Hormone Treatment

Hormone Treatment for Acne

Hormone therapy is a drinkable medication used for moderate or higher acne in women. Our hormone treatment is a combination of the ‘pill’ and a drug called ‘spironolactone’.

The low-dose Pill was developed in the USA in 1973 and is now taken daily by more than 100 million women worldwide. Japan is a backward country for the pill, but in Europe, including France, the Netherlands and Germany, about 50% of women aged 15-49 of childbearing potential take the pill for contraceptive purposes and it is also used as a treatment for acne and other skin conditions.

Spironolactone was originally used as a diuretic and heart failure treatment for many years, but its ability to suppress male hormones led to its application in the treatment of acne about 15 years ago. In addition to spironolactone, other preparations include Aldactone and NeuDouble.

Benefits and characteristics of hormone therapy

The effectiveness rate of hormonal treatment for acne is over 95%, making it the second most effective treatment after Accutane treatment. It is also known to be very safe and has a lower probability of causing serious side effects than antibiotics or antipyretic painkillers.

The disadvantage is that it takes some time for the effects to appear, with 30% of patients experiencing a transient exacerbation of acne during the first three months of treatment. On average, acne gradually improves from the fourth month. Another drawback is the high recurrence rate of approximately 60%. In the event of recurrence, 20% of patients return to pre-treatment levels.

Even if the treatment is symptomatic, eliminating all acne once and maintaining it afterwards is very important in terms of avoiding acne scars as much as possible. Some people also reach an age when they are naturally acne-free by continuing treatment to control their symptoms.

The treatment is often continued even after the skin has cleared up, with an average treatment period of 1~2 years. The main advantage is that it is extremely safe and can be taken for a long period of time if side effects are properly checked.

Hormone therapy is recommended for those who want to be treated with medication that has as few side effects as possible. It is also recommended for those suffering from gynecological diseases and symptoms such as irregular periods, dysmenorrhoea, polycystic ovary syndrome, endometriosis and menstrual pain, as it works in particular to improve these symptoms.

*With regard to the recurrence rate, a recurrence is defined as a return of the number of new pimples to more than 1/3 of the pre-treatment state after the end of treatment.

Read also. (*Japanese-language page)

Women also produce ‘male hormones’ in their bodies. The two organs that secrete male hormones are the ovaries and the adrenal glands (cortex). Male hormones have undesirable effects on women, such as making hair thicker, increasing the size of the sebaceous glands and aggravating acne.

Women with excessive levels of male hormones, or with normal levels but high sensitivity to male hormones, may suffer from acne.

Our hormone therapy involves the use of the pill, which contains small amounts of female and progestin hormones. Female hormones act to improve the texture of the skin, reduce the size of pores and increase the moisture content of the skin. Depending on the type, progestins can either strengthen or weaken the action of male hormones, and for the treatment of acne, those with the power to suppress male hormone activity are used.

Spironolactone is also used in our clinic, and spironolactone has an anti-androgenic effect and suppresses male hormones. It is very safe and can increase the cure rate of acne when treated with spironolactone and pills.

On the other hand, it is known that spironolactone is only effective for as long as you are taking it and that there is a rebound, so our approach is to gradually reduce the dose of the medicine to prevent rebound once the pill has become effective.

By testing male and female hormone levels, it is possible to see the hormonal balance a person has. However, we do not actively perform hormone testing.

The main reasons for this are that treatment is effective for most women without testing, that hormone levels are normal in cases of high sensitivity to male hormones, and that it is an expensive test (JPY 9,746 for four female hormones plus male hormone test).

On the other hand, women who have suffered from acne for many years and have symptoms such as irregular menstruation should have a hormone test. This is because a gynaecological condition called ‘polycystic ovary syndrome’ (PCOs) may be hidden: patients with PCOs have a higher level of LH, a female hormone, than FSH, and male hormone levels are often elevated.

