Hormonal Acne: Causes and Treatments

By Samantha

Hormonal acne is when the hormones we produce are imbalanced, causing increase of inflammation and sebum production in the skin leading to more acne breakouts.  Hormones such as estrogen, testosterone, and cortisol, to name a few, can directly impact acne.  Our Hormones are responsible for the amount of oil that our oil glands produce. 

The four biggest hormones which affect our skin health are estrogen, testosterone, cortisol, and thyroid hormones.

It is actually difficult to directly measure hormone imbalances since tests may read levels as normal and levels are different during different times of the day. 

Signs Of Hormonal Acne

Hormonal acne can occur at any age - common triggers are puberty, during periods, pregnancy, times of increased mental , physical, or emotional stress, to changes in medication such as going off hormonal birth control. 

Hormonal acne usually happens in the lower half of the face and around the jawline. 

Hormonal acne tends to occur during:

• Puberty
• Menstruation
• Pregnancy
• Menopause
• PCOS
• High Stress

What Hormonal Acne Looks Like

Hormonal acne can range from either small pustules and whiteheads to larger cystic acne. 

If you have more cystic acne around the jawline, chances are likely that it is hormonal acne.

Hormonal acne is usually more common in females, but males can also experience it. 

Causes Of Hormonal Acne

In many cases, hormonal acne is caused by too much testosterone  to your estrogen ratio, and a prolonged increase in cortisol too seems to be linked to more acne.  

A decrease in estrogen levels in women such as during menopause can cause hormonal acne.

Some publications indicate that women are more sensitive to androgen hormones due to increased receptors of androgen in skin and sebum producing cells. 

Stress

Yep, stress causes an increase in acne. Stress releases the hormone cortisol, which creates inflammation in the body. This inflammation can then lead to impair skin function and an increase in hormonal acne.   Stress management techniques may help prevent flare ups. 

Menstruation

How To Reduce Hormonal Acne

Tackling hormonal acne may need a combination of several methods of treatment as skincare alone may not be enough to prevent it. 

Reduce Sugar Intake

During a hormonal breakout, the sugars in processed foods could cause more hormonal breakouts.  High glycemic foods result in insulin spikes which increases systemic inflammation and can result in more acne.

If you struggle with skin that is sensitive to sugars, you might consider taking a  glucose support supplement and following a  skin-friendly diet.

Limit Dairy

Like processed sugars, dairy is horrible for hormonal acne. For some people, hormonal acne could disappear completely by eliminating dairy. 

There's also positive association between intake increase of dairy to increase of IGF-1 ( Insulin-like growth factor ).  

You may think I never drink miik - but dairy is hidden is many food products and ingredient lists and easily found in everyday foods, from sandwiches, soups,  sauces like dressing, dips, and sandwich spreads, whey protein powder, most baked goods and many prepackaged foods.  

The fact is that dairy is high in sugar too which can cause a decrease of estrogen, and is generally a pro inflammatory food which can lead acne to form, and if you have hormonal acne you’ll want to substitute it with plant based alternatives to see if that helps. 

Hormone Balancing Tea

Diet is not always the miracle answer to acne, but for many people what they eat makes a huge difference in their hormonal acne.

Studies have also shown that increasing  spearmint tea consumption could also help to  reduce testosterone levels, and therefore improve hormonal acne, however this is not recommended for men.

Consult your physician before trying a herbal remedy for hormonal acne. 

Exfoliation

Exfoliation is a must for people with hormonal acne. Exfoliation helps to remove the extra sebum and dead skin that can clog pores and create acne.  Exfoliating can be done 1-3 times a week and we recommend a chemical exfoliator. 

The Banish Pumpkin Enzyme Masque  is great for exfoliation because of the natural pumpkin enzymes and AHA glycolic acid in the mask. 

Azelaic Acid

Research shows Azelaic Acid applied twice a day at 15-20% concentrations is effective for moderate hormonal inflammatory acne.   It seems to have an anti-inflammatory effect on the skin and is usually well tolerated. 

Adaptogens 

Adaptogens are best if you are experience stress related acne.  An  adaptogen is a plant or plant extract used in herbal medicine which is believed to stabilize the body and create a state of homeostasis or balance.

Ashwagandha and Holy Basil are both popular adaptogens said to help acne. It can reduce stress to help reduce hormonal acne.  

Adaptogens like Maca and Vitex are touted to help with  hormonal side effects and alleviate PMS symptoms, but it isn’t clear whether or not they are effective for acne.

Retinoids

For hormonal acne that just doesn't want to back down, retinoids may be a more suitable treatment option. Retinoids are great for increasing skin turnover, increasing collagen, and it has anti-inflammatory effects too. 

