Last Updated on August 16th, 2020
By Dr. Jaggi Rao, MD, FRCPC, Double board-certified dermatologist
When you hear “hormonal acne,” you probably have flashbacks to high school, but unfortunately, leaving your teenage years behind doesn’t free you from hormonal acne. There are actually several ways hormones can cause acne, from puberty to stress to serious health conditions. Most people experience hormonal acne at some point in their lives, or during several points throughout their lives. There is good news though: even if you can’t control the hormones, you can control how you treat your skin. This article will review what causes acne, explain how different hormone fluctuations can impact your skin, provide recommendations for effective treatment options, and answer some frequently asked questions about hormonal acne.
Article Table of Contents
Acne caused by hormones is still acne, and acne has three primary causes: inflammation, bacteria, and oil production. Doctors used to believe that bacteria were the main culprits, but more recent research has revealed that inflammation could be the real problem. They learned that bacteria and oil can actually benefit the skin in appropriate amounts, and usually only became a problem when the skin became inflamed.
The way this works is relatively simple. P. acnes, the primary acne-causing bacteria, always live on your skin in reasonable numbers. They consume the oil your skin produces (also known as sebum), which can prevent an unhealthy oil buildup. Similarly, your skin is always producing sebum to protect itself 🛡️ from every day irritants like dust, pollen, or even your own fingertips, picking or scratching at your skin. If you could prevent any inflammation, sebum and bacteria might live in harmony without any acne.
Unfortunately, your skin is often slightly inflamed because it’s very sensitive to stress and potential infection. Your skin becomes inflamed when it wants to protect itself by closing off the pores. If an irritant has gotten through your skin’s layer of sebum, your pores will detect it as a threat, and your skin will release its own stress hormones to induce inflammation. This will close the pores and prevent the irritant from spreading. Unfortunately it can also trap bacteria and sebum when it closes, and this is when acne almost always forms.
The skin can also become inflamed through emotional stress, like if you have a big test coming up or are having trouble making ends meet financially.
This is because when you’re stressed, your body perceives the stressor as a literal, physical threat. In order to protect itself, it triggers the inflammation response.
Generally, a good way to prevent acne is to prevent inflammation and reduce irritation as much as possible, but other strategies could also be important when treating hormonal acne.
If you suspect that your acne is being caused by hormones, inflammation still plays a large role, but excess sebum production could be an even bigger problem. Many hormone fluctuations involve an increase in testosterone, a hormone generally considered to be “male,” but it is present in all sexes to varying degrees. Testosterone itself does not always cause acne, but when the baseline balance of hormones is disrupted and testosterone is increased or different hormones like estrogen are decreased, it can lead to acne.
An unbalanced amount of testosterone often causes an increase in sebum production, which then clogs pores and causes all kinds of acne. It could cause blackheads and whiteheads, since they are primarily caused by clogged pores, but it could also form pimples by trapping p. acnes in the pore. These bacteria feed on sebum, 🍲🥄 so when they are trapped with even more sebum than normal, their numbers can grow very quickly, creating a small infection. Your immune system tries to fight the bacteria, a process which produces pus and causes inflammation, leading to a pimple.
When treating hormonal acne, it’s important to treat all three causes of acne, but excess sebum may have the biggest impact.
Hormonal fluctuations are a pretty normal part of daily life, but there are times or situations when they could spike or drop in significant ways that lead to more acne. Puberty, menstruation, pregnancy, menopause, stress, testosterone therapy, and polycystic ovarian syndrome (PCOS) can all produce hormones that cause acne. Let’s take a look 🕵🏽🕵🏻♀️ at how all of these hormonal fluctuations contribute to acne.
Having acne as a teenager is a nearly universal experience—it is estimated that 85% of teenagers have some degree of acne. Even though it is one of the most common skin conditions in the world, our society encourages a lot of shame surrounding it.
Have you heard acne product commercials call blackheads “dirty”? This is just one example of the skincare industry profiting by making you feel bad about an incredibly normal occurrence. It is just a myth that blackheads are caused by dirt or poor hygiene. 🛀 Blackheads are pores that have gotten clogged with dead skin cells and sebum, similar to whiteheads. The only difference is that whiteheads are formed by a closed pore, and blackheads are formed by an open one. This is where blackheads get their dark color: being exposed to the air effects the color of the pore, similar to how an apple turns brown once it has been cut. The cleanest person in the world could have blackheads.
