When topical creams and over-the-counter treatments fail, acne lab tests, blood tests used to identify underlying medical causes of persistent acne. Also known as hormonal acne workup, these tests help move beyond surface-level fixes and target what’s really driving breakouts. Many people assume acne is just about oil and bacteria—but for adults, especially women, it’s often a sign of something deeper inside.
Common hormonal acne, acne triggered by imbalances in androgens, estrogen, or progesterone shows up around the jawline, chin, or neck and flares before periods. If you’re dealing with this pattern, doctors may order tests for testosterone, a male hormone that can surge in women and trigger excess oil and clogged pores, DHEA-S, a precursor hormone made by the adrenal glands that can spike in conditions like PCOS, or insulin resistance, a condition where cells don’t respond well to insulin, leading to higher androgen levels and worse acne. These aren’t just random checks—they’re direct links to why your skin won’t clear. A 2023 study in the Journal of Clinical Endocrinology found that over 70% of women with persistent adult acne had at least one measurable hormonal or metabolic issue.
Polycystic ovary syndrome, or PCOS, a common endocrine disorder affecting up to 1 in 10 women, often presenting with acne, irregular periods, and excess hair growth, is one of the top reasons for lab testing in acne cases. But it’s not the only one. Thyroid imbalances, high cortisol from chronic stress, and even rare adrenal tumors can mimic acne. Lab tests don’t just confirm diagnoses—they rule out dangerous conditions that look like plain breakouts. Without testing, you might waste months on the wrong treatments while the real problem grows.
What you find in those results changes everything. High testosterone? Spironolactone might be more effective than benzoyl peroxide. Insulin resistance? Metformin and diet tweaks can clear skin faster than any cream. And if your labs are normal? That’s useful too—it tells you to focus on topical care, lifestyle, or gut health instead.
Below, you’ll find real-world breakdowns of how these tests connect to treatment choices, what doctors look for in results, and how to talk to your provider about getting the right panels. No guesswork. No myths. Just what the numbers mean for your skin.
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