Background: Acne is one of the most common dermatological conditions, affecting individuals of all ages and genders. While it is often associated with adolescence, a significant number of adult females experience acne well beyond their teenage years. Materials and Methods: A prospective, observational study was conducted over 12 months at a dermatology outpatient clinic, involving 100 adult female participants aged 18-45 years diagnosed with acne. The Global Acne Grading System (GAGS) was used to assess acne severity at baseline and after six months. Hormonal profiles, including serum testosterone, estradiol, progesterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH), were measured. Pearson correlation analysis was used to evaluate the relationship between hormone levels and acne severity, and data were analyzed using SPSS version 23.0. Results: At baseline, 40% of participants had mild acne, 35% moderate, and 25% severe. Significant reductions were observed in both serum testosterone (50.2 ± 5.3 ng/dL to 47.5 ± 4.8 ng/dL, p = 0.03) and estradiol levels (120.4 ± 12.6 pg/mL to 115.6 ± 10.9 pg/mL, p = 0.045) after six months. GAGS scores improved significantly in all groups: mild acne decreased by 1.5 (p = 0.02), moderate by 2.0 (p = 0.01), and severe by 3.5 (p = 0.005). Pearson correlation showed a positive association between testosterone levels and acne severity (r = 0.32, p = 0.02), while estradiol levels had a negative correlation with acne severity (r = -0.28, p = 0.03). Conclusion: The study demonstrated that hormonal imbalances, particularly elevated testosterone and reduced estradiol levels, significantly influence acne severity in adult females. Hormonal therapies targeting these imbalances, combined with lifestyle modifications, may offer effective management of acne.