In the mysterious world of the human body, sex hormones should be considered one of the most amazing substances. When we enter this colorful period of life, the sex hormones in our body preside over a series of physiological changes: the onset of menstruation in women and the appearance of secondary sexual characteristics in men, such as beards and throat knots, etc. Along with these important changes, acne begins to appear on the face, which is why people also call acne ” youthful beauty acne”. The relationship between sex hormones and acne is so close. Generally speaking, both men and women have male hormones (androgens) and female hormones (estrogens) in their bodies, but due to the difference in gender, the ratio of the two in the body is different, i.e., men are mainly androgens and women are mainly estrogens. Where are the sex hormones secreted from? Modern research has confirmed that male androgens come from the testes and adrenal glands, while female androgens come from the ovaries and adrenal glands. The adrenal glands are located behind the human peritoneum, above the two kidneys, and they secrete androgens when the body is stressed, irritable, or anxious. All the androgens in the body’s circulation originate from it, with dehydroepiandrosterone and dehydroepiandrosterone sulfate being the main ones. Estrogen can promote skin metabolism and blood circulation, making the skin delicate and shiny, and inhibit the secretion of sebaceous glands and reduce the size of pores. Androgens, on the contrary, stimulate the enlargement of sebaceous glands, increase sebum secretion and keratinization of hair follicle sebaceous gland ducts. On the one hand, androgens promote sebum secretion, and on the other hand, they block the keratinization of the hair follicle opening, resulting in poor sebum excretion, resulting in the retention of large amounts of sebum and the formation of acne. The retained sebum becomes the best medium for Acinetobacter, which rapidly multiplies and secretes a large amount of lysoesterase, which breaks down the triglycerides in sebum, leading to an increase in free fatty acids, which in turn can stimulate the hair follicle sebaceous glands and trigger inflammatory reactions. This leads to the formation of pustules and red “bumps”, which are common in clinical practice, and in severe cases, cysts. It is clear from the above that increased androgen levels are the pathophysiological basis for acne. We know that there are two types of sex hormones in the body: androgens and estrogens. When the ratio of the two is appropriate, the body maintains a balanced internal environment. When the ratio is right, the body maintains a balanced internal environment. If not, the “order” is disrupted and problems arise, including acne. However, in clinical practice, we find that many patients with normal serum androgen levels still have acne or even severe cystic acne. This suggests that there must be other factors in the body. The results of the study found that in many acne patients, the elevated serum levels of androgens were not obvious, but in their skin lesions, dihydrotestosterone was significantly higher than in normal controls. Therefore, it is believed that the occurrence of acne is due to a disturbance in the metabolism of androgens in the peripheral skin tissues, i.e., the increased sensitivity of androgen receptors in the sebaceous glands themselves to androgens leads to increased synthesis of dihydrotestosterone in skin tissues. Therefore, the increased sensitivity of androgen receptors is also one of the main causes of acne development. Clinically, acne occurs in only a fraction of the population due to excess androgens in the bloodstream. Studies have also found that androgen receptors (AR) and estrogen receptors (ER) are present in human leukocytes, and their sensitivity also plays a significant role in the development of acne. Increased levels of AR in peripheral blood leukocytes, imbalance in the ratio between AR and ER, and increased sensitivity of AR to normal serum levels of androgens may all contribute to the development of acne. Therefore, clinically increased androgen levels, or an imbalance in the ratio of male to female (relatively highest androgen levels and relatively decreased estrogen levels), and increased androgen receptor sensitivity are initiating factors in the development of acne and provide the conditions for acne to develop. In addition, data also show that the incidence of acne varies among different races, with the incidence in Europe and the United States being higher than that in Africa and Asia, which, in addition to ethnicity, is also related to androgen levels.