Blood samples should be taken ‘on the morning of the third to fifth day of menstruation’ as the hormonal balance can fluctuate. If you wish to be tested, please make an appointment to coincide with the timing (testing is not available if you are on hormonal medication).

Treatment cases of hormone therapy

To view case studies of acne treatment with hormone therapy, click below.

Treatment case 1 (red face and papules)

How she came to our clinic

Female in her 20s. She began to develop acne in junior high school, and from her 20s onwards, red pimples began to appear extensively on her entire face. She had been receiving insurance treatment at a dermatology clinic for several years, but as no improvement was observed, she underwent a treatment called ‘arc light therapy’ at an osteopathic clinic twice a week for about 50 sessions over seven months. However, there was no improvement at all, so she came to our clinic.

Photos before treatment

Countless fine papules are present on the entire face and the entire face is reddened due to acne inflammation and hyperpigmentation.

Red Face and Red Acne
Red Face and Red Acne

Hormonal therapy with the pill and spironolactone was initiated.

Photos after 8 months

New acne has decreased dramatically. The inflammation has also subsided and the redness of the entire face has improved. After about three months of treatment, the acne has improved and salicylic acid macrogol peels are performed once a month and the hyperpigmentation of the acne scars is less noticeable.

Reddened Face and Red Acne After Treatment
Reddened Face and Red Acne After Treatment

Commentary

The patient was treated with the pill and spironolactone for approximately three years, which was once completed. During the following three years, the skin condition had settled down, but the patient was treated again with hormonal therapy because of recurrence, although the condition was not as bad as when the patient was first diagnosed.

According to our data, the recurrence rate of hormone therapy is more than 60%, which is a disadvantage compared to isotretinoin (Accutane) in that it is more likely to recur.

For this reason, we explain that the patient should take the drug until the disease has lost some of its virulence (disease momentum). The advantage is that it is relatively safe and can be taken internally over a long period of time, and can be taken on a maintenance basis to prevent acne scars from increasing.

How she came to our clinic

Female in her 20s. She had been suffering from acne since around junior high school and was treated with Chinese herbal medicine and Bepiogel at a nearby dermatology clinic, which once improved, but recurred and worsened after she entered the workforce. Afterwards, she again underwent insurance treatment including topical medication, Chinese medicine and antibiotics, but there was no improvement, and she was prescribed low-dose pills (Favoir) by a gynaecologist, but there was no improvement, so she came to our clinic.

Photos before treatment

Small red acne
Small red acne

It is not severe, but there is a mixture of fine white and red acne, mainly on the cheeks and chin, and the acne makes the skin look uneven. Treatment was started with a change from Favoire, which she had been taking at her previous doctor, to a type of pill that suppresses male hormone activity, with the addition of spironolactone.

Photos after 1 year

The following photographs are taken one year after the start of treatment. The new growth of acne has disappeared and the skin has returned to its original clean, bare state.

Small red acne after treatment
Small red acne after treatment

Commentary

Hormonal acne treatment requires an approximate period of three to four months to improve. In addition, the initial aggravation is most common in the first month and may last up to three months.

It is not suitable for those who want a quick cure, but for those who want a treatment option with fewer side effects.

The advantages of hormone therapy are that, in addition to relatively few side effects, it is also easier to use for patients with PMS, irregular periods or PCOs (polycystic ovarian syndrome), as menstrual pain is reduced and periods (bleeding) occur regularly.

Disadvantages include a high recurrence rate and, although rare, the risk of thrombosis, breast cancer and cervical cancer must also be taken into account.

Even if the treatment does not lead to a radical cure and is symptomatic, controlling acne is very important for the skin as it prevents the formation of acne scars.

Patients whose photographs are published have given written consent for publication. Photographs taken during consultations are for medical records and are protected by the Personal Data Protection Act. Please be assured that they will not be published without your consent.

