Do some men with acne vulgaris have raised levels of LH?

OBJECTIVE Acne vulgaris is androgen related and in some cases is associated with excess androgen production, which in men would be mainly testicular o r adrenal in origin. Ordinarily, testosterone synthesis in the testis is co ntrolled by serum LH. In order to ascertain whether acne vulgaris in men mi ght be consequent on abnormalities at the hypothalmic/pituitary level we ha ve compared serum LH levels in men with and without acne. DESIGN AND PATIENTS 111 men with acne vulgaris were compared with 51 acne-f ree men. MEASUREMENTS Serum levels of LH, FSH and oestradiol were measured by automa ted ELISA, Dehydroepiandrosterone sulphate (DHEA-S), 17 alpha-hydroxyproges terone, 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 w as less in the acne patients (difference between the slopes 0.073 U/year (9 5% confidence interval (CI), 0.016 to 0.130)). The age distributions in the acne and control groups differed. In order to compare means, standardizati ons were used to assess the difference in the means in populations of men w ith age distributions similar to the cases and controls. After standardizat ion to the age distribution of the controls, the acne patients had higher m eans 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 l evels, 2.74 nmol/l (95% CI, 0.53 to 4.95) and a lower mean BMI, -1.30 kg/m( 2) (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 th e findings suggest that a sub-group of men with acne have raised serum LH l evels.