Today was my last dermatology appointment for the Accutane. I'm a mixture of excited and sad. I'm excited because the Accutane has been such a hassle. Monthly doctor's appointments and blood draws, debilitating side effects, and just the stress of putting this into my system. So now it's over. Awesome.

Except that my dermatologist isn't exactly happy with my results. Yes, I'm much improved. 90% in fact. But according to him, he likes to end things at 100%. He even suggested staying on it longer or switching brands.

Right now, I'm just not up for that though. My body needs a break. I need a break. To just feel normal again. To not be so tired, so fatigued. To go one day without a headache or muscle ache or joint pain. For my body to just feel closer to whole rather than endlessly worn out.

There's always the option to go back on it if my acne begins to get severe again. So that piece of information is a slight comfort. At least we could try again.

I just don't want to have to try again. I don't want to have my acne get worse again. I'd like to see even further improvement and know that my skin might be 100% clear at some point. I'm just not sure how to get there.

We know that my acne is caused by PCOS. That's been established. But the problem is that my treatments for PCOS are running low. I've tried spiro, the most common and most effective. I just can't manage the side effects. I feel depressed, no desire, just can't function when I'm on it. Even at the lowest dose possible.

I'm currently on birth control, which didn't help in the past and really doesn't seem to be helping now. I can switch birth controls to Yaz which has a form of spiro in it...which means I run the risk of the side effects. But the stroke risk really freaks me out...being diabetic and all.

My last option is the one I'm trying to bank on. I want to go on Metformin. Research isn't clear whether it can help PCOS related acne or not, but it does show improvement in other symptoms (like hirsutism, weight gain, and the pesky insulin resistance). The overall decrease in insulin resistance would mean a lower dose of insulin in general. Which might mean less acne since my body would be using insulin properly instead of being unable to handle such high doses.

So Wednesday, I'm begging my endo to put me on it. I have the positive research and personal accounts. I just hope she doesn't try to argue the point. It's something that I need to do. I need to try this.

As far as the birth control, I'm giving Ortho Tri Cyclen Lo another few months before switching. We'll see how it continues to progress. And then we'll assess and see if switching is a good idea for me. Stress doesn't help stroke risk anyway. And acne is a major stressor in my life right now.

Until then, I'm just celebrating that I have 19 more days on the Accutane. So hopefully only a month left of these horrid side effects. And hopefully a month to continue to improve my skin...again, here's hoping.