Do Dermatologists Do Blood Tests for Acne? What to Ask For

Hand holding the breakoutLabs at-home blood collection device

Short answer: usually not. Most acne is diagnosed by looking at your skin, and no blood tests are needed for most people. Dermatologists typically order hormone tests when there are signs of excess androgens (like irregular periods or unwanted hair growth), sudden or severe acne, or acne that isn't responding to treatment. The usual panel includes free and total testosterone, SHBG and DHEA-S, sometimes with LH, FSH, prolactin and 17-hydroxyprogesterone.

Do dermatologists take blood tests for acne?

Most of the time, no. Acne is a clinical diagnosis: your dermatologist looks at the type of spots, where they are and how severe they are, and asks about your history. DermNet, a dermatologist-run reference, states plainly that no tests are necessary for most patients with acne. Tests are used to look for infection, to investigate an underlying cause, or to monitor certain treatments (DermNet).

The American Academy of Dermatology's acne guidelines (Zaenglein et al., 2016, updated by Reynolds et al., 2024) focus on treatment choices, from topical retinoids and benzoyl peroxide to antibiotics, hormonal options and isotretinoin. Blood work is the exception, not the starting point.

That's why many people with persistent acne have never had acne-specific labs, or have had a routine panel that didn't include the relevant markers. If that sounds familiar, read why your bloodwork can look normal when you still have acne.

When do dermatologists order hormone tests for acne?

Hormone testing is usually considered when something suggests your acne has a hormonal driver. Common reasons include:

Signs of hyperandrogenism (high androgen levels), such as unwanted hair growth on the face or body, which can point to conditions like polycystic ovary syndrome (PCOS) or congenital adrenal hyperplasia (DermNet).
Irregular periods alongside acne (Elsaie, 2016).
Acne that doesn't respond to standard treatments (Elsaie, 2016).
Sudden-onset, cystic or widespread acne, which is often a sign of excess androgens (Elsaie, 2016).
Signs of high prolactin or Cushing syndrome, or a possible pregnancy that would change treatment choices (DermNet).

In young men, sudden severe acne can also be a clue to anabolic steroid use, which dermatologists are advised to recognize and address (Melnik et al., 2007). For more on patterns, see signs of hormonal acne and hormonal acne and PCOS.

What blood tests do dermatologists do for hormonal acne?

There isn't a single "acne blood test." What gets ordered depends on your symptoms. These are the tests most often listed in dermatology references:

Test	What it checks	When it's typically ordered	In the BreakoutLabs test?
Total testosterone	Overall testosterone level	Suspected hormonal acne, signs of androgen excess	Yes
Free testosterone	The active, unbound portion	Usually ordered with total testosterone and SHBG	Yes
SHBG	The protein that binds testosterone and keeps it inactive	Alongside testosterone to judge how much is active	Yes
DHEA-S	Androgen made mainly by the adrenal glands	Suspected adrenal source of androgens	Yes
Cortisol	Stress hormone; high levels can suggest Cushing syndrome	Signs of Cushing syndrome	Yes (morning)
LH and FSH	Pituitary hormones that control the ovaries	Suspected PCOS	No
Prolactin	Pituitary hormone	Signs suggesting high prolactin	No
17-hydroxyprogesterone	Marker for congenital adrenal hyperplasia	Suspected adrenal enzyme problem	No
Thyroid (TSH)	Thyroid function	Sometimes included in a broader workup	No

DermNet lists testosterone, SHBG, free androgen index, DHEA-S, 17-hydroxyprogesterone, LH, FSH, prolactin and cortisol among the hormone tests that may be requested (DermNet). Some studies of adult women with acne also include thyroid tests in the workup (Bansal et al., 2020). In women with persistent acne, low SHBG can be the main abnormal finding even when other hormones look normal (Sardana et al., 2016). For a deeper look at each marker, see our guide to blood tests for acne and low SHBG and acne.

Blood tests to monitor acne treatment

Some medications come with their own lab checks. For isotretinoin, these can include liver function, fasting cholesterol and triglycerides, and pregnancy tests (DermNet). For spironolactone, one large study found routine potassium checks were rarely useful in healthy young women (Plovanich et al., 2015). Your doctor decides what monitoring you need.

When should acne blood tests be done?

Timing matters for hormones. DermNet recommends drawing blood between 8 and 10 am during the first half of the menstrual cycle. Hormonal birth control can also affect results, so tell your doctor what you take. Don't stop any medication to get tested without their guidance.

How to ask your doctor for blood tests for acne

Describe the pattern, not just the acne. Mention irregular periods, unwanted hair growth, sudden onset or acne that hasn't improved on treatment.
Name the tests. Ask whether free and total testosterone, SHBG and DHEA-S make sense for you, and whether LH, FSH, prolactin or 17-hydroxyprogesterone are needed.
Ask about timing. Morning, and early in your cycle if you menstruate.
Bring a list of everything you take. Supplements and medications can affect both your skin and your results. See supplements that can cause acne.
Ask what the results would change. A good question is: "If this comes back abnormal, how would it change my treatment?"

How BreakoutLabs fits in

The BreakoutLabs Acne Root Cause Test covers several of the markers dermatologists use for hormonal acne: Free and Total Testosterone, SHBG, DHEA-S and Cortisol, plus hsCRP (inflammation), HbA1c (blood sugar), Vitamin D, Vitamin B12, Ferritin, Albumin and Creatinine. You collect a small sample at home in the morning with a painless device on the back of your upper arm, it's processed in a CLIA-certified lab, and results are ready 5 business days after the lab receives it, with a personalized Clear Skin Blueprint you can bring to your doctor.

It does not measure LH, FSH, prolactin, 17-hydroxyprogesterone or thyroid hormones, so if your doctor suspects PCOS, a pituitary issue or an adrenal enzyme problem, you'll still need those tests through them. See what the Acne Root Cause Test measures.

Frequently asked questions

What is the acne blood test called?

There's no single named test. Doctors usually order a hormone or androgen panel: free and total testosterone, SHBG and DHEA-S, with other tests added depending on your symptoms.

Can a blood test tell what's causing my acne?

Sometimes. Blood tests can reveal hormone patterns, like low SHBG or high DHEA-S, that point to a driver. But normal results are common, and some causes of acne, like products, habits or how sensitive your skin is, don't show up in blood.

Should men get blood tests for acne?

Usually not for typical acne. Testing may make sense for sudden, severe acne, or when hormones, supplements or steroids might be involved.

Will my dermatologist order blood tests if I ask?

Testing is more likely when there's a clinical reason, such as irregular periods, signs of excess androgens or treatment resistance. Explaining your symptoms clearly makes that conversation easier.

Ruling out your skincare too? Hormones explain a lot, but not everything. Paste any product into our free pore clogger checker to see which ingredients are likely to clog pores.