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Hormonal Acne: What’s Really Causing It

hormonal acne

It’s just teenage hormonal acne. It’ll go away.

Your acne is from your hormones. Go on the pill, that’ll solve it.

Acne around your period – that’s just normal PMS.

As a woman who still had persistent acne in her mid-twenties, I’m pretty sure my ‘pubescent teenage acne’ is not what was going on. I was frustrated by the guessing game of trying to work out my acne patterns. Acne on my jawline and chin.. that’s hormonal right? Acne on my period, that’s definitely hormonal. But what if I was getting it throughout my cycle too? I was so f***ing confused. So I dove headfirst into finding the answers to the big questions:

What really is hormonal acne? And is it JUST my hormones causing my acne?

What is Hormonal Acne?

Hormonal acne is exactly what you think – acne caused by changes in your hormones. Stereotypically, adult hormonal acne is located on the lower half of the face, along the jawline and around the chin – where the deepest hair follicles are located. If your acne is appearing in this area and fluctuates around certain parts of your cycle (or kicked off during big hormonal changes like puberty, pregnancy or menopause), it’s highly likely that your acne is hormonal.

Now, bear with me for the next section cause we’re going to have to get a little bit scientific. To understand the root cause of hormonal acne it’s important to know how our hormones affect our skin – and they are a MAJOR player in the acne arena!

The Hormone Players

Hormones are simply chemical messengers produced in the body, with multiple hormones having a flow on affect to other hormones. For the sake of simplicity in this article, we’re going to focus on our reproductive hormones, namely: Estrogen, Progesterone and Androgens (such as Testosterone).

In an ideal world, our reproductive hormones are in a constant state of balance – like if you were balancing along a see-saw. When our hormones get out of balance, that’s when we can start to experience symptoms within our bodies such as acne.

Reproductive hormones need to remain in state of balance. An imbalance of these hormones is what causes hormonal acne.

Androgens (Testosterone and DHT)

Androgens, also known as your male hormones, are the main hormones that regulate the production of sebum – your skin’s natural oil.

In a nutshell, acne forms when there is a build-up of sebum and skin cells inside the pore or hair follicle, trapping acne-causing bacteria into the skin. This then results in inflammation, and you guessed it, acne.

Testosterone acts on direct androgen receptors in the skin’s sebaceous glands (where sebum is produced) causing an increase in sebum in the pore. However, testosterone is also converted to dihydrotestosterone (DHT) by the enzyme 5α-reductase, converting it to a form that is 5 to 10 times stronger than testosterone. It’s like Bruce Banner turning into the Hulk (just for those Marvel fans out there). So, when we’ve got an increase in testosterone, it can lead to an increase its supercharged version, DHT, causing a serious increase in sebum production resulting in acne.

Progesterone

Progesterone in normal levels, has been shown to inhibit the activity of 5α-reductase. This means that there is less testosterone converted into the stronger DHT thus reducing sebum production. But when in excess, progesterone may have the potential to exacerbate acne. This can be seen in menstrual cycle fluctuations and in progestin-based birth control methods (more on this later). The exact effects of high levels of progesterone in relation to acne is still under debate with suggestions that it can cause an increase in sebum production and compression of the pore size.

Estrogen

Estrogen is where things can get a little complicated. Estrogen in balanced levels can cause a reduction in testosterone via multiple mechanisms and so reduces testosterones unwanted effects on sebum production and acne formation. Sounds great right?

However, when estrogen is out of balance it can also result in acne. The acneic effect of estrogen is primarily due to the ratio between estrogen levels compared to progesterone and testosterone. For example: Low levels of estrogen (which can be accentuated during certain parts of our cycle) relative to testosterone means that the effects of testosterone levels can be more pronounced and you can see a testosterone driven flare-up of acne. This is why women transitioning into menopause can experience acne when their estrogen levels drop rapidly compared to testosterone.

When estrogen levels are high in relation to progesterone, an imbalance called estrogen dominance, it can also trigger acne flare ups. As we mentioned before, progesterone inhibits the enzyme that converts testosterone into its hulk-like form DHT. So, when estrogen is more dominant, testosterone is more likely to convert into DHT leading to the unwanted increase in hormonal breakouts. It’s an imbalance of our hormonal see-saw.

Higher levels of estrogen can also cause inflammatory changes in the body which can also contribute to the formation of acne.

When hormones are in balance it doesn't contribute to the formation of hormonal acne
When hormones are imbalanced, it leads to a cascade of events that can cause the production of hormonal acne

What Causes Hormonal Acne?

