*Department of internal medicine, college of medicine, Hawler Medical University, Erbil, Iraq. **Department of dermatology, Rezgari Teaching Hospital, Erbil, Iraq. Introduction Acne vulgaris is a chronic inflammatory disease of the pilo-sebaceous unit resulting from androgen-induced increased sebum production, altered keratinization, inflammation, and bacterial colonization of hair follicles on the face, neck, chest and back. Facial scarring due to acne affects up to 20% of teenagers. Acne can persist into adulthood, with detrimental effects on self-esteem. Acne is a common disease that affects the majority of the adolescent population and a large number of young adult population. Both clinical observations and experimental evidence confirm the importance of androgens in the pathophysiology of acne. Acne is a common feature in the course of endocrine diseases characterized by raised levels of androgens. On the other hand raised androgen levels in women with acne have been repeatedly demonstrated in many studies. The skin is a typical target tissue for androgen and testosterone, a major androgen in human blood that stimulate many metabolic processes in the endothelium of sebaceous gland. Androgens cause enlargement and overstimulation of the sebaceous glands in people with acne and this leads to overproduction of sebum coupled with sluggish exfoliation process leads to blocked pores and development of acne. Sebaceous glands contain most of the steroidogenic enzymes necessary for final production of testosterone and di-hydrotestosterone. Some acne patients showed various degrees of hyper-androgenemia although there was no positive correlation between the severity of acne and markers of androgenecity. Certain diseases that cause an increase in androgen production Background and objective: Acne vulgaris is a chronic inflammatory disease of the pilosebaceous units, characterized by comedones, papules, pustules and nodules. Acne affects primarily the face, neck, upper trunk. Acne typically begins at puberty and it is often the first sign of increased sex hormone production. In all women with acne the possibility of hyperandrogenic state should be considered. The aim of this study was to determine the relationship between abnormal testosterone level and other virilising signs in young females with acne vulgaris. Methods: This case-control study was carried out from April 2013 to January 2014 in the consultation Department of Dermatology and Venereology at Rizgary Teaching Hospital in Erbil city. Sixty females were considered group A (case group with acne) and 60 females were considered as group B ( control group) without acne. Results: The mean±SD serum testosterone level was significantly higher among patients with acne compared to the control group (0.51 ng/ml ± 0.27 compared to 0.31 ng/ml ± 0.12, P ˂0.05). Irregular cycle was found in 28 cases (46.6%). Conclusion: The study showed presence of a significant association between serum testosterone level and acne vulgaris in female patients.