Best Treatments for Adult Hormonal Acne in Women, and Which One Fits You

Which treatments do doctors use for adult hormonal acne?

A 2025 review of hormonal acne therapies in Dermatology and Therapy covers three main options: combined birth control pills, spironolactone and clascoterone.

Combined birth control pills are the standard pill containing two hormones. If you've wondered whether a different brand would have cleared your skin better, the review found that different brands and doses generally work about equally well for acne.

Spironolactone is a daily pill that doesn't double as birth control. The American Acne & Rosacea Society's status report on acne in adult women describes it as "widely accepted as an oral agent that can be effective" for this group.

Clascoterone is a 1% prescription cream you apply twice a day. A 2024 analysis in Dermatology and Therapy lists it as one of three new topical acne treatments approved in the US and Canada since 2019. The 2025 review groups it with the hormonal treatments, which makes it the only cream among the review's three main hormonal options and the route for women who want to treat hormonal acne without taking a pill.

Tretinoin is a prescription vitamin A cream. A doctor may consider a topical retinoid like tretinoin alongside a hormonal treatment, an approach covered in the American Academy of Dermatology's acne guidelines. Tretinoin is part of Hot or Nothing's skin plans.

How do I know which one fits me?

Start with what you want besides clearer skin:

• You also want birth control. A combined pill may handle both if your doctor confirms it's safe for you. The American Acne & Rosacea Society says that for adult women without measurable androgen excess (higher-than-normal levels of hormones such as testosterone), using the pill for acne is "most rational in patients who also desire a method of contraception." If you suspect your hormones run high, ask your doctor whether testing makes sense before you choose. Because combined pills contain estrogen, doctors check for conditions that make them unsafe, such as a history of blood clots, migraine with aura or smoking after age 35, as the 2025 hormonal therapy review discusses.
• You want a pill but not birth control. Spironolactone may suit you. It doesn't prevent pregnancy and isn't used during pregnancy, so if you could become pregnant, expect your doctor to talk through contraception while you take it. The 2025 review tells dermatologists to discuss contraceptive options and make an individual decision with each patient.
• You'd rather keep treatment on your skin. Clascoterone is the cream route. Tretinoin is another topical your doctor can consider.

If you're pregnant or planning a pregnancy, tell your doctor before choosing, because that changes which of these options a doctor will consider.

One customer review on Nurx's spironolactone page, posted under the name "Patrick," says the medication "really cleaned up my face" and warns: "It will take about 3 months and you might get some more acne at first." The reviewer had used it "for over 6 months." This is a single testimonial on the seller's own site. It isn't clinical evidence and doesn't show what most people experience.

What does treatment cost and how do I get it?

The two prices below aren't directly comparable. Nurx's figure is a monthly prescription service with extra fees. GoodRx's figures are the pharmacy price for one tube of medication, with no doctor visit included.

Spironolactone through Nurx: Nurx's spironolactone page lists the medication at $30 a month, "as low as $0 with insurance." Nurx says not all insurance plans are accepted, and a medical review and support fee costs extra. The page doesn't show a date for its price. To get it:

1. Complete an online consultation with a Nurx medical provider.
2. If the provider prescribes it, the medication ships and bills monthly.
3. The provider checks in to confirm it's working.

Generic tretinoin 0.025% cream (one 45 g tube): GoodRx's tretinoin page, which states its coupon prices were last updated on 08/18/26, shows:

• $38.68 with the standard GoodRx coupon, compared with a $72.01 retail price
• $27.59 at CVS or Target with a GoodRx Companion membership, which starts at $9.99 a month when paid yearly

These are medication prices only. You need a prescription before you can use either one, and any doctor visit to get that prescription costs extra. Prices change, so confirm the current figure with each provider before you pay.

If you want a doctor-led plan built around your skin goals, start with the Hot or Nothing quiz. A doctor reviews your health history before anything is prescribed. Pricing and checkout come from the clinical partner, not from the quiz.