Not necessarily. You can create underlined text, using \L and \l such as:
(defun test (txt2uline / txt txtstr txtpos newtxt)
(setq txt (vlax-ename->vla-object (car (entsel "\nSelect text: "))) txtstr (vla-get-textstring txt) txtpos (vl-string-search txt2uline txtstr 0) newtxt (strcat (substr txtstr 1 txtpos) "\\L" (substr txtstr (1+ txtpos)(strlen txt2uline)) "\\l" (substr txtstr (+ (1+ txtpos)(strlen txt2uline)))) ) (vla-put-textstring txt newtxt)
)
See the AciveX and VBA Customization Guide for a list of all the codes that can be used. I'm not sure what Nate meant by "points".....if he meant the text height, that can be altered also.
Jeff