Why does Propecia (Finasteride) make acne so much worse when conventional science says it should do the opposite?

Question

Whenever I try taking propecia, I get horrible acne after less than a week of taking it and so now I have given up on Propecia. It seems to go against the "science" out there that has associated high DHT levels with more sebum and acne. Logic leads me to conclude that Testosterone must be the real cause of increased sebum and acne, not DHT, as propecia increases free T levels in the blood by inhibiting conversion into DHT. ANy insight on this from someone who knows the science?

Jeff Donovan, MD, PhD · Answer

About 3/4 of patients have an improvement in their acne with blockade of 5 alpha reductase. However, 1/4 do not have an improvement and some even get worse. Studies by Kohler et al showed clearly that some patients have worsening acne on finasteride. There is more to acne that DHT and there is not just “one type” of acne.

Reference

Kohler C, Tschumi K, Bodmer C, et al. Effect of finasteride 5mg (Proscar) on acne and alopecia in female patients with 72. normal serum levels of free testosterone. Gynecol Endocrinol. 2007;23:142–145

Parsa Mohebi, MD, FISHRS · Answer

I am hearing different side effects from finasteride from my patients. Although there might be some that are not really documented, in many cases you need to look for other factors that may have occurred concomitantly.

William Rassman, MD (retired) · Answer

There are no rules as our bodies reach differently to the same drugs.  Your acne has its own course and you need to discuss this with your doctor

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Why does Propecia (Finasteride) make acne so much worse when conventional science says it should do the opposite?

Answers (3)

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