Its a difficult topic - you hear about all sorts of advice/information....some sources i've read say what you eat doesn't do things, i.e. having spots and acne is nothing to do with a poor diet for example - which quite frankly i find absurd, through personal experience too - to quote "you are what you eat"....inevitably in ideal world, to be drug free is best, but if you are trying hard to improve the situation of your skin through natural means - good exercise and food/drink intake....and its not working, then go to the GP, i did this and i went through probably about 4-5 different courses, none of which worked - the 'end of the line' treatment is something called roaccutane, and of course, some people have laser treatment.
Hormones and lifestyle - i think the latter has much to say regarding spots and acne...good healthy diet and exercise really helps, but if doesnt work, go to the GP and get something prescribed. With regards to my experience of roaccutane, "the drugs don't work, they just make you worseeee" relates - aka the verve.