James C. Shaw
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    TLDR Hormonal treatments can help with acne, especially in women, by lowering androgen levels or blocking their effects.
    In the 2002 review, it was found that androgens are crucial for acne development, but acne severity does not correlate directly with androgen levels, suggesting other factors like receptor sensitivity play a role. Hormonal treatments, particularly for women, can be effective by reducing androgen levels or blocking receptors. Oral contraceptives and androgen receptor blockers like spironolactone, flutamide, and cyproterone are highlighted, with spironolactone improving acne by 50 to 100% at doses of 100 to 200 mg/day and being well-tolerated. Flutamide showed an 80% improvement in acne but has a risk of hepatotoxicity. Cyproterone is also effective but has rare hepatotoxicity reports. 5α-reductase inhibitors and corticosteroids are mentioned for specific cases. The review concludes hormonal treatments are valuable, especially when standard therapies fail or in cases of hyperandrogenism, with a combination of oral contraceptives and androgen receptor blockers often used for better outcomes.
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