We all know that androgens cause acne. However, there are instances that birth control pills fail at the project of resolving mild to moderate acne. That's where anti-androgens come in. In such instances, your doctor might prescribe anti-androgen drugs to specifically control the hormone levels in the body.

A new method of fighting acne is to hinder the unwanted action of androgens in the skin or in the sebaceous glands. The agents employed in this method are called anti-androgens.

Anti-androgen treatment is the right choice when oral and topical acne treatments don't seem to work for you, if you are unable or refuse to take a birth control pill, or if you have a hormonal imbalance wherein your body is manufacturing high levels of androgen.

If acne medications that used to work for you have lost their effectiveness, or your acne has turned for the worse, then ask your doctor if you need to be tested for androgen overproduction.

Two of the most widely used anti-androgens for inhibiting acne growth are spironolactone and flutamide.

Spironolactone and Acne

Spironolactone is primarily intended as a diuretic agent for hypertension, liver disease and heart failure. However, by possessing anti-androgenic properties, it has also been found effective against acne, seborrhea and hirsutism. One of its functions is to obstruct androgen receptors.

Spironolactone is effective for women suffering from recurring breakouts of severe acne. Spironolactone has a powerful anti-androgenic property that brings down oil production.

The dosage of spironolactone, taken at night, starts from a low 50 mg daily which is gradually increased to 200 mg daily. Positive results in the skin condition may take from 3 to 6 months, perhaps more.

Depending on the user's health condition, side effects may include:

- Watery stool
- Loss of alertness and drowsiness
- Nausea and headache
- Erratic menstrual cycles which include frequent menstruation, mid-monthly bleeding or stopping menses altogether
- Breast tenderness and pain

Flutamide and Acne

Flutamide is a purely non-steroidal oral anti-androgen that has been proven to be effective against stubborn female adult acne. Daily dosages of 250 mg are taken, combined with an oral birth control pill.

Flutamide is the oldest anti-androgen that is still in use. Its most severe side effect, fatal hepatitis, has been reported by some users, although its occurrence is rare. Pregnancy and other health risk concerns should be discussed with a doctor before undergoing flutamide treatment.

To minimize adverse side effects, the liver should be closely observed for the duration of the treatment. Nowadays, bicalutamide is the drug of choice that is slowly replacing flutamide because of its fewer recorded side effects.

The Disadvantages of Anti-androgens on Acne

Anti-androgens are not suitable for treatment of male patients because it gives rise to various male disorders including feminization of male characteristics (voice, physique, body hair, etc.), temporary impotence and diminished sexual urge. Male patients are instead recommended to use finasteride, which is first and foremost a treatment for male pattern alopecia, but has demonstrated substantial efficiency in treating acne.