Homeostasis of the cutaneous microenvironment is complex and depends on multiple intrinsic and extrinsic factors, including the influence of hormones. Hormones exert action on the hair follicle and associated sebaceous glands via both endocrine and intracrine mechanisms. The profound impact of hormonal action on follicular homeostasis can be leveraged in the treatment of disorders, such as acne and hidradenitis suppurativa. The clinician must have an intimate knowledge of the rationale for use, mechanism of action, and possible side effects of hormonal therapy when using these agents to treat adolescents with cutaneous disease.