Those who cannot receive hormone therapy

The following people may not be eligible for hormone therapy

  1. those who are importing medicines on their own
    Please note that we only treat patients who are able to receive medicines and treatment under the responsibility of a doctor.
  2. men who are male
  3. premenopausal patients
    The epiphyseal line may close and height may stop.
  4. those under 18 years of age
    If you are under 18 years of age, you must be accompanied by a parent or guardian at your first visit to prescribe medicines. On return visits, the patient can be seen in person alone.
  5. Tobacco smokers
    Due to their interaction with tobacco, we always ask smokers to stop smoking.
  6. People over 40 years of age
  7. Pregnant, lactating or planning to become pregnant within a year
  1. have a BMI (weight divided by height squared) of more than 30
  2. have a history of breast cancer, cervical cancer, cervical epithelial tumours, Crohn’s disease, ulcerative colitis, hypertension, hyperlipidaemia, diabetes, severe liver disorders, renal disorders, liver tumours, otosclerosis, antiphospholipid antibody syndrome, thrombophilia, pulmonary hypertension, atrial fibrillation, valvular heart disease, endocarditis, porphyria or epilepsy
  3. those with migraine with aura (e.g. darkening in front of the eyes, twinkling, narrowing of vision, etc.), those over 35 years of age with migraine headaches
  4. those with abnormal genital bleeding with no confirmed diagnosis
  5. those with high blood pressure, jaundice, persistent itching or herpes during pregnancy

Side effects of hormone therapy

The pill is used by more than 100 million women every day worldwide and is one of the safest drugs available. In some Western countries, about half of women in their 20s and 30s use it (Germany 52.6%, France 43.8%).

It has been prescribed for more than 50 years and is recognised as a safe drug, but at the beginning of taking it, symptoms such as nausea, headache, breast pain and swelling may occur due to changes in the hormonal balance. Most of these side effects gradually lessen as you continue taking the drug.

Some people worry: “Will taking it affect my pregnancy?” However, there is almost no chance of becoming pregnant while taking the pill, as it has a contraceptive effect. There is no evidence that it is harder to get pregnant after stopping taking the pill.

Some patients are afraid of getting cancer, but within five years of taking the pill, the increased risk of breast and cervical cancer is small, while the risk of uterine, ovarian and colorectal cancer is reduced.

Breast cancer is estimated to affect one in 12 Japanese people, but the risk is thought to be up to 1.2 times higher. The risk gradually disappears once you stop taking the drug.

Data show that there is little increase in the risk of cervical cancer if the woman has been taking the pill for five years or less, but the risk doubles if the woman has been taking the pill for 10 years or more. We recommend screening for cervical cancer once every two years from the 20s and once a year from the 30s for breast cancer, regardless of whether you are on the pill or not.

Other very rare cases of liver damage and liver cancer have been reported overseas in people taking cyproterone acetate (Diane Sucy) long-term. At our clinic, we change the type of pill if not necessary and there has not been a single case of liver cancer reported in the past.

Regarding the risk of thrombosis (a disease in which blood clots and clogs in the veins or arteries) caused by the pill, it should be noted that it can increase from three to up to seven times, depending on the type of medication.

For example, Yaz is known to have one of the highest risks of thrombosis among low-dose pills, with three deaths reported in the past out of 140 000 patients prescribed in Japan. Even if it does not lead to deaths, the number of people who have developed thrombosis is reported to be 87, which is higher than that of other pills.

However, 3 out of 140,000 people means 2.1 deaths per 100,000 people. Statistically, this is one in four compared to the probability of dying in a road accident, and one in 80 compared to the probability of dying from smoking.

As a rule, we do not prescribe to people at risk of thrombosis after checking their age, blood pressure, weight, smoking history and pre-existing medical conditions such as hyperlipidaemia and migraine headaches with aura. In addition, we always ask our patients to quit smoking, even if they are young and in their 20s and only smoke one cigarette a day.

