Prescribed both Spironolactone and Isotretinoin. Need advice please!!

Hey everyone

I'm 25F and I'm posting to seek some guidance from this amazing community regrading my acne. Sorry for the long post ahead.

So I started using tretinoin 0.05 back in August last year and likely destroyed my barrier. I never had acne before that and only started it for anti-aging but ended up with severe acne breakouts that just wouldn't end. I stopped tretonoin 1.5-2 months in but the breakouts continued to happen. I was prescribed Doxycycline 100mg in Jan this year by a dermatologist. It helped reduce the number of new pimples I would get but I was still getting them every 2-3 days.

I finally started using differin gel last week (started at twice a week and have only used it thrice now). I haven't gotten any new pimples this week although I do know it might be too soon to tell if differin is actually working.

I visited another dermatologist today and she straight up prescribed Spironolactone 50mg daily and oral isotretinoin 20mg daily for 3 months. Now I'm very concerned b/c isn't this too aggressive and I've always thought of isotretinoin as the last resort treatment for acne? I'm also concerned if the dermatologist was one of those who puts everyone female with acne on isotretinoin and Spironolactone.

For further context, I have PCOS (have had menstrual irregularities all my life but NEVER acne: in fact, I would always be complemented for my clear skin) and AGA (currently on oral minoxidil 1.25mg daily). Mind you, the dermatologist didn't know I have pcos (I know I'm dumb….I completely forgot to mention for some reason).

My questions:
1. I know you all aren't dermatologists but from lurking on this sub, I know you all are very knowledgeable in skincare. I would really appreciate your opinion on whether such an aggressive treatment is really necessary. Or should I just take the plunge since its just 3 months anyways?
2. Should I consider taking only one of Spironolactone and isotretinoin or both? I'm not very keen on Spironolactone b/c I already pee a lot and don't want to have to pee all the damn time.
3. Should I just continue differin for a while and see how that works or would that be a waste of time? I've also been thinking adding some chemical exfoliation once a week (I have Paula's choice 2% BHA exfoliant)
4. If I do take isotretinon, I'm aware of the short term side effect of extreme dryness but are there any long term side effects to using it?

I've attached pictures of the current state of my acne here.

I'm sorry again for the long post but I'd really appreciate any advice! Thankyou so much!