When starting retinoids, your skin may be more sensitive and inflamed at first  since retinoids can be irritating to the skin.

If this happens, you can try applying every other day or layer it over moisturizer, and you may want to exfoliate less often if you're also using a retinoid.   Beginners should start with over the counter versions containing retinol at lower percentages. 

The strongest version you can get over the counter in the U.S. is adapalene sold as the brand differin.    You can get prescribed tretinoin by your doctor. 

Tea Tree Oil

Studies have shown that tea tree oil at 5% concentration is as effective as benzoyl peroxide in reducing mild to moderate acne. 

Make sure that your product that contains tea tree oil isn't mixed in a formula with highly comedogenic oils as that could worsen acne. 

Benzoyl Peroxide

Benzoyl peroxide is an effective treatment for all kinds of hormonal acne.  Benzoyl peroxide can reduce the amount of inflammation on the skin by eliminating acne causing bacteria on the skin surface.  It can be drying, so pair with a moisturizer. 

Antibiotics  should not be used for hormonal acne, because hormonal acnes root cause isn't due to bacteria. 

If you're using topical treatments for hormonal acne, more is not always better.

Using multiple treatments can increase irritation and impair the skin barrier, so if you notice more burning, redness, or peeling itching skin, take it back and stick to one treatment only for a while until your skin adjusts. 

Oral Hormone Therapies

Of course, hormone therapy is an an effective option for hormonal acne that is resistant to other treatments aren't showing improvement.  Usually it works by blocking androgen receptors. 

Consider the pros and cons of going on hormone therapies to treat acne since they can come with their own plethora of side effects.  

If you decide to go off hormone therapies, it's possible acne could return back.  Depending on your hormonal imbalance, your doctor can do further testing and prescribe the right treatment plan for you.  

Birth Control Pill

IUDs and implants which only release progestin may make acne worse, whereas certain  birth control pills increase estrogen levels to combat hormonal acne if your hormonal acne cause is a lower ratio of estrogen. 

Birth control pills come with their own list of several side effects too. 

Spironolactone

For many women with hormonal acne, spironolactone is a very effective treatment option and it works because it is an anti androgen which will block androgen receptors.

Sprionolactone is recognized by the FDA only to treat high blood pressure and fluid retention, but doctors may prescribe it off label for hormonal acne. 

Cyproterone acetate

Another study using cyproterone acetate in a topical cream showed significant decrease in the amount of hormonal acne after 3 months of using it, and generally no ill side effects.   Taking it orally can have much more side effects though so a topical cream may be a better option.  

Isotretinoin

Of course, for the very severe cases of hormonal acne, treatment of isotretinoin or Accutane may be required. Although  relapse rates for hormonal acne tend to be higher, it will still decrease the severity if other treatments aren't working. 

With consistent therapy (lifestyle, topical, and sometimes oral), hormonal acne can effectively be controlled so you can have your skin – and your life – back!

Types Of Hormonal Imbalances That Cause Acne

Estrogen

Estrogen is important for determining how our skin looks and feels. As we age our estrogen levels change; our skin becomes dry, fragile, saggy, and has a general decrease in elasticity.  However, an overproduction of estrogen can be harmful as well. This can cause a worsened menstrual cycle, PMS, and hyperpigmentation or discoloration of the skin.

Testosterone & Androgens

Androgens is the term for any male hormones such as testosterone, or DHEAS.  Testosterone controls sebum production, which is important for skin health and nourishing your skin with natural oils. However, when an overproduction of oil occurs, the pore becomes clogged and acne is born! 

Cortisol

Cortisol, also known as the stress hormone, has a massive impact on our skin. A surge in cortisol causes an increase in sebum production and spikes inflammation, one of the biggest triggers for acne. Chronic stress and high levels of cortisol can lead to unhealthy habits of coping like consuming excess alcohol, refined carbs, and sugar, which in turn can all make acne worse. 

Thyroid Hormones 

 Thyroid hormones are one more way your skins appearance can be affected. According to Dr. Trevor Cates,

  “An overactive thyroid can cause warm, sweaty, and flushed skin, while an active thyroid can lead to dry, coarse skin with a reduced ability to perspire.If you suffer from skin problems and have weight, digestion (constipation or diarrhea), or energy issues (fatigue or feeling overly stimulated),you should talk with your doctor about thyroid testing.” 

It's best to get your thyroid levels tested along with all your other hormones too so you know exactly what sort of imbalance you are dealing with, or you may not have a hormone imbalance which can help you rule out certain causes.

How long have you had hormonal acne, and which remedies gave you results?