Although it is not possible to prevent thrombosis 100% completely, we try to prevent it as much as possible by giving them lifestyle guidance and a detailed side effect sheet to read about conditions and symptoms that increase the risk of thrombosis.

Spironolactone is also a safe medication, but blood samples should be taken regularly as rare side effects such as increased blood potassium and kidney dysfunction have been reported.

Common side effects are irregular bleeding (menstrual irregularities) and dry skin, but these are not dangerous side effects. Other side effects may include diuresis and decreased blood pressure.

Some people experience allergic reactions such as urticaria, rashes and itchy skin immediately after starting to take the drug and up to four weeks afterwards. Although very rare, anaphylactic shock (sudden drop in blood pressure, breathing difficulties and facial oedema), toxic epidermal necrolysis and Stevens-Johnson syndrome (high fever, severe skin and mucous membrane disorders) due to severe allergies have also been reported, but are not as frequent as with other drugs.

Fees (included tax)

Susie [1 pack/ 28 days]¥2,486
Yasmin [1 pack/ 28 days] ¥2,948
Mercilon (very low dose) [1 pack/ 28 days]¥2,486
Labelfeuille [1 pack/ 28 days]¥2,178
Spironolactone 25mg [1 tablet]¥33
  1. A medical examination is always required to prescribe medicines.
  2. An examination to check for side effects is required at the first time, then once every three months and once every six months after entering a stable phase.
  3. Our clinic prescribes the pill for acne treatment and contraceptive purposes, and as it is an unapproved drug in Japan, it is not covered by the Pharmaceutical Side Effects Relief Scheme (guarantee from the pharmaceutical company in case of serious side effects).

The prices below are an example of the cost of acne treatment with hormone therapy. Prices vary depending on the type and amount of medication used. The price is slightly higher at the first visit because of the initial consultation and examination costs, but from the fourth month onwards, as the acne improves and the amount of medication is reduced, the price also decreases.

In the phase of reduced dosage, the cost per month is approximately ¥6,000; after a year or so, when the acne has completely settled down and entered a stable phase, the treatment switches to low-dose pills only, with the average treatment cost per month being approximately ¥3,000-4,000.

Examples of initial treatment [1 month’s worth]

First consultation fee¥3,850
Susie [1 pack]¥2,486
Spironolactone 25mg [112 tablets]¥3,696
Examinations feeBlood test ¥2,948
Urine test ¥1,056
Total fees¥14,036

Examples of treatment during the medicine reduction phase [3 month’s worth]

Repeate consultation fee¥1,650
Susie [3 packs]¥7,458
Spironolactone 25mg [168 tablets]¥5,544
Examinations feeBlood test ¥2,948
Total fees¥17,600

Examples of treatment during the stabilisation phase [6 month’s worth]

Repeate consultation fee¥1,650
Mercilon [6 packs]¥14,916
Examinations feeBlood test ¥2,948
Total fees¥16,214

Appointments and Enquiries

For return visits, please inform us of your 'consultation ticket number' when making an enquiry.
●Hada no clinic Koenji (TEL 03-5913-7435)
4F Anfini Building, 4-6-7 Koenji Minami, Suginami-ku, Tokyo
Mon.~Sta. : 10:30 am - 1:30 pm / 3:30 pm - 6:30 pm
Sun. and Public holiday : closed
●Hada no clinic Kojimachi (TEL 03-6261-7433)
B1F Chichibuya Building, 3-7-4 Kojimachi, Chiyoda-ku, Tokyo
Mon.~Fri. : 11:00 am - 2:00 pm / 4:00 pm - 7:00 pm
Sta. and Sun. : 10:00 am - 1:00 pm / 3:00 pm - 6:00 pm
Public holiday : closed
*Full appointments are required.
*We are very sorry, but sometimes it is difficult to get through on the phone due to the high volume of calls. We ask for your understanding as we have a limited number of staff.
*Please note that a separate 'telephone re-consultation fee' will be charged if a doctor responds to medical questions.