You should get the book The Hormonally Vulnerable Woman by Geoffrey Redmond. It talks all about Spiro and birth control pills and all kinds of things. Anyway it says you need about 100mgs to 200mgs for it to work on acne. And it takes about 2 to 4 months to work. I am on 100mgs and am on day 49. I have seen a major difference with the oil control, I don't have any oil any more. Before spiro I would wash my face and about a half hour later my face would be oily again. It sucked. I am still breaking out, but I think it was be/c of my birth control pills. My breakout all started from alesse so I stopped that and then switched to yasmin which wasn't the right birth control pill for me either so I had to go back to OTC again (I stopped using it a few years ago be/c of the mood swings I was getting, they were bad) but my face was great on it. So I am on day 3 on the birth control pill, so I'm hoping that things will start to work out now. And my derm did the same thing yours did. He put me on doxy first but that didn't help, it still isn't and I've been taking the doxy longer then the spiro. I don't put anything at all on my face be/c it just seemed to make it worse. How long have you been on spiro? I do think you need to be on a higher dose though. The book says some times 75 mgs can work. By the way I am 23 yrs old and I get cyst acne and it can be sooo painful :(