Objective: Acne vulgaris is androgen related and in some cases is associated with excess androgen production, which in men would be mainly testicular or adrenal in origin. Ordinarily, testosterone synthesis in the testis is controlled by serum LH. In order to ascertain whether acne vulgaris in men might be consequent on abnormalities at the hypothalmic/pituitary level we have compared serum LH levels in men with and without acne.
Design and patients: 111 men with acne vulgaris were compared with 51 acne-free men.
Measurements: Serum levels of LH, FSH and oestradiol were measured by automated ELISA. Dehydroepiandrosterone sulphate (DHEA-S), 17 alpha-hydroxyprogesterone, 11-deoxycortisol, androstenedione and testosterone were measured by radioimmunoassay, and SHBG by immunoradiometric assay.
Results: The controls showed a fall in serum LH with age: the rate of fall was less in the acne patients (difference between the slopes 0.073 U/year (95% confidence interval (CI), 0.016 to 0.130)). The age distributions in the acne and control groups differed. In order to compare means, standardizations were used to assess the difference in the means in populations of men with age distributions similar to the cases and controls. After standardization to the age distribution of the controls, the acne patients had higher means of serum LH, difference between the means 0.80 U/I (95% CI, 0.31 to 1.30), androstenedione, 1.09 nmol/l (95% CI, 0.15 to 2.03) and testosterone levels, 2.74 nmol/l (95% CI, 0.53 to 4.95) and a lower mean BMI, -1.30 kg/m2 (95% CI, -2.40 to -0.19). After standardization to the age distribution of the acne patients the means of LH, androstenedione and testosterone were still higher in the acne patients but not necessarily significantly so.
Conclusion: LH fell more slowly with age in the men with acne as compared to the controls. In our heterogeneous group of patients with acne vulgaris the findings suggest that a sub-group of men with acne have raised serum LH levels.