In my clinical work, I often encounter many patients with persistent acne who think or have been misled by others that there is an endocrine problem, so they first or at the same time register with the endocrinology department for consultation, or even spend a lot of money in the endocrinology department and do many tests, and then come back to the dermatology department after everything is found to be normal. This is obviously unnecessary. There is no denying that sex hormones, especially androgens, are closely related to the occurrence of acne, but a large number of studies have confirmed that the vast majority of acne patients lack evidence of endocrine disease. I. In which cases is an endocrine test necessary? There are certain specific manifestations for choosing an endocrine examination. If a female patient has more severe acne, repeatedly persistent acne, combined with hirsutism, oily skin, seborrheic alopecia, and also has clear irregular menstrual cycles (especially prolonged cycles and low volume), these require consideration of the possibility of androgen excess. Other rare clinical manifestations of hyperandrogenism are full moon face, buffalo back, hypersexuality, enlarged clitoris, deep pronunciation, and acanthosis nigricans. Women with hyperandrogenism may also present with insulin resistance, obesity, and infertility, which require attention to exclude polycystic ovary syndrome (PCOS). The above mentioned manifestations need to be examined under the guidance of a doctor. II. How to check? Sex hormone testing is best done on an empty stomach on the 3rd to 5th day of menstruation. Oral contraceptives can mask androgenemia, but oral cyproterone or spironolactone are not affected. Contraceptive pills need to be stopped for 4 to 6 weeks before testing. Screening laboratory test indicators include serum dehydroepiandrosterone (DHEAS), total testosterone level, free testosterone, luteinizing hormone to follicle stimulating hormone ratio (LH/FSH), etc. How to judge the results? The interpretation of items and normal values may vary from one laboratory test to another. Usually androgens can come from the adrenal glands and ovaries. Detection of DHEAS can be used to determine androgens of adrenal origin. Adrenal tumors should be considered when DHEAS levels are greater than 8000ng/L, and congenital adrenal hyperplasia may be present at levels between 4000 and 8000ng/L. An abnormally high serum total testosterone level suggests excess androgens of ovarian origin. When the blood testosterone level reaches 150-200ng/dl, or LH/FSH ratio >2-3, it suggests polycystic ovary syndrome. At this time, the patient may present with irregular menstrual cycles, spontaneous abortions, obesity, insulin resistance and hirsutism. The value of ultrasonography for the detection of polycystic ovary syndrome is controversial. This test is non-abnormal and ovarian cysts can be present in normal androgen levels, while the presence of ovaries is often not detected in the presence of hyperandrogenism or other associated records. Because of this the diagnosis of polycystic ovary syndrome is mainly based on serum sex hormone test values and other clinical manifestations. It should be noted that most women with acne have androgen levels within the normal range. Although studies have found that the blood levels of sex hormones in women with acne are higher than those in women without acne, they are usually within the normal range. In view of the above, acne patients should first go to a dermatologist for an evaluation of their condition and other manifestations before deciding whether to go to an endocrinologist. This can avoid more time and money spent on consultation at large hospitals, and also improve the accuracy of choosing a department and avoid blind consultation and examination.