"I am a female, age 25, and I smoke weed daily). I believe the testosterone is breaking me out, but I really do not want to quit (it helps with a number of issues) and I don’t want to go back on the pill to regulate my hormones. Suggestions?"
Acne is a very common and frustrating skin condition for young adults and usually improves for most individuals between age 20-30. There are several physiologic processes that lead to acne including the way your body makes skin cells, produces protective oils, fights bacteria in your skin, and responds to skin irritants. A dysregulation in any of those processes can worsen acne. Hormonal changes that occur normally with age, menstrual cycles, or with stress can also affect those processes and worsen acne too.
The treatment of acne depends on the severity and whether or not you are pregnant or trying to become pregnant. The four main medications are salicylic acid, topical retinoids, benzoyl peroxide, and topical antibiotics. Severe acne is treated with oral forms of these medications which carry significant risks and should be discussed with your doctor.
Medications that regulate your hormones can also be used to treat acne if the methods above have not been effective. These medications include low dose oral estrogen/progesterone (also known as birth control or oral contraceptives) and spironolactone. Spironolactone essentially lowers effective testosterone levels but can also affect your blood pressure and electrolyte levels so needs to be monitored with blood tests at least once per year.
Finally, there are very few studies suggesting that cannabis products may be helpful for the treatment of acne. Smoked cannabis is similar to tobacco smoke in terms of particulate matter and hydrocarbons, which are known to irritate skin. There are very preliminary studies, such as the one referenced below, that suggest topical cannabinoid (CBD) products may help with acne because of their anti-inflammatory effect; however, the topical products on the market are often oil-based since THC/CBD are fat soluble molecules. Oil-based products are great for eczema but tend to make acne worse.
In summary, there are no studies showing that cannabis-infused topicals are effective in treating acne and have more potential for harm than good based on the other substances that cannabis topicals often contain. My suggestion would be to discontinue daily smoked cannabis and use a vaporizer instead if you must consume that frequently. Most importantly, talk to your primary care doctor or dermatologist about the numerous safe and effective options that are already available on the market summarized above.