expensive than going the conventional route. The doctor prescribes the right amount of hormones for you, and they come in the form of a cream, pills, or lozenges. When I was on diane 35 (stronger than dianette), the doctor also prescribed androcur (which you can't get in the US, but it works like other anti-androgens) because any estrogenic/progesterone bcp can raise testosterone indirectly because it increases the ratio of testosterone: estrogen & progesterone in the body. Also, pills like dianette can cause weight gain if you are getting more estrogen than your body needs. I was eating like a horse too, and it really messed up my metabolism because I gained weight that I couldn't lose easily. I had to practically starve myself and exercise a lot to lose 1/2 a pound. I was normal weight when I started, so at first I didn't mind a bit of weight gain, but then it spiraled out of control. I was also getting very depressed and scared of other side effects, so for me it was not the way to go.

There are actually some ways to manage which hormones and what quantities you get for your body. It's called bioidentical hormone therapy, but it's definitely more expensive than going the conventional route. The doctor prescribes the right amount of hormones for you, and they come in the form of a cream, pills, or lozenges. When I was on diane 35 (stronger than dianette), the doctor also prescribed androcur (which you can't get in the US, but it works like other anti-androgens) because any estrogenic/progesterone bcp can raise testosterone indirectly because it increases the ratio of testosterone: estrogen & progesterone in the body. Also, pills like dianette can cause weight gain if you are getting more estrogen than your body needs. I was eating like a horse too, and it really messed up my metabolism because I gained weight that I couldn't lose easily. I had to practically starve myself and exercise a lot to lose 1/2 a pound. I was normal weight when I started, so at first I didn't mind a bit of weight gain, but then it spiraled out of control. I was also getting very depressed and scared of other side effects, so for me it was not the way to go.

Thanks for the reply again WishClean. I've never heard of bioidentical hormone therapy but it sounds ideal. I live in the UK though and I seriously doubt that it would be available on the NHS. I'm a bit confused now because I thought that Dianette and Diane 35 were the same thing. The one I'm on is under the brand name Co-Cyprindiol and contains 2mg of Cyproterone Acetate and 35 micrograms of Ethinylestradiol if that means anything to you. I've heard of androcur but I don't know if they prescribe it in the UK. I have a dermatology appointment next Friday though so I might ask them about it. I seem to be always hungry on this pill it's really annoying. I really hope it doesn't make me gain too much weight that I then can't lose! Is depression a side-effect of these kind of pills? The thing I've been most worried about is the DVT risk but I generally just try not to think about it too much! Other than eating more than usual I haven't really seen any bad side-effects from it so far *touch wood*.

The side effects won't be evident until you take it long term. It's not recommended for long term use. Usually doctors will prescribe diane or dianette (which I think is the lighter version that was formulated after they assessed the side effects of diane) for a few months, and then switch you to a different pill after that time period. For me, it caused mood swings, bloating, and weight gain. It screwed up my metabolism.

Androcur is a European drug, so it should still be available in the UK. I was on it over 10 years ago, but women still take it. The combination of both diane and androcur was too strong for me. The can both cause weight gain. As for the depression, if you are prone to it then anything that messes with your hormones has the potential to affect your mood.

When I was a student in the UK, my experiences with the NHS were horrible. The doctors were clueless about hormonal acne and they would just throw pills at me to see what happens with no real concern about my health. One time, they gave me yaz and an anti-depressant, as if that would fix the problem! Needless to say, my cycle got very messed up and even on birth control my periods were never regular. I eventually turned to herbs and supplements to regulate my cycles. It's been over 5 years now since I quit taking birth control and antibiotics (although I did take antibiotics for an infection for a short period of time almost 2 years ago), and my periods are now regular. So yeah, I don't have much confidence in the NHS or doctors who prescribe hormonal treatments without doing a full hormonal panel test first.

Also, I think you are right in avoiding accutane, especially if your acne is hormonal. Accutane will suppress the acne but will not get to the root of the problem, that's why hormonal acne returns after accutane treatments.

You should start monitoring your cycles and acne breakouts to see if there is a pattern. My worst flare ups happen during ovulation (mid-cycle) rather than before or during my period...that's how I know there's something hormonally off. But they have been more mild since I started eating healthier and taking some supplements.

The side effects won't be evident until you take it long term. It's not recommended for long term use. Usually doctors will prescribe diane or dianette (which I think is the lighter version that was formulated after they assessed the side effects of diane) for a few months, and then switch you to a different pill after that time period. For me, it caused mood swings, bloating, and weight gain. It screwed up my metabolism.

Androcur is a European drug, so it should still be available in the UK. I was on it over 10 years ago, but women still take it. The combination of both diane and androcur was too strong for me. The can both cause weight gain. As for the depression, if you are prone to it then anything that messes with your hormones has the potential to affect your mood.

When I was a student in the UK, my experiences with the NHS were horrible. The doctors were clueless about hormonal acne and they would just throw pills at me to see what happens with no real concern about my health. One time, they gave me yaz and an anti-depressant, as if that would fix the problem! Needless to say, my cycle got very messed up and even on birth control my periods were never regular. I eventually turned to herbs and supplements to regulate my cycles. It's been over 5 years now since I quit taking birth control and antibiotics (although I did take antibiotics for an infection for a short period of time almost 2 years ago), and my periods are now regular. So yeah, I don't have much confidence in the NHS or doctors who prescribe hormonal treatments without doing a full hormonal panel test first.

Also, I think you are right in avoiding accutane, especially if your acne is hormonal. Accutane will suppress the acne but will not get to the root of the problem, that's why hormonal acne returns after accutane treatments.

You should start monitoring your cycles and acne breakouts to see if there is a pattern. My worst flare ups happen during ovulation (mid-cycle) rather than before or during my period...that's how I know there's something hormonally off. But they have been more mild since I started eating healthier and taking some supplements.

Yeh my doctor's only prescribed me 6 months of it but I haven't been able to discuss what will happen after that yet. The only bad thing it's done to me so far is make me eat way too much! I might look into the Androcur if it's a European drug. I haven't noticed any particularly bad mood effects, if anything I feel better in myself than I did before taking it (probably because the acne's improved and I'm no longer on my period almost constantly), but I am on anti-depressants anyway so that could be a factor.

I'm sorry to hear you had such a rubbish experience with the NHS when you were a student. I think they're really good on some things and not so good on others and they do often seem to treat the symptoms rather than the cause. I'm on antibiotics for the acne as well now. It's a bit frustrating that nobody bothered to explain the results of my hormones tests to me though because I'm fairly convinced my acne is hormonal, though I can't really explain why it got so much worse this summer in particular.

Thanks, I am very keen to avoid Accutane because a) I think the side-effects are very downplayed by doctors and I don't want to do something that has the potential to affect my overall health for the rest of my life unless I'm utterly desperate and b) I don't trust it not to play havoc with the depression that I already have anyway. I have heard that hormonal acne comes back after Accutane treatments as well so in all likelihood it might be completely ineffective for me anyway.

Can you monitor acne breakouts in relation to your cycle even if you're on the pill and antibiotics? I literally have no idea how my acne relates to my cycle because before taking the pill I effectively didn't even have a cycle and was just getting breakouts all the time. It has improved a lot now but I do still break out unfortunately.