# Why Topical Anti Androgens Matter for Acne
Acne is fundamentally a hormonal condition, and understanding this connection has opened new treatment possibilities that go beyond traditional approaches. For decades, dermatologists focused on bacteria and inflammation, but research has revealed that hormones play a central role in activating the sebaceous glands that produce acne. This discovery led to the development of topical anti-androgen medications, which represent a significant shift in how we can treat acne at its source.
The hormone most responsible for acne is dihydrotestosterone, commonly called DHT. This hormone binds to receptors in the skin and hair follicles, triggering increased sebum production and inflammation. Topical anti-androgens work by blocking DHT from attaching to these receptors, essentially preventing the hormone from activating the acne-causing process. Unlike oral medications that affect hormones throughout the entire body, topical anti-androgens work directly where the problem occurs, in the skin itself.
One of the most important topical anti-androgens is clascoterone, which was first approved by the FDA in 2020 as a 1% cream for treating acne in people 12 years and older. Clascoterone works by competitively binding to androgen receptors, blocking DHT from attaching to these same receptors. Because it acts locally on the skin rather than systemically throughout the body, it avoids many of the side effects associated with oral anti-androgen medications.
The effectiveness of topical anti-androgens extends across different patient populations. Research shows that these medications work effectively in both men and women, and in both adolescents and adults. This broad effectiveness suggests that hormonal mechanisms are fundamental to acne development across all these groups. Studies have found that clascoterone produces significant improvement in acne lesion counts with minimal systemic absorption, meaning the medication stays where it is applied rather than entering the bloodstream in significant amounts.
Dosing flexibility is another advantage of topical anti-androgens. While higher doses tend to be more effective, research has demonstrated that even lower concentrations can provide meaningful acne improvement. This allows dermatologists to tailor treatment to individual patient needs and tolerance levels.
The safety profile of topical anti-androgens is particularly noteworthy. Because these medications act locally and are metabolized quickly, the risk of systemic hormonal side effects appears low. Clinical data from acne trials showed no significant suppression of systemic hormone markers, even after weeks of application. This is a major advantage over oral anti-androgen drugs, which can affect hormone levels throughout the body and may cause side effects like breast tenderness, irregular menstrual cycles, or other hormonal changes.
Topical anti-androgens also improve treatment adherence in practical ways. Patients can apply a cream or solution to affected areas rather than taking daily pills, which reduces stigma and makes treatment easier to maintain consistently. This matters because acne treatment is not a quick fix but rather a long-term process requiring sustained effort and patience.
Modern acne treatment increasingly uses combination approaches that target multiple pathways simultaneously. Topical anti-androgens work well alongside other medications like retinoids and benzoyl peroxide, which address different aspects of acne formation. Retinoids help normalize skin cell turnover, benzoyl peroxide fights bacteria, and anti-androgens reduce the hormonal drive behind sebum production and inflammation. This multi-mechanism approach often produces better results than any single medication alone.
The development of topical anti-androgens represents an important evolution in acne treatment because it directly addresses a fundamental cause rather than just managing symptoms. By blocking the hormonal activation of sebaceous glands, these medications can prevent acne from developing in the first place, rather than simply treating existing lesions. This preventive aspect makes them particularly valuable for long-term acne management.
For patients who have struggled with acne despite trying conventional treatments, topical anti-androgens offer a new option with a different mechanism of action. They are particularly useful for patients who cannot tolerate or prefer to avoid oral medications, or for those whose acne appears to be driven by hormonal factors. The combination of local action, good safety profile, and proven effectiveness makes topical anti-androgens an important tool in modern dermatology.
Sources
https://www.dermatologytimes.com/view/acne-treatment-it-s-marathon-not-a-sprint
https://hairgrowthdoctor.com/clascoterone-cure-hair-loss/
https://pubmed.ncbi.nlm.nih.gov/41384221/?fc=None&ff=20251221162358&v=2.18.0.post22+67