Hormonal acne isn’t just caused by high or low levels of certain hormones. As our hormones are all interconnected in a hormonal web, they rely on a balance between each of them to maintain clear skin. The delicate balance of these hormones is influenced by both factors in our internal environment (our bodies) and our external environment. Things that can contribute to these imbalances include:

Diet

What you eat can have a significant effect on the formation of hormonal acne. Eating a highly processed, high sugar diet can cause rapid spikes in blood sugar levels and insulin. A rapid increase in insulin can directly increase testosterone levels but also increases the production of insulin-like growth factor-1 (IGF-1). This growth factor further increases testosterone as well as stimulating the overproduction of skin cells. Now you’ve created a perfect acne cocktail of increased skin cells mixed with increased sebum levels. This then results in a waxy plug inside the pore that can trap acne-causing bacteria deep inside.

Similarly, all dairy products stimulate the production of IGF-1 leading to acne. Dairy to the skin is what Voldemort is to Harry Potter – basically its worst enemy. So unfortunately, if you’re acne prone, it might be a good idea to temporarily breakup with your love of a cheese board, whey protein in your smoothies or your morning coffee with milk (come join the oat milk latte club – best alternative out there I promise!).

A frequent consumption of soy products can also contribute to an increase in estrogen. This is because soy is a phytoestrogen meaning that it mimics the natural estrogen in our body. When we have too much of these phytoestrogens, it can throw off the balance of estrogen and can lead to hormonal acne.

Over Supplementation

Vitamin D, B12 and zinc are all needed by the body in their correct dosages. However, OVER supplementation of these nutrients can increase the body’s testosterone levels which increases the skin’s sebum production and can lead to acne. Check your supplement labels to ensure you are not exceeding your recommended daily intake, especially if you’re taking more than one supplement. For example, I’ve found some Vitamin D supplements have 250-500% of your recommended daily intake. Our body just doesn’t need that much.

Environmental Factors

Endocrine disruptors are chemicals that mimic the natural hormones in the body. Xenoestrogens have an estrogen-like effect and can lead to an estrogen imbalance and most commonly lead to estrogen dominance. These can be found in plastics, cosmetics (shampoo, conditioners and makeups) and pesticides. Studies have also shown that chemicals such as phthalates can also interfere with estrogen receptors causing an imbalance. These are found in cosmetics, perfumes, or anything listed on a product as “fragrance”.

High androgen Birth Control

As empowered women who should get to enjoy sex without stressing about getting pregnant, the birth control arena is challenging and limited. I honestly wish there was a better solution for women that doesn’t disrupt our hormones or our gut health – but more on that another time.

Some birth control options are low in estrogens but high in androgens which can lead to acne. Progestin – the synthetic version of progesterone – can sometimes behave like androgens and can cause acne. Contraceptives that commonly contribute to acne are: hormonal IUDs (Marina, Skyla); implants (e.g nexaplon); progestin-only injections (e.g DMPA) and the mini-pill (e.g Microlut).

Certain combination pills can be beneficial in the treatment of acne due to their anti-androgenic effect. However, if you are looking at going on the pill solely as a solution to your acne, unfortunately you will only be seeking a band-aid solution rather than fixing the root cause. Historically, some women can see an improvement in their skin, but end up experiencing worse acne once they come off it. It’s like putting a plug in a leaky bucket – when you eventually take the plug out, it will just start leaking again. You haven’t actually fixed anything.

Gut Health

How can I talk about hormones without mentioning the gut. Did you know that we have an entire portion of gut bacteria that are dedicated to estrogen metabolism known as the estrobolome? When we have a dysbiotic gut (an imbalance of bad bacteria and good bacteria), these bad bacteria can secrete an enzyme called beta-glucuronidase. This enzyme re-activates estrogen in your gut causing it to recirculate back in your body instead of metabolising it out through your stool. This can then cause an excess of estrogen and, if imbalanced with other hormones, can lead to acne. Similarly, if you’re not going to the toilet consistently (yes, I’m talking about poo), estrogen that is stuck inside your bowel can be reabsorbed back into your body causing estrogen dominance.

PCOS

Women who have been diagnosed with polycystic ovarian syndrome already have an excess of androgens being produced by their body (known as hyperandrogenism). It’s been reported that 10-34% of women with PCOS have acne as a symptom. Acne is also exacerbated by the fact that women with PCOS are often insulin resistant, meaning they produce insulin but their bodies can’t effectively use it. This increase in insulin in the body can also trigger the increased production of DHT in the sebaceous glands causing acne.

Top Hacks to take control of your hormonal acne

Now that we know how an imbalance of our sex hormones can occur within the body, the main question is how do we balance out these hormones and prevent hormonal acne?

Diet – Avoiding certain acne triggers like sugar, dairy, soy, inflammatory foods and oils. Opt for a minimally processed, wholefood diet rich in an abundance of plants, high quality fats and organic animal proteins (if you chose that way). Your gut bacteria and your skin are going to thank you for it.

Eliminate pore-clogging ingredients – If you have hidden pore-cloggers in your products it means that these ingredients are already blocking your pores. If there is a hormonal imbalance causing an increase in sebum, it can exacerbate the already clogged pore, making it more inflamed and cause acne. That’s why sometimes acne that emerges in the “hormonal areas” during around ovulation or your period can actually be due to the pore cloggers you’ve been using all month – it just rears its ugly head when there’s a shift in hormones .