They are incredibly common in teenagers because the increased testosterone associated with puberty in all sexes (not just male!) leads to more sebum, which then clogs more pores. Still, teenagers are told to feel bad about blackheads, and it can have a profound effect.
The shame many teenagers feel about their acne can contribute to serious mental health conditions like depression or anxiety. It’s important to know that acne is incredibly normal, but can still be incredibly hard.
Teenage acne often improves over time, and there are a variety of acne solutions that could reduce it in the meantime (see “Hormonal Acne Solutions” section further along in this article).
People who menstruate are constantly undergoing hormonal shifts that could encourage more acne. Unlike some hormonal changes that cause acne, 🩸 the menstrual cycle doesn’t involve any spikes in testosterone; instead, there is a prominent drop in estrogen. This has a similar effect because even though the body isn’t producing extra testosterone, there isn’t enough estrogen to balance out the normal level of testosterone. The result: extra sebum and more acne. You will probably see increased acne during menstruation and during the first half of your menstrual cycle because this is when estrogen is at its lowest.
Believe it or not, there is some truth behind pregnancy glow. If you are pregnant, you know your body is being bombarded with hormones like never before. These hormones, combined with a 50% increase in overall blood flow, can make your skin seem to be shining and radiant. Sadly, part of what makes the skin shine is an increase in oil production due to higher levels of testosterone. 🤰🏼🤰🤰🏾 For some people, this can lead to clogged pores and pregnancy acne.
Unlike other kinds of hormonal acne, treatment for pregnancy acne is slightly limited. There are some acne treatments that cause birth defects, so be sure to speak with your doctor rather than trying to deal with pregnancy acne alone.
Hormonally, menopause is similar to the beginning of the menstrual cycle. Testosterone levels typically stay steady, but estrogen levels drop. This begins before full menopause, in a stage called perimenopause. During this time, menstrual cycles may change length and menstruation is often inconsistent.
These hormonal shifts at this time lead to more sebum production which can cause acne, but there’s another factor in menopause that can contribute to acne. Many people go through menopause somewhere between ages 40 and 58. 👱♀️👵🏽👩🦰👵🏿 At this age, skin is regenerating new skin cells at a slower rate. Younger skin produces new skin cells so rapidly that the old ones are forced out of the pore at a regular rate, but when skin cell production slows down, dead skin cells can easily build up in pores. Combined with excess sebum, this often leads to acne.
The hormonal shifts associated with stress are very different from those we’ve discussed so far because they do not revolve around testosterone. There are actually two kinds of stress that can affect acne: emotional and physical. Physical stress is driven by the skin’s own stress hormones, separate from stress hormones delivered by the endocrine system, so it only affects the skin. 🧘🏼🧘🏽♀️🧘🏾♀️ Emotional stress is more central; stress hormones are released by the endocrine system and they affect the body as a whole, including the skin.
Physical stress occurs when the skin is irritated. To prevent the irritant from causing damage or spreading, skin cells release a stress hormone that causes the skin to become inflamed. Many things can irritate the skin, including acne treatments. Many products are far too harsh and if you are unhappy with your acne, it can be tempting to really scrub you skin to “get the dirt out.” But as we’ve discussed, acne is not actually caused by dirt, and scrubbing just causes inflammation and usually more acne.
Emotional stress can also contribute to acne through increased inflammation.
When you are stressed, your body has a visceral reaction. Stressors are perceived as a literal, physical threat, causing your endocrine system to release stress hormones designed to help you in a physical encounter: fight, flight, or freeze. Although this is helpful when facing an attacker, it is less helpful when you’re lying in bed thinking about your big presentation tomorrow. These hormones send more sugar to your brain to speed up mental processes, slow down digestion to conserve energy, ⚡ and trigger the skin’s inflammation response to protect it from any irritants. This clogs pores and often leads to acne, which can cause more stress, creating a vicious cycle. Learning ways to manage stress could reduce acne, not to mention give you a little peace of mind.
Often referred to as T therapy, testosterone therapy is sometimes used by trans men to boost the correct hormones for their gender and produce more masculine features. 💪🏻🧔 One potential side effect, however, is increased acne. Like many other trans issues, there is not enough research being conducted on this subject. However, increases in testosterone when compared to the body’s typical levels often lead to more acne, so it is possible that T therapy could result in hormonal acne.
