When I got a little bitty goalie that secretes hormones delicately shoved into my uterus last October at an OBGYN practice with the name “Downtown Women,” I finally felt fully grown. Minutes later, however, a more acute feeling surfaced, one that can really only be described as the pain of a million little tiny cheapo earrings pricking my guts. When it hit, I was shopping on the second floor of a fast fashion chain near the gynecologist for a dress to wear to a wedding. I lay down in the dressing room, finally infertile, and almost ready to die.
The pain subsided. A day later, I felt free. A week later, I got sexually rejected by no less than 10 University of Michigan frat boys at that very wedding. A month later, I got my first IUD-related cystic pimple. Two months after that, I still had it. Then I got a bunch more.
It would be an enormous disservice to my greasy, bespotted, whiny younger self to say this was my first brush with acne. It wasn’t. I’d had all sorts of teen acne before, plus the lifestyle-based acne that arises when, for some reason, in your mandatory freshman year gym class, you are forced to participate in a swimming unit. I had plenty of acne! But never hard, painful cysts. As a woman in her mid-twenties, I refused to pick at it or burn it off with too-harsh benzoyl peroxide. So I did what all adult women do: consult British and Korean teens on the internet. They told me to try a spot of Buffering Lotion, or a cortisone shot (that insurance didn’t cover and I still haven’t paid for!! Please don’t tell Dr. Chien!), and some PRID Drawing Salve.
Nothing really helped. That is, until I resigned myself to the fact that no matter how much goo (brown goo, in the case of PRID) I put on my face, this problem was internal. Not in a spiritual way. (I work very hard on my mental health!) I mean, like, hormonally speaking. According to my legion of anonymous teens, there was one solution that could work, if I was patient. It was called spironolactone, and I couldn’t pronounce it.
(Turns out it’s pronounced Spir-o-no-lact-one, so uh, exactly like it’s spelled.)
Scientifically speaking, spironolactone is a diuretic that helps your kidneys expel water and salt. It’s like dandelion tea, but in pill form! Also, with more side effects! Initially, Spiro was developed to treat hyperaldosteronism, a condition that causes the body to produce too much of the hormone aldosterone, by restoring the body’s sodium and potassium level. Spiro also has been used as a hypertension drug. But one day, as I imagine it, a bunch of stodgy old physicians from near and far gathered around a body that was a medical oddity: a woman with perfect skin! Nurse, I’ll have 100 CCs of whatever pill she’s taking, stat!
So it probably definitely went like that, and now, off-label Spiro use is all the rage.
Endocrinologists and dermatologists now prescribe the pill for adult and cystic acne. Essentially, Spiro inhibits sebum in the sebaceous glands. Typically, women with an androgen excess have overactive sebaceous glands, which causes acne. I am woman with a lot of androgen, hear me roar! And yet, I am by no means woman with any amount of patience, so in the days and weeks immediately after I asked my endocrinologist to put me on Spiro, I felt duped.
(Unrelated: every woman should have her thyroid checked by her endocrinologist! It could be the reason why you’re so sad all the time!)
I expected to go to sleep and wake up with creamy, hyperpigmentation-free skin, fully inhibited sebaceous glands, and without hypertension, to boot. Instead, for weeks, I woke up looking the same. It shouldn’t be a disappointment to look in the mirror every morning, particularly when you’re as young and as period-free as you’re ever gonna get. I tracked the progress of my skin on Spiro on my newsletter, dutifully. A few months went by; nothing changed. People emailed me telling me to stick with it! as if I was thinking about dropping out of medical school or an ill-advised improv class. Without them, I may not be here today. By here I mean the laundry room of my apartment building, typing for Man Repeller and listening to Britney’s latest ouevre.
Around three months in, I asked my endocrinologist if she could take me up off my starting dose of 50 mg, up to 100, and still, nothing happened. I developed a self-conscious tic in which I would hold my hand up to my face when I spoke. I’d seen Lindsay Lohan do this in interviews in the mid-aughts, and while I’ve always wanted a bad reputation (“The cocaine in the pants I was wearing on my body wasn’t mine.” –Lindsay in 2007, almost verbatim), I want a worry-free face more.
Then, about six months in, I woke up a changed woman. My long-suffering chin — which had, for months, been hard, lumpy, and painful — became smooth. My cheeks, which had, over the winter, begun to take on a rough, graveled texture, resurfaced themselves. Even the pimple above my lip that’s recurred every single month disappeared. (Though part of that may be because I no longer get my period with my IUD.) (Also worth noting: many women stop getting their periods after they go on Spiro, too).
We often talk about acne as it relates to “self esteem” (the latter is some growing-up-in-the-nineties concept that I still don’t understand), but not enough as a condition that affects mental health. Years later, my mind still has a tendency to delineate full semesters of high school of college as “good” or “bad” based on what my skin looked like for those months. I’ve spent most of my life trying to find quick fixes –– practically bleaching my face off with Proactiv or some generic Walgreens knockoff, dousing it with apple cider vinegar, hoarding my family pantry’s collection of hydrocolloid bandages, overexfoliating until my skin was the dry, thin consistency of crepey string lights. It took me an entire adolescence to discover that those fixes weren’t quick, and perhaps not fixes at all.
Spiro isn’t quick, either, but it fixed me for now. An added bonus is that somehow the Spiro impelled my scalp follicles to quickly regrow the baby hairs that I’d previously destroyed with both heat and fingers in my quest of looking low-maintenance-tousled — and spent several hundred dollars trying to repair. Turns out a lot of women take Spiro when they lose hair due to stress. It does stress me out thinking about whether or not I’m going to be on Spiro and a whole handful of other pills for the rest of my life, but I’m trying to take it one day at a time. You should too. (Also: ask your doctor! That’s what they’re there for.)
The other Real Talk downside of Spironolactone, besides the reality that it can take over six months to become effective, is that it messes with potassium levels. That means regular blood withdrawal to make sure you don’t have dangerously high potassium levels, and, if you are me, regular time spent pretending to be brave in front of a hunky phlebotomist. Just this week, I’ve gone down half a dose because I’ve been feeling lightheaded when I stand up. If you’re a rational-headed person, you might argue that having better skin is not worth feeling nauseous several times a day. I might argue right back that having skin that doesn’t require a Pyrex cup worth of primer and foundation it is worth literally everything I have to my name, which are, in order of importance to me: my AM/PM pill towers, my Pyrex 2-cup measuring cup, and that dress I wore to that wedding.
Photographed by Krista Anna Lewis; creative direction by Emily Zirimis.