Believe it or not but some of the worst pore-clogging culprits are the ones marketed as natural or organic. I was honestly using these products for years without making the connection to my acne. Do yourself a favour and compare the list of pore clogging ingredients against all your personal products including skincare, suncreen, makeup, shampoo, conditioner, and detergents. This is one of the easiest things to do. By just eliminating pore clogging ingredients in your products, you will start to notice a significant improvement in your skin.

Sleep – Studies have shown that people who tend to have poorer sleep have a higher prevalence of acne. Crazy right?! Sleep is so important to regulate levels of your stress hormones. If you’re not getting enough sleep, it can cause higher cortisol levels which completely messes up the balance between estrogen and progesterone. Sleep also reduces inflammation in the body, helps regulate our hunger hormones (including insulin) and essentially helps repair skin tissue overnight. Beauty sleep is actually a thing!

Check your supplements – Check the dosage of vitamin D, b12 and zinc on the back of your supplements to see if you could be over-supplementing and impacting the balance of your hormones. Tip: Be careful when you take multiple supplements and multivitamins that have these ingredients added. Even if each individual supplement has the correct dosage, when you take them all in one day, you might be exceeding what your body needs.

Avoid hormone disrupters: I know this is hard because we live in an environment full of hormone disrupters, but there are little changes you can make that will keep your hormones happy and also the environment. Climate change bonus points! Some ideas include:

  • not heating things in plastic
  • avoiding BPA like certain plastics and cans
  • removing your coffee cup lid before you drink (or extra points for using a keep cup)
  • switching to more natural essential oil perfumes to avoid things with ‘fragrances’
  • filtering your tap water
  • drinking from a reusable water bottle not plastic disposable ones
  • eating organic produce (where able)

Seek support from a health practitioner If you’ve tried all the above and think you may have some underlying gut issues or hormonal imbalances, it may be worth getting tested to know your true levels throughout the cycle. Test it, don’t guess it! This can be done by working closely with a holistic practitioner who can provide individualised advice and help guide you through your stages of internal healing. Remember, true beauty is from the inside out!

So when you get told that acne is ‘just hormonal and you have to deal with it’, I give you full permission to do an internal eye roll. There are multiple factors that contribute to hormonal imbalances and acne. The good news is there’s SO much you can do to help rebalance your hormones, reduce your internal inflammation and manage your hormonal acne at the same time! Your body naturally wants to be in a state of equilibrium, you just have to give it the right tools.

As always, I love hearing from you! What resonated the most for you? Is there anything that you’ve tried that has been effective? Leave a comment below and let us know.

Sending big love always,

References

Azziz R, Woods KS, Reyna R, et al. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 89(6):2745-9 (2004 Jun).

Baker, J. M., Al-Nakkash, L., & Herbst-Kralovetz, M. M. (2017). Estrogen-gut microbiome axis: Physiological and clinical implications. Maturitas103, 45–53. https://doi.org/10.1016/j.maturitas.2017.06.025

Bakry, O. A., El Shazly, R. M., El Farargy, S. M., & Kotb, D. (2014). Role of hormones and blood lipids in the pathogenesis of acne vulgaris in non-obese, non-hirsute females. Indian dermatology online journal5(Suppl 1), S9–S16. https://doi.org/10.4103/2229-5178.144506

Cappel M, Mauger D, Thiboutot D. Correlation Between Serum Levels of Insulin-like Growth Factor 1, Dehydroepiandrosterone Sulfate, and Dihydrotestosterone and Acne Lesion Counts in Adult Women. Arch Dermatol. 2005;141(3):333–338. doi:10.1001/archpedi.161.4.356

Ebede, T. L., Arch, E. L., & Berson, D. (2009). Hormonal treatment of acne in women. The Journal of clinical and aesthetic dermatology2(12), 16–22.

Elsaie M. L. (2016). Hormonal treatment of acne vulgaris: an update. Clinical, cosmetic and investigational dermatology9, 241–248. https://doi.org/10.2147/CCID.S114830

Makrantonaki, E., Ganceviciene, R., & Zouboulis, C. (2011). An update on the role of the sebaceous gland in the pathogenesis of acne. Dermato-endocrinology3(1), 41–49. https://doi.org/10.4161/derm.3.1.13900

Schrom, K. P., Ahsanuddin, S., Baechtold, M., Tripathi, R., Ramser, A., & Baron, E. (2019). Acne Severity and Sleep Quality in Adults. Clocks & sleep1(4), 510–516. https://doi.org/10.3390/clockssleep1040039

Zamil DH, Perez-Sanchez A, Katta R. Acne related to dietary supplements. Dermatol Online J. 2020 Aug 15;26(8):13030/qt9rp7t2p2. PMID: 32941710.

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