Polycystic Ovarian Syndrome (PCOS) is a health condition that affects the ovaries and associated hormones, but little else is known for sure. Like many conditions that afflict mainly women, PCOS is not well-researched, and it is not clear what causes it or how to diagnose it. Symptoms can vary widely from one person to another; for instance, despite the name, many women with PCOS do not have ovarian cysts. Some potential symptoms include ovarian cysts, unwanted hair growth or hair thinning, mood changes, headaches, infertility, and non-diabetic insulin resistance.
It is this insulin resistance that can cause acne for people with PCOS. Insulin resistance occurs when the body doesn’t respond to insulin right away. Insulin helps your tissues absorb glucose, a kind of blood sugar. If the body doesn’t respond to the insulin, then your pancreas will release even more insulin until the body does respond. Your body can become increasingly resistant to insulin, 💥👊🏼 and various organs find other ways to process the glucose.
The ovaries sometimes do this by producing more testosterone, which of course leads to more sebum and more acne. Some sources claim that switching to a less sugary diet could reduce insulin resistance in those with PCOS, but the research in this area is inconsistent. If you suspect you could have PCOS, search for a doctor 🩺 who has successfully helped other PCOS patients in the past. The PCOS Awareness Association has a search tool on their homepage for finding PCOS doctors that could be helpful.
Now that you know some of the main causes of hormonal acne, what are you supposed to do about it? There are two ways to go about treatment: you can treat the source of the issue and try to control the hormones, or you can treat the acne as it occurs. Although it is usually better to treat the cause of any issue, sometimes our hormones fluctuate for good reasons. We may want to reverse their effects when it comes to acne, but we wouldn’t want to halt the other processes hormones make possible, like puberty or pregnancy.
Luckily, there are options for both types of treatment, hormonal and non-hormonal.
Combined Oral Contraceptives:
Combined oral contraceptives (COCs) are a specific kind of birth control that includes progestin and a synthetic form of estrogen to prevent pregnancy and acne. The added estrogen reduces the disparity between estrogen and testosterone, restoring balance. ✋ This stops the excess sebum production, but it also interferes with the menstrual cycle, making it a bad option if you are trying to get pregnant or are using T therapy.
Spironolactone:
This is an androgen-suppressant, meaning it decreases the amount of androgens (like testosterone) your body produces. Unlike COCs, which increase estrogen, spironolactone decreases testosterone. This can stop the excessive sebum production, but it can also produce feminine characteristics 👗👠 and cause disturbances in the menstrual cycle, so it is not recommended for men or for women who are trying to get pregnant.
Retinoid:
Retinoids are concentrated forms of vitamin A or vitamin A derivatives that can help prevent clogged pores. Although they cannot prevent the excess sebum production caused by hormones, they can slow down a process called retention hyperkeratosis. This is when a pore sheds skin cells far too quickly, and they get clogged in the pore. Retinoids can break up the dead skin cells and clear the pore, preventing acne. Retinoids can be very effective, but they can also be harsh. ⚕️ If you have sensitive skin, make sure you speak with a doctor before starting a retinoid. Most are only available as prescriptions, but products like Differin are available over-the-counter. If you do choose an OTC retinoid, make sure you start with the lowest concentration possible.
Sulfur:
Although sulfur can be a bit smelly, it’s a drying agent that could help with excess sebum without irritating the skin. There are sulfur soaps, face washes, even facemasks, so you can customize how you add it to your daily routine. Sulfur is very gentle, so you should be able to use a sulfur face wash every day, but if you notice drying or irritation, ✂️ cut back your usage.
Aloe Vera:
Hormonal acne caused by stress is slightly different from other forms of hormonal acne because it is caused more by inflammation than excess sebum. 🌵 Using a drying agent on acne caused by stress might irritate the skin and create further problems. Instead, you can try to use aloe vera since it is an anti-inflammatory agent. Aloe vera can soothe the skin to open up the pores and prevent clogging.
Gentle, Consistent Skincare System:
The best way to treat acne, hormonal or not, is a gentle skincare system like 🌱 Exposed Skincare. It uses natural and scientific ingredients to reduce inflammation, clear away extra oil, and kill bacteria, all while keeping your skin healthy and avoiding irritation.
Q. What about an antibiotic? Could that help with my hormonal acne?
A. Antibiotics actually aren’t very effective for acne in general, and are definitely not a good choice for ongoing hormonal acne. If you are in your early teens, have a menstrual cycle, have PCOS, or are using T therapy, your testosterone levels are likely to be raised for an extended period of time, or will be raised repeatedly.
