Hormones are the initiating factor of acne. Androgens stimulate sebaceous cells to secrete more sebum, which increases the secretion of sebum and stimulates hyperkeratosis of hair follicle ducts, which thickens the hair follicle walls and prevents sebum excretion. This is the initiating factor of acne. Estrogen inhibits the function of the sebaceous glands and reduces the occurrence of acne. In men, the organs that secrete androgens are the testes and adrenal glands (eunuchs who were castrated in the ancient court had fewer androgens and did not suffer from acne); in women, the ovaries, placenta and adrenal glands also secrete androgens. Anti-androgen drugs can treat acne. Androgens play a role in the development of acne. Female patients with moderate or severe acne who also have high androgen levels and high androgen activity such as seborrhea, acne, hirsutism, and androgenic alopecia should be treated with anti-androgen therapy in a timely manner. The mechanism of action of oral anti-androgen therapy for acne: ① By reducing the excessive secretion of androgens caused by ovarian and adrenal cortical hyperfunction, it plays an anti-sebum secretion role. (ii) It can inhibit the ability of sebaceous gland cells and keratin-forming cells to convert testosterone. ③It can also act directly on hair follicle sebaceous glands to reduce sebum secretion and inhibit acne formation. Third, the choice of anti-androgen drugs The main anti-androgens are androstenedione and metformin, and the choice of their types is also very important. Androstadienone, also known as spironolactone, is an aldosterone compound. Mechanism of action: ① Competitive inhibition of dihydrotestosterone binding to receptors in skin target organs, thus affecting its action and inhibiting sebaceous gland growth and sebum secretion. ②Inhibit 5-alpha reductase and reduce the conversion of testosterone to dihydrotestosterone. The recommended dose is 1-2mg/(kg.d) for 3-6 months. Adverse effects are menstrual irregularities (probability of occurrence is positively correlated with dose), nausea, drowsiness, fatigue, dizziness or headache and hypercalcemia. Contraindicated in pregnant women. Not recommended for male patients, who may experience breast development and breast tenderness after use. Metacycline, or cimetidine, has a weak anti-androgenic effect, competitively blocking the binding of dihydrotestosterone to its receptors without affecting serum androgen levels, thereby inhibiting sebum production. The recommended dose is 200 mg 3 times daily for 4-6 weeks.