Notes From My Dermatologist
My treatment plan to wean off of spironolactone & balance my hormones naturally
I have been taking spironolactone since March 2024, and it has worked wonders in clearing up my acne. However, I recognize that spironolactone is simply a temporary solution—a bandage rather than a cure. I know I won’t truly be free of hormonal acne until I address the underlying hormonal imbalance, which requires significant lifestyle changes.
Over the past three months, since my last dermatologist visit, I’ve started making those changes, but this is just the beginning. There’s still a long road ahead before I feel like I’ve truly “cured” my hormonal acne.
At this month’s check-in, I worked with my dermatologist to outline a formal treatment plan for gradually weaning off 100mg of spironolactone, focusing on healing my hormonal acne and naturally regulating my hormones.
Step 1: Gradual Reduction
Weaning off spironolactone should be done gradually to prevent a sudden hormonal imbalance or acne flare-ups. This layout is the ideal approach to take with my current dosage.
Month 1: Reduce to 75 mg/day.
Month 2: Reduce to 50 mg/day.
Month 3: Reduce to 25 mg/day.
Month 4: Discontinue.
But my dermatologist and I are being a bit more experimental in our approach so this is how I am going to tackle it.
My current dosage: 100mg/day
Month 1: 50mg/day
Month 2: Discontinue & introduce new supplements one by one to accurately track the effectiveness of each one.
Month 3: Check in with my dermatologist and assess skin progress, reactions, & overall health.
After our check in, we will adjust the treatment plan based on how my skin and hormones respond. I can always go back on Spironolactone if my acne requires it.
Step 2: Alternative Treatments for Hormonal Acne
While tapering off spironolactone, introduce or maintain acne-fighting treatments that support hormonal balance:
Topical Treatments:
Retinoids: Use tretinoin or adapalene to promote cell turnover and prevent clogged pores. — I’m currently using tretinoin 6 times a week so I’ll keep this up.
Azelaic Acid: Helps reduce inflammation, lighten post-inflammatory hyperpigmentation, and is safe for sensitive skin — I use this as needed if I have stubborn acne scars or emerging breakouts to address so I will also keep this as is.
Benzoyl Peroxide (2.5-5%): Spot-treat active acne to reduce bacteria. — I use PanOxyl as needed when I have a breakout to treat so I will keep as is.
Niacinamide: Supports oil control and reduces redness.
Oral Treatments:
Consider switching to a low-dose oral antibiotic (like doxycycline) as a temporary anti-inflammatory measure during the transition. — I’m still on the fence about this, if my skin flares up then I will use it.
Oral Zinc (30-50mg/day): Can help reduce acne inflammation.
Step 3: Hormonal Support
To naturally balance hormones and prevent acne flare-ups:
Dietary Adjustments:
Incorporate omega-3-rich foods like salmon, chia seeds, and walnuts.
Eat more cruciferous vegetables (broccoli, kale, cauliflower) to support estrogen detoxification.
Reduce sugar, dairy, and processed foods, as these can worsen hormonal imbalances.
Add fermented foods like yogurt, kimchi, and sauerkraut to support gut health.
Supplements:
DIM (Diindolylmethane): Supports estrogen metabolism.
Vitamin D3: Ensures hormonal health and supports skin healing (2,000-4,000 IU/day or as advised).
Maca Root - 500mg/day: An adaptogen that supports fertility and libido which is connected to estrogen productions in your body.
Pumpkin Seed Oil - 3000mg/day: Increases estrogen production to counteract androgens.
Magnesium: Helps regulate cortisol levels and balance hormones.
Evening Primrose Oil: May reduce hormonal acne by supporting skin health.
Probiotics: Improve gut health, which is linked to hormone regulation.
Lifestyle Changes:
Exercise Regularly: Helps regulate cortisol and insulin levels.
Sleep 7-9 Hours: Proper rest supports hormone balance.
Stress Management: Practice mindfulness, yoga, or other relaxation techniques.
Step 4: Regular Monitoring
Schedule follow-ups every 2-3 months to track skin's progress and adjust treatments as needed.
Consider hormone testing (e.g., testosterone, DHEA, and progesterone) to monitor any imbalances during the process.
Step 5: Additional Skincare Tips
Use a gentle cleanser and avoid over-exfoliating to maintain the skin barrier.
Incorporate non-comedogenic moisturizers with ceramides or hyaluronic acid to keep skin hydrated.
Apply SPF 50+ sunscreen daily, as hormonal acne treatments like retinoids can make skin photosensitive.
This gradual and supportive approach should minimize any disruptions to my skin or hormones while ensuring a smoother transition off spironolactone. My goal is to be off of spironolactone by June.