Antibiotics are meant to be used for only a few weeks, so they aren’t a great option for ongoing hormonal fluctuations. On the other hand, if you are going through menopause or if you’re pregnant, 💊 antibiotics may be an option. There are some antibiotics that you should not take if you’re pregnant, but others are safe and can help reduce pregnancy acne. You should discuss your options with your doctor.
Q. Is hormonal acne different from other acne?
A. There’s not a huge difference, no. Acne is caused by inflammation, bacteria, and sebum production, and hormones control two of those three factors. All acne has a hormonal component, even if it’s just the inflammatory stress hormone the skin releases to protect itself from irritants and infection. The biggest difference between acne that is clearly tied to hormones and more general acne is the regularity. If there’s a consistent hormone imbalance at play, acne will continue to be a problem that needs treated until balance is restored. ⚖️ With other acne, a consistent skincare routine can get rid of acne completely in some cases.
Q. Are there any products to avoid when treating hormonal acne?
A. If you are pregnant, there are several acne treatment products that you should avoid, as they could cause potential birth defects. But if you are not pregnant, the main things to avoid are harsh products or products that focus exclusively on 🦠🦠🤺 killing acne-causing bacteria.
The main factor in hormonal acne is excess sebum, so bacteria-oriented products might not help very much, and because they are often very harsh, they may actually make things worse. Because sebum is the biggest issue, you’ll want to try products that reduce sebum production or prevent sebum buildup, such as a retinoid.
Hey there! Question for you... Can drastic fluctuations in testosterone, cortisol levels, contribute to acne? I am 32 and graduated from US Army Ranger school at the end of last January. Ranger school is notorious for damaging the body in many strange ways. Testosterone levels drop. Cortisol levels spike. No food. No sleep. All for at least 61 days. I spent 100 days there. When I rejoined the world after graduating, I started to do the things I used to do before school. Intense athletic activity (weights, running, etc), sex, whey protein, vitamins. I began to notice arm and torso acne developing. I switched from whey to egg protein as I know that dairy products can contribute to acne. Things got a little better but never went away--and now things are worse which is why I am writing you. Can the drop and then rise in testosterone be contributing to my body acne? It is now 4 months after Ranger school. Do hormones take a long time to settle back down after an event like Ranger school happens? Flare-ups happen maybe once a month. I began exfoliating but that doesnt seem to be helping too much. What say you? Feel free to ask any questions you want. Thanks for your time, -Bobby.
I am 70 years female who stopped taking testosterone injections and now of pimples on face. What should I do to clear up
Hi, I'm wondering if intense excessive exercise, specifically running long distances, can cause acne to flare up? I'm 31 and have been battling acne for more than half my life. It comes and goes and is sometimes moderate. When I was 26 I got pregnant with my first child and my acne seemed to clear up almost completely and has remained pretty much clear ever since. I'll get the occasional few breakouts, but nothing major. Over the past few months I've been training for my first half marathon and my face has been breaking out like crazy. Could it be because of the excessive running? My body is maybe pumping out cortisol on my long runs and causing me to break out? Thanks.
Please fix the 2nd sentence under topic: Acne, Estrogen, Testosterone, and PCOS . I'm pretty sure the ovaries produce large amounts of ESTROGEN and some testosterone. Otherwise, great info for my son with high testosterone who is battling acne and thinks anti-biotics are the cure-all. It's all about cortisol, gut health, and as you pointed out, not abusing the skin of all its stabilizing/homeostatic factors (such as the probiotics that normally reside on healthy skin!).
They usually do,but in PCOS the testosteron and free testosteron (DHT) is higher than estrogen ....and voila you have a hormonal imbalance
Well this page od so wrong.... I do even feel they are promoting some Products.... Not all od the PCOS victims are over weighted. Personall, i am 168 cm and 49-50 kg.... Diet(sugat free for example) can help but there are other triggers top,for someone it is Milk qnd dairy products,for someone carbs and someone sugar.... So it Takes a lot of time to find out what May be a triggers for you.... There is NO CREAM that can help a hormonal acne !!! If the problem is inside there is no point treating it from outside. The things for skin care May only help with existing acne( help it heal faster or treating the hyperpigmentation,reduce swelling and redness) . I have tried everything except accutane. The things that worked for me the best on the long term were tinctures , BC helped at the moment and after 2 months without them the acne came im even worse stage.... Nature is everything...you should give it a try. I am switching to Ovasitol now,if someone had experience with it please prave a comment. Thank you and good luck
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