Thought only teens get acne? Most of us get disappointed to find pimples—and even acne—popping up years or even decades later. But it does happen, and hormones can be why. Here’s what hormones cause acne and what you can do.
Understanding what hormones cause acne
Though not always, in many cases, hormones—and hormone fluctuations—can definitely be behind breakouts. If you’re dealing with hormonal acne, your breakouts are most likely to happen in a specific area of your face. While your forehead and cheeks may be mostly in the clear, your chin, jawline, and right around your mouth might not be so lucky. It’s common to see pastules, cysts, whiteheads, and blackheads crop up in these areas. So what hormones can you point the finger at?
Before you contact your doc for a deep-dive into testing all the things, it’s worth thinking about your stress levels first. There are so many demands placed on us as women and mothers. Work, childcare, family problems, caring for others, school, what’s for dinner: the list just goes on and on. The truth is, most of us walk around stressed and don’t even know it. It’s become how we live.
While some stress is healthy and keep us on our toes, too much of a stress response is anything but good for your body. It can also be behind your acne too. How? When you’re stressing, your body signals for the release of more hormones called adrenaline and cortisol. These hormones are amazing—but only in the right amounts. Once they get and stay in overdrive, your skin starts to produce more sebum, or oil. Hello, acne. And then there’s a double-whammy: your breakout will also be made worse by high cortisol due to increased inflammation. (Ouch, right?!)
Testosterone and dihydrotestosterone
When thinking about what hormones cause acne, it’s impossible not to think about androgens. Androgens are by far the most common culprit of hormonal acne. Two androgens are especially key for understanding hormonal acne: testosterone and dihydrotestosterone (DHT). Higher-than-ideal levels of free testosterone and DHT can absolutely be what’s causing your acne. The most likely reason why a woman might have high free testosterone is due to a very common condition called polycystic ovarian syndrome, or PCOS. (Other reasons, like ovarian tumors or Cushings, are pretty rare.) Why the elevated free testosterone levels in PCOS?
Testosterone in your body can link up to a protein in your blood called sex hormone-binding globulin, or SHBG. Women with PCOS usually have lower SHBG than women without PCOS. The reason for this is usually insulin resistance. With low SHBG, free testosterone may be high—and that means your body can make more DHT. DHT is a lot stronger than testosterone and affects the skin and hair follicles.
Okay, but why are so many cases of hormonal acne caused by androgens? The reason is because your skin’s oil-producing glands have a lot of receptors for androgens. When androgens connect with the receptors, it cues the production of even more oil, or sebum. The sebum then starts to build up in your pores, leaving you more prone to pimples.
Before estrogen gets more blame than it already does, let’s first say that it’s super important to your body. It helps with heart health and cholesterol, keeps your skin supple, lets your joints feel good, and so much more. But if you have too much of it? You might notice a whole bunch of unpleasant side effects—including pimples. Like androgen hormones, estrogen influences how much sebum (oil) your skin makes. Too much sebum clogs up pores. The result: painful, deep-feeling acne.
But wait: how does estrogen get high to begin with? Estrogen naturally rises and falls with your cycle. That’s one reason so many women complain of breakouts before their period. However, more of us than ever are also living life with estrogen dominance. Estrogen dominance is when you have too much estrogen consistently. Usually, this happens in your 30s as your progesterone levels drop. Progesterone is a hormone that balances estrogen. Without enough progesterone, estrogen tips the scales in its favor and leaves you feeling too many of its effects. Like acne, weight gain, heavy periods, and much more.
Low levels of progesterone can cause acne because of their role in estrogen dominance. But high progesterone needs to take some blame too. Elevated progesterone isn’t as common as low progesterone, but it does happen in situations outside of pregnancy. For some, ovarian cysts are behind high progesterone. Other causes include issues with adrenal glands or more hormone replacement therapy than you really need. Some symptoms to look out for? Common ones look like mood swings, bloating, a lack of energy, difficulty waking up in the morning, and tender breasts.
And then, of course, there’s acne. Progesterone raises your body temperature. You might sweat more. But, at the same time, progesterone affects your water retention—even in your skin. You might be thrilled at first with how your face looks more youthful. However, that extra hydration from within is also compressing pores. Smaller pores and more sweat = greater risk of clogged pores and trapped bacteria. And we all know what that means: acne.
You didn’t say anything about thyroid issues causing acne. Do thyroid hormones cause acne?
Whether or not thyroid issues definitively cause acne is still somewhat up for debate, medically. But here’s why we give side-eye to that debate and say that these hormones cause acne—at least indirectly. Like all hormones, thyroid hormones do much more than they get credit for. Sure, they affect your energy. But that really means they affect your metabolism. And that’s huge. If your thyroid hormones are too low (hypothyroidism) or too high (hyperthyroidism), other hormones become out of balance too.
Here’s a great (and common!) example. Hypothyroidism is known to lower sebum production and dry out skin. So does that mean it can’t cause acne? For some women, it won’t. But, over time, hypothyroidism can lead to estrogen dominance—which we talked about being a cause of hormonal acne. How does that work? If you’re hypothyroid, whether from not enough replacement hormone or other reasons, your digestion (among other things) slows down. That makes it harder for your body to eliminate excess estrogen through your poop. Some of that estrogen in your digestive tract will recirculate into your body and raise your overall estrogen levels. In fact, estrogen, progesterone, and thyroid hormones are all intricately linked. Imbalances in one can absolutely worsen functions of the other. And if you’re hypothyroid due to Hashimoto’s? Inflammation also may make your hormonal acne worse.
Also, it’s important for physicians and women to realize that cortisol levels are impacted by a hypothyroid state. If you have untreated or under-treated hypothyroidism, you’re more likely to have trouble clearing cortisol out of your system. This raises your overall cortisol levels, at least for awhile. Continued hypothyroidism that isn’t treated optimally eventually can lead to low cortisol from HPA-axis dysfunction.
So what helps hormonal acne?
Tried all the topical things and nothing’s working? There’s a limit to what external things can accomplish with hormonal acne. Topical creams and even antibiotics are limited in their effect when your acne has a hormonal cause. Though switching your diet won’t magically cure your acne, it can help to limit refined foods and dairy and incorporate plenty of fresh foods and omega-3s.
You may need the help of your physician for hormonal acne. But here’s the thing: if you ask your primary care physician, and you’re probably going to get this response: birth control can help. And they’re not wrong. It can help clear up acne. However, hormonal birth control isn’t for everyone—even though almost every woman gets offered it. Here’s what gets left unsaid in prescribing it: it can cause acne too. It also disrupts your body’s natural feedback loops, which are so important to natural hormone balance. By the time you go off of it, it can leave you feeling worse than you did before—and your acne may come right back.
If your symptoms and labs point to high androgens, you might ask your physician for anti-androgen prescription medication, like finasteride. Even if your labs are normal, it’s possible that hormones are still causing your acne. Your body might just be more sensitive to androgens than some other women.