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What is the Cause of Acne: E2 or DHT?

Been doing an exhaustive research on both scientific papers and anecdotal experiences from different forums about what causes acne. There’s divided opinion on the answer: either high/crashed estrogen (E2) or high DHT (coming from conversion of high free test).

So what’s your opinion?

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I think both can cause acne. More androgens can cause acne by the release of more sebum (oils) by the skin. Estrogen can also cause acne, but I am not sure of the mechanism.

FWIW, I am prone to acne (terrible as a teenager, and have the scars to prove it), and I am blasting now (875 mg Test per week), and I am not getting much acne. I am washing more, I am using an AI (adex 0.25 mg EOD), and I am using finasteride (0.5 mg ED). Not recommending any of this, just giving my experience.

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I have pretty severe acne on my shoulders, chest and upper arms. I just got blood work done.

free test: 328.7 (range: 35 - 155 pg/mL)
DHT: 56 (range: 12 - 65 ng/dL)
E2: 41 (range: < or = 29 pg/mL)

I thought my E2 was going to be much higher than that. And prior to these results I thought my acne was caused by high E2. Now I think it is likely the DHT causing issues for me.

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Without blood work is difficult to assess. But maybe finasteride is contributing in keeping DHT under control, because 0.875 mg of Arimidex per week for 875 mg/week of test I think is still putting E2 out of range.

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Given your blood work, what makes you think is DHT and not E2?
Your DHT is in range, while E2 is above it.

I have upcoming blood work. I really need to get it done. Had some car issues that made that tough. I am trying to do it this week. I would bet that both are over range on my protocol.

Finasteride will lower DHT by about 70% max. If you take 10 mg a day you will reduce DHT by about 70%, if you take 0.5 mg a day, you will reduce DHT by about 65%. The dose response curve is flat very quickly. My DHT scales pretty linearly with Testosterone (I plot this stuff out cause I am a nerd). I would expect my DHT to be around 376 (scale was like 20-60). With the finasteride, I expect it to be around 140. We will see if my hypothesis is correct when I pull bloods.

The AI is under-dosed purposefully. I don’t shoot for being in range, I shoot for not having symptoms. I was a bit watery, so I started 0.25 EOD, and that helped enough, so I stayed there.

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Good information here. Thanks!

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41 E2 is not very high, when taking in account how high my total test and free test is. But you’re right, it could be the cause.

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Ive noticed that areas that are getting hairier tend ro get acne but it goes away, and before you know it Im hairier than when the acne started. Although it happens a lot when I lower my dose a bit. Still I think pores that are being stimulated with hair growth, will get clogged with microscopic hair follicles and this causes acne in some cases

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This is my dht level while on 7 mg daily