Interesting you mention acne. I have very dry skin, but twice have had what the called acne years back. I will be 60 in a couple of weeks, but have been trialling Tibolone for 3 and a half months. I hadn't noticed any benefit other than I am sleeping better, but now the 'acne' has started. I was originally prescribed antibiotics, but they didn't help. I found it eventually went after about a year, but it was unsightly, irritated and left permanent redness, so I am not happy. I still have hot flushes, but they have never been too bad and I would never have sought HRT for just that. I took Tibolone as I have very low levels of testosterone, but recent a blood test shows there is no change. The sex hormone binding glob was low a year ago, but now is even lower. I don't know what that means, but I have an appointment with a private gynaecologist next month, so I will find out.