Trigger Warning: This post contains images and content regarding skin picking and mild dermatillomania.

I took perverse satisfaction in scratching my acne and lacerating my pustules. Cathartic. That’s what it was. During the start of my third year at U of T, my skin inexplicably exploded, but really, it was a long time coming. Greasy skin catching the overhead light in pictures and the errant skin-deep red blip on my cheek were the dreaded hallmarks of hormonal acne. When I was focusing on code, rereading the same OSTEP passage thrice in a row, or trying to figure out backpropagation, my fingers sought my face. The picking was habitual, the marring felt permanent. I almost took pleasure in feeling subhuman, like the rules of society didn’t apply to me. I could pull inward, reticent and hyperfocused on my courses and academic work, so I could survive and keep my head above water. But the truth is, at some point, it got to me.

I finally caved in and went to a dermatologist. I went in with a little notebook scrawled with the products I’ve used and some topicals I’ve tried in the past. My doctor gave my skin a cursory look and said something to the effect of, “As with most things, you can blame men here”. He explained that my acne was most likely androgen-driven, prescribed me 50 mg of spironolactone a day, and I was on my way.

I felt a little hesitant to take the off-label prescription, but at that point, I simply didn’t care. Almost out of spite, I took the pills, which left a smoky aromatic aftertaste in my mouth. I wanted to prove that they would do nothing; I (wrongly) felt myself impervious to the ingested chemicals and compounds. Hence, I took no images to chronicle my acne progression between February and June. I didn’t even notice anything until my brother pointed out that my forehead was blazingly clear.

But of course, all good things must come to an end. Just my luck, there was a national shortage of spironolactone, and none of the pharmacies in my area had any idea when supplies would be replenished. It didn’t help that I only realized I could fax my refill prescription to my dermatologist after I booked and attended an appointment for a refill, foregoing two months of medication for no reason. Instead of doing the sane thing and contacting my dermatologist to look for alternatives in the interim, I went down a rabbit hole to find the “root cause” of my suffering. My real fear was sacrificing potential muscle gain from strength training after reading conflicting Reddit posts on spironolactone’s effect on body composition. Moreover, taking an off-label drug for years must certainly come with long-term side effects. So, I tried incorporating more fermented foods, popping Costco multivitamins, magnesium and K2+D3 supplements, opting for almond milk, and drinking Spearmint tea, which, in all honesty, tasted like cat piss. I got some satin pillow cases and even tried procuring topical spironolactone from a compounding pharmacy. But due to a short shelf life and the accompanying exorbitant costs, I quickly abandoned that route.

Despite my best efforts and unwavering optimism, my acne just got worse and worse, and worse. The rebound acne encroached on more of my skin than what I had started with, and that was the hardest pill to swallow. On more than one occasion, I’ve taken pictures of my acne and tried to coax ad-hoc diagnoses and perspectives from ChatGPT. During my chats with ChatGPT, I couldn’t help but question why I was gripped by the throes of acne. A pernicious salvo that laid siege to my skin and ravaged my cheeks. Genetics as an explanation wasn’t cutting it. This must be a melange, a hormonal cocktail brewed from micro-adaptations to cope with my environment; there had to be some reason, some trigger… except maybe it was just genetics. The girl who tried to steer clear of a mirror growing up because she thought it was a vain and superficial compulsion started obsessively taking pictures and scrutinizing every angry mark. It wasn’t just the acne that stung, but the growing chasm between my skin and the peak glowing potential I witnessed during those dreamy summer months before it all turned into a hellscape.

After some convincing from ChatGPT, yes, I’m aware how dystopian that sounds, I went back on spironolactone. But it felt like an excruciatingly interminable slow march; it still is. Partly because, unlike the first time around, I was emotionally invested and knew spironolactone was my ultimate panacea. I would have bouts of self-sabotaging cycles where I would pick until my fingernails came away bloody, then regret it immediately afterwards. I needed to finish what I started, even at my own detriment, a pendulum of extremes.

I felt like I was right back where I started, but I’m glad to be on spironolactone again. It’s definitely made my acne more tenable and given me a sense of agency over my skin. Except for the fact that I’m having two periods a month now.

…

But the thought of fighting my urges and letting my acne dry up, crust, convalesce, and flake away also has its own perverse satisfaction.