Hormonal acne check

The hormonal acne check is a nine-marker blood panel for adult women whose breakouts sit along the jaw, chin and neck. It measures androgens and the proteins that carry them, plus the cycle hormones that shape them. It costs $169 with your own doctor's signed request, or $249 with a KnowLuna doctor who requests the panel and explains the results in a 20-minute video consult. Collect at an accredited Australian centre, or choose a home kit or a nurse visit at checkout (options below).

What it measures

• Total testosterone: the main androgen measured in women. Oil glands respond to androgens, which is why this is the starting point.
• Free testosterone: the fraction not bound to protein, and the part that reaches the skin. It is calculated from total testosterone and SHBG rather than measured directly, because direct assays are unreliable at female levels.
• SHBG: the binding protein. Low SHBG leaves more testosterone active even when the total sits inside the range.
• Free androgen index: testosterone and SHBG expressed as one figure, usually the most useful single reading of androgen activity.
• DHEA-S: an androgen made by the adrenal glands rather than the ovaries, which helps locate where excess androgen is coming from.
• Oestradiol: the main oestrogen, read for cycle context alongside FSH and LH.
• LH and FSH: the pituitary hormones that drive the cycle. Their pattern is one of the features doctors consider in PCOS.
• Prolactin: when raised, it disturbs cycles and can shift the androgen picture, so it is checked before conclusions are drawn.

Who it's for

Adult women with acne that started or returned after the teenage years, especially where it sits along the jawline, chin and neck, flares before a period, and comes with irregular cycles, unwanted hair growth or scalp thinning. It also suits women whose skin changed after stopping hormonal contraception. It is for adults aged 18 and over.

Is my acne hormonal?

No blood test defines hormonal acne on its own, but a few clues make it more likely. Look for:

• Breakouts along the jawline, chin, neck and sometimes the upper back and chest rather than the forehead.
• Deep, tender lumps that sit under the skin for days rather than surface whiteheads.
• A reliable flare in the week or so before your period.
• Acne that arrived or worsened in your twenties or thirties.
• Cycles that are irregular, long or missing.
• Coarse hair growth on the chin, upper lip, chest or abdomen.
• Thinning at the part or crown of your scalp.
• A change after starting or stopping hormonal contraception.

The more of these you recognise, the more useful a hormone panel is likely to be, and the stronger the case for asking whether PCOS is part of the picture.

What you'll learn, and what you won't

You'll learn whether androgen activity is raised, whether it looks ovarian or adrenal, whether prolactin is disturbing your cycle, and whether the overall pattern is one that doctors assess for PCOS. Each marker is explained against your laboratory's range and read as a pattern.

What it cannot do: it cannot examine your skin, grade your acne, tell you which skincare or therapy to use, or promise that a normal result means your acne is not hormone-driven. Many women with genuinely hormone-driven acne have androgen levels inside the normal range, because skin sensitivity to androgens varies. This page does not recommend any medicine or product. A blood test is one input to a doctor's assessment, not a diagnosis on its own.

When a blood test is worth it

It is most worth doing when acne comes with other androgen signs: irregular or absent periods, unwanted hair growth, scalp thinning, or acne that appeared suddenly and severely in adulthood. In those situations the result changes the conversation, because a raised free androgen index is one of the features assessed for PCOS, an LH that runs high is a supporting clue, and a markedly high testosterone or DHEA-S is always investigated further.

It is less likely to change anything if your cycles are regular, you have no other androgen signs and your acne is mild. In that case a skin assessment usually comes first. We would rather say that plainly than sell you a test that will not help.

Reference ranges and what they mean

Marker	Typical adult range	What it usually means
Total testosterone	Laboratory-specific female range	Mild elevation is common with PCOS. A clearly high result is always investigated further by a doctor.
Free testosterone and free androgen index	Laboratory-specific; the index is calculated from testosterone and SHBG	A raised index with acne, cycle change or unwanted hair growth is the classic androgen-excess pattern.
SHBG	Laboratory-specific female range	Low SHBG raises free androgen activity and often travels with insulin resistance. Combined hormonal contraception raises it.
DHEA-S	Laboratory-specific range that falls with age	Mildly raised is common and often means little. A clearly high level points towards the adrenal glands.
Oestradiol, LH and FSH	Cycle-dependent; day 2 to 5 values are the reference point	An LH that runs high relative to FSH is one supporting feature in PCOS, never the whole basis for it.
Prolactin	Laboratory-specific female range; a mildly raised result is usually repeated	Stress, sleep and a recent meal can lift prolactin, so one high reading is confirmed before it is acted on, and the laboratory checks for macroprolactin, an inactive form that can give a falsely high reading. Some medicines also raise prolactin, so tell your doctor what you take.

Ranges vary by laboratory; your report shows the range your lab uses. Typical ranges on this page are drawn from Pathology Tests Explained (RCPA) and the sources listed below.

When to do this test

Day 2 to 5 of your cycle if you have cycles, collected in the morning. No fasting needed. Androgens peak in the morning, and early-cycle collection gives FSH, LH and oestradiol a clean reference point. If your periods are irregular or absent, collect on any day and tell us, because your doctor reads the result against that. Combined (oestrogen-containing) contraception raises SHBG and lowers free testosterone, so a panel taken on the combined pill or the vaginal ring reflects the contraception as much as you; progestogen-only methods have a smaller and less predictable effect. Androgen testing is most informative after about three months off combined hormonal contraception, where stopping is safe and practical. Tell us what you use. Avoid collecting straight after a workout or a stressful morning, since prolactin responds to both.

How it works

• Order online. Either upload the request your own doctor has signed, or a KnowLuna women's health doctor reviews your short questionnaire and requests the panel.
• Collect at an accredited centre near you, in the morning, on day 2 to 5 where that applies. Or choose a home kit or a nurse visit (options below).
• Results are usually ready within a few business days, explained in plain English in your account, with a 20-minute doctor consult if you chose that option. Abnormal results are always followed up by a doctor.

Choose how you collect

Every option is the same accredited test and the same report. Pick what suits you at checkout; the fee, if any, is added to either pathway price.

Common questions

Sources and further reading

• Pathology Tests Explained (RCPA): testosterone
• Pathology Tests Explained (RCPA): sex hormone binding globulin (SHBG)
• Pathology Tests Explained (RCPA): DHEA-S
• Monash University: International Evidence-based Guideline for the Assessment and Management of PCOS 2023
• Healthdirect: acne
• Better Health Channel: acne

General information only, not medical advice. A test result is one input to a doctor's assessment, not a diagnosis on its own, and every abnormal result is followed up by a KnowLuna doctor. If your symptoms are severe or sudden, see a doctor promptly. Read our medical disclaimer.

Related

• All symptom-led checks
• PCOS panel
• Female hormone panel
• Hormonal acne in women: how to tell, and which hormones to check
• Testosterone, SHBG and DHEA-S in women
• The hormones behind PCOS