Acne

Acne is a long-term skin disease that occurs when hair follicles become clogged with dead skin cells and oil from the skin (Pic. 1). Acne is characterized by areas of blackheads, whiteheads, pimples, and greasy skin, and may result in scarring. The resulting appearance can lead to anxiety, reduced self-esteem and, in extreme cases, depression or thoughts of suicide.

Acne primarily affects skin with a greater number of oil glands, including the face (Pic. 2), upper part of the chest, and back (Pic. 3). During puberty, in both sexes, acne is often brought on by an increase in androgens such as testosterone. Excessive growth of the bacteria Propionibacterium acnes, which is normally present on the skin, is often involved.

Hormonal activity, such as occurs during menstrual cycles and puberty, may contribute to the formation of acne. During puberty, an increase in sex hormones called androgens (hyperandrogenism) causes the follicular glands to grow larger and make more sebum. Acne that first develops between the ages of 21 and 25 is uncommon. Several hormones have been linked to acne, including the androgens testosterone, dihydrotestosterone (DHT), and dehydroepiandrosterone sulfate (DHEA-S), as well as insulin-like growth factor 1 (IGF-1) and growth hormone (GH). Both androgens and IGF-1 seem to be essential for acne to occur, as acne does not develop in individuals with complete androgen insensitivity syndrome (CAIS) or Laron syndrome (insensitivity to GH, resulting in extremely low IGF-1 levels).

Medical conditions that commonly cause a high-androgen state, such as polycystic ovary syndrome, congenital adrenal hyperplasia, and androgen-secreting tumors, can cause acne in affected individuals. Conversely, people who lack androgenic hormones or are insensitive to the effects of androgens rarely have acne. An increase in androgen (and sebum) synthesis may also be seen during pregnancy. Acne can be a side effect of testosterone replacement therapy or of anabolic steroid use. Anabolic steroids are commonly found in over-the-counter bodybuilding supplements.

Polycystic ovary syndrome

Polycystic ovary syndrome (PCOS), the most common endocrine disorder among women of reproductive age, is characterized by the coexistence of hyperandrogenism, ovulatory dysfunction, and polycystic ovaries (PCO). The most common signs are acne and hirsutism (male pattern of hair growth) due to high levels of masculinizing hormones.

Endometrial hyperplasia

Endometrial hyperplasia is a condition of excessive proliferation of the cells of the endometrium, or inner lining of the uterus. Most cases of endometrial hyperplasia result from high levels of estrogens, combined with insufficient levels of the progesterone-like hormones which ordinarily counteract estrogen's proliferative effects on this tissue. Endometrial hyperplasia is a significant risk factor for the development or even co-existence of endometrial cancer, so careful monitoring and treatment of women with this disorder is essential.

The estrogen-progesterone combination therapy remains the main option for the treatment of hyperandrogenism for women who do not wish to become pregnant. It can be effective for hirsutism, acne and androgenic alopecia, and to prevent endometrial hyperplasia and its complications.

Amenorrhoea

Amenorrhoea is the absence of a menstrual period in a woman of reproductive age. When amenorrhoea is caused by abnormal production of testosterone, the hormone imbalance may cause acne. 

Oligomenorrhea

Oligomenorrhea is infrequent (or, in occasional usage, very light) menstruation. More strictly, it is menstrual periods occurring at intervals of greater than 35 days, with only four to nine periods in a year. Androgen excess is frequently associated with oligomenorrhea together with acne.