One of the biggest hurdles to getting spiro prescribed is finding a sympathetic doctor. As a mom, I spent lots of time and money to get to that point. I wanted her to try spiro a couple of years ago but got talked out of it by a nurse practitioner who told me how dangerous that would be. So my daughter took accutane instead with very poor results. I would recommend you buy Dr. Geoffrey Redmond's book "The Hormonally Vulnerable Woman". It has lots of good info in it about spiro, hormone issues, potassium issues and, of course, acne. I considered flying out to New York City with my daughter to visit him at one point. They told me it would only take one visit. Fortunately, our own HMO derm prescribed it with no hesitation. She takes Yasmin and 50 mgs. spiro and other than being thirsty and more tired than usual, she is fine. The doctor has advised against exercising heavily during very hot or humid weather. He said she could pass out under those circumstances. She gets her potassium levels checked periodically and all is well and normal. I wish she could be off of drugs altogether but that does not seem possible at this point in her life. In the meantime, her skin is clear and smooth and she seems happy and content with her results and able to concentrate on college life.