# How Androgen Blockers Are Changing Acne Treatment
For decades, dermatologists have relied on the same basic approaches to treat acne: antibiotics, retinoids, and benzoyl peroxide. While these treatments work for many people, they come with drawbacks. Retinoids cause peeling and dryness. Benzoyl peroxide can irritate sensitive skin. Antibiotics lose effectiveness over time as bacteria develop resistance. Now, a new class of medication called topical androgen receptor inhibitors is offering a different path forward, one that addresses acne at its hormonal root without the side effects patients have long tolerated.
The key to understanding this breakthrough lies in understanding what causes acne in the first place. Acne develops when hormones called androgens trigger oil glands in the skin to produce excess sebum. This excess oil, combined with dead skin cells and bacteria, clogs pores and creates the inflammation we see as acne. For years, the only way to block these hormones was through oral medications that affected the entire body’s hormone system. Now, scientists have developed a way to block these hormones directly where acne forms: in the skin itself.
Clascoterone, also known by its chemical name Cortexolone 17alpha-propionate, is the first topical androgen receptor inhibitor to gain significant attention in acne treatment. The medication works by binding to androgen receptors in the skin and blocking the hormones that trigger oil production. When applied as a cream, it acts locally on the skin without entering the bloodstream in meaningful amounts. This local action is what makes it fundamentally different from older hormonal acne treatments.
The difference between local and systemic action matters enormously for patients. Oral hormonal treatments like spironolactone or birth control pills work throughout the entire body. They can reduce acne effectively, but they also affect hormone levels everywhere, which can lead to side effects like mood changes, weight gain, or changes in sexual function. Because clascoterone works only where it is applied, these systemic side effects do not occur. Studies of clascoterone in acne patients found no significant suppression of hormones measured in the blood, even after weeks of regular use.
The tolerability profile of clascoterone sets it apart from other topical acne medications as well. Retinoids, which are highly effective for acne, require what dermatologists call a “tolerance period.” Patients must gradually increase their use while their skin adjusts, experiencing redness, peeling, and dryness along the way. Many people stop using retinoids because the side effects are simply too uncomfortable. Clascoterone shows a completely different pattern. In clinical trials, investigators recorded no cases of peeling, dryness, redness, or swelling. Patient reports of stinging, burning, or itching were either absent or minimal. This tolerability advantage means patients are more likely to use the medication consistently, which is essential for acne treatment to work.
The mechanism of action also opens new possibilities for treating other conditions. Researchers are exploring whether clascoterone might help with male pattern baldness, since the same hormonal process that causes acne-related oil production also drives hair loss in genetically susceptible people. Early phase three trials of a five percent clascoterone solution for male pattern baldness have shown promising results, with some studies reporting up to 539 percent relative improvement in hair count compared to placebo. This suggests that blocking androgen receptors locally could address multiple hormone-driven skin and hair conditions without the risks of systemic hormone suppression.
The approval of clascoterone for acne treatment represents a shift in how dermatologists think about hormonal skin conditions. For decades, the choice was between topical treatments that did not address the hormonal cause of acne and oral medications that affected the entire body. Clascoterone fills a middle ground: it is topical like benzoyl peroxide or retinoids, but it addresses the hormonal root cause like oral medications do. It achieves this without requiring patients to accept systemic side effects or to take daily pills.
The practical advantages extend beyond just tolerability and safety. Patients using clascoterone apply a topical solution rather than taking oral medication. This approach reduces stigma and worry associated with systemic hormone therapy. Some patients avoid hormonal acne treatments entirely because they are uncomfortable with the idea of altering their body’s hormone levels. A topical option that works locally may appeal to these patients and bring treatment to people who previously chose to live with untreated acne.
The development of clascoterone also reflects a broader shift in dermatology toward precision medicine. Rather than using broad-spectrum treatments that affect the entire body, modern dermatology increasingly targets the specific biological pathways that cause skin disease. By targeting androgen receptor signaling directly at the site where acne forms, clascoterone represents this new approach. It allows dermatologists to preserve the body’s hormonal balance elsewhere while addressing the skin problem locally.
For patients with moderate acne who have struggled with the side effects of retinoids or who prefer not to take oral hormonal medications, clascoterone offers a new option. It is particularly valuable for people who need consistent, long-term acne treatment but have found existing options either ineffective or too uncomfortable to use regularly. The medication’s strong safety profile and excellent tolerability mean that compliance with treatment is likely to be higher than with older options.
The introduction of clascoterone into dermatology also raises important questions about how we should treat acne in the future. If a medication can block hormonal acne at the skin level without systemic effects, should this become a first-line treatment? Should it be combined with other topical treatments for better results? These are questions that dermatologists are actively exploring as more clinical data becomes available.
It is important to note that clascoterone is not a cure for acne. Like other acne treatments, it works best as part of a comprehensive skin care routine that includes gentle cleansing and sun protection. Some patients may still benefit from combining clascoterone with other treatments like topical retinoids or benzoyl peroxide, depending on the severity and type of their acne. The medication represents an important new tool in the dermatologist’s toolkit, not a replacement for all other approaches.
The approval and development of clascoterone also highlights how understanding the biology of skin disease leads to better treatments. Acne has been a common problem for centuries, but only in recent decades have scientists fully understood the hormonal mechanisms that drive it. This understanding has led to increasingly targeted treatments that address the root cause while minimizing side effects. Clascoterone exemplifies this progress.
As more patients gain access to clascoterone and more clinical data accumulates, dermatologists will develop a clearer picture of how best to use this medication. It may become a standard first-line treatment for hormonal acne
