Many acne-sufferers are curious as to how different hormones affect their skin – particularly estrogen. Hormonal acne can be triggered by a range of different hormones, and it’s no surprise that many (especially women) would suspect their estrogen levels may play a role. So does estrogen cause acne? The answer isn’t so cut-and-dry, but we’ll dive into the key details on the relationship between estrogen and acne below.
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What Causes Hormonal Acne?
On a basic level, hormonal acne (also referred to as simply adult acne) is caused by an overproduction of sebum, inflammation, and clogged pores. These changes in the skin can be triggered by hormonal fluctuations.
A rise in the levels of the sex hormones androgens (like testosterone, which is found in both males and females, although in higher levels in men) is one of the main causes of hormonal acne. This is because testosterone stimulates the production of oil, leading to breakouts. That said, a change in the levels of estrogen (the female sex hormone, although it is found in low levels in males) and progesterone (another female sex hormone that likewise is found in low levels in males) can also be tied to acne.
Hormonal acne is more common in women, but men can also be affected. This type of acne typically affects the lower part of the face, around the jaw, chin, and lower cheeks.
Managing hormonal acne requires a multi-pronged approach. Researched topical treatments that a dermatologist may prescribe include solutions like prescription-strength retinoids, benzoyl peroxide, and azelaic acid. These are often combined with oral treatments, such as hormonal anti-androgens (like Spironolactone), isotretinoin (also colloquially referred to as Accutane), and oral contraceptives. Anti-androgens and oral contraceptives are only prescribed to women dealing with hormonal acne, but both men and women can take isotretinoin to tackle breakouts.
Additionally, establishing a skincare that includes a skin type-appropriate cleanser and a moisturizer is essential for maintaining skin health. You may also choose to use over-the-counter topical acne treatments, such as a retinol.
Estrogen & Acne
Estrogen can have a major effect on the skin. It slows down sebum production (essentially balancing out the effects of testosterone and progesterone), and can also lead to skin that looks and feels moisturized and supple.
We already know that estrogen can be related to acne, but exactly how? Here’s how different levels of estrogen can play a role in skin health.
Does High Estrogen Cause Acne?
There are a few instances in which it would appear higher levels of estrogen leads to acne, but there’s often another underlying explanation. For example, women dealing with polycystic ovary syndrome (PCOS) can produce excess estrogen, and often experience adult acne as a side effect of the condition. However, acne related to PCOS is often tied to higher levels of testosterone, rather than a change in estrogen levels.
High levels of both estrogen and progesterone are produced during pregnancy. However, pregnancy-related acne is tied to progesterone, since this hormone (like testosterone) triggers sebum production.
Many women experience an increase in hormonal acne in the middle of their menstrual cycle, when estrogen levels are at their highest. However, there are other factors at play: luteinising hormones. These hormones can have an effect on the body’s increased production of androgens – which can cause acne.
Does Low Estrogen Cause Acne?
As noted, estrogen helps suppress the production of sebum. This means that, when estrogen levels are on the lower end, they aren’t as powerful at balancing out the effects of testosterone (the androgen that can lead to increased oil production). With that in mind, when estrogen levels are low there can be a greater risk of experiencing breakouts.
Many women will notice they experience breakouts right before or during their period, which is when estrogen levels are low. Estrogen levels also decrease rapidly during menopause, altering the balance between estrogen and other androgens (like testosterone). This is largely why some women can experience acne during menopause.
Does Estrogen Birth Control Cause Acne?
Since oral contraceptives (birth control) affect hormones, there’s a chance that they could lead to breakouts. In particular, birth control pills that are made with progestin alone have a higher risk of causing breakouts.
That said, birth control pills that combine progestin and estrogen have been shown to be effective in controlling acne. That is because they work in tandem to reduce androgens in the body, which affects sebum production. This means there’s a lower risk of the pores becoming clogged and acne forming.
The FDA has approved four birth control pills (Ortho Tri-Cyclen, Yax, Beyaz, and Estrostep FE) for the treatment of acne.
Does Estrogen HRT Cause Acne?
Hormone replacement therapy (HRT) is most commonly prescribed to women to help relieve many of the symptoms associated with menopause. In this therapy, the body is supplemented with specific hormones (typically a combination of estrogen and progesterone or estrogen alone, since these hormones can dramatically decrease during this time) to rebalance hormones to an optimal level.
Some studies have revealed that, in addition to helping with symptoms of menopause, this type of therapy may actually improve the complexion by increasing skin thickness and softening the appearance of wrinkles. With this in mind, HRT used to treat symptoms of menopause likely won’t cause acne, since this supplementation can actually help the body counteract the effects of testosterone on the skin. In fact, it may help reduce the risk of experiencing menopausal acne.
How to Manage Estrogen Levels
If your estrogen levels are unbalanced (either too high or too low), a medical professional may decide to prescribe an appropriate treatment to help keep those levels in balance. However, there are other lifestyle changes that you can implement to keep your hormones optimally balanced.
Cleveland Clinic notes that, both in the case of high and low levels of estrogen, reducing stress is essential, as an excess in stress hormones can affect the reproductive system hormones. Diet can also influence hormone levels, as can sleep quality.
Cleveland Clinic also notes that being underweight and over exercising both increase the risk of having low estrogen levels. The organization also states that those with high levels of estrogen may be able to help manage their hormones by safely decreasing excess body fat.
Ultimately, it’s important to recognize that a major part of rebalancing your estrogen levels requires addressing the trigger(s) that may be affecting them. A medical professional can help you decide if you truly have too high or too low estrogen levels, and what treatment is necessary to tackle that imbalance to improve your skin and target any other symptoms you may be experiencing.
What Other Hormones Trigger Acne Breakouts?
We’ve discussed a bit about how both testosterone and progesterone can play a role in hormonal breakouts, as both of these hormones can trigger the skin to produce an excess of sebum.
An increase in progesterone levels during pregnancy can trigger breakouts. Unfortunately, since so many topical and oral treatments used to treat hormonal acne are unsafe to use during pregnancy, there are limitations on what to do during this time. However, there are still options for pregnant women looking to control their breakouts.
Changes in testosterone levels can also lead to breakouts in both men and women. Studies have shown that those that deal with breakouts may produce more testosterone compared to those without acne. Many will start to experience this increase in testosterone-caused acne during puberty, but it can continue through adulthood.
Hormonal Acne in Men vs. Women
As noted, hormonal acne is more common in women, but that certainly doesn’t mean men are in the clear. Both men and women can be affected by hormonal acne – there are just some differences in how different hormones affect men and women.
As noted, for women, estrogen and progesterone levels can both play a role in breakouts. Additionally, while females have lower levels of testosterone compared to males, this hormone plays a role in breakouts in both sexes. Research has shown that women with acne frequently have excess androgen hormones (including testosterone). For men, high testosterone levels are the main culprit for adult acne.
Men don’t deal with monthly fluctuations in hormones like women do. That said, there are certain activities and factors that can influence testosterone levels and lead to breakouts. This can include stress, weight, age, diet, