Although environmental and hereditary factors certainly contribute, androgens, DHT in particular, have a much greater influence on the development of acne than estrogens, with estrogens believed to have a variable "protective effect" in some individuals.
No doubt higher testosterone levels are a major contributor to the roughly two fold higher incidence in adolescent males compared to females and an near tripling of the more severe form of acne (cystic, nodular, pustular) in males during this period of remarkably elevated testosterone levels.
Moreover if elevated E-2 was indeed causative the use of AI's would be expected to impart a difference in the development, progression or regression, of "AAS associated acne" and they most certainly do not IME. (Perhaps Dr. S is aware of a study, pro or con to enrich this thread)
Moreover considering the toxicity of Accutane it should only be used for recalcitrant forms of nodular-cystic acne which can create scaring. This form of acne is very rare after the age of FOURTY, especially with facial involvement, even in body builders on AAS.
Lastly using Accutane as the "go to drug" for BB whom develop acne, or as prophylaxis, is asking for unnecessary complications and should be eschewed IMO
Regards
JIM