I think affected people have mutations in folate cycle. and if you had acne, that means you do have problems with fats.
low glutathione from mutations in folate cycle, fatty liver, bile blockage can develop at any age.
We have POIS people and majority of them got POIS at 17 -18-20 years old, and they never took any drugs. finasteride, or any other drugs.
They could have had wrong diet for their body chemistry, mutations, low glutathione, some heavy use of antibiotics. etc.
Then you have heavy steroids abusers. Most of them develop fatty liver. We had tons of those with POIS on our forum. Then they are predisposed to crashes from finasteride. or from even an infection. We had some people crash in PSF style from infection, and never recover.
We had people crash PFS style from vaccines. And never recover
Then you have drug users, pot smokers. etc CB1 receptor directly causes fatty liver.
The Role of Endocannabinoids System in Fatty Liver Disease and Therapeutic Potentials
We had ton of those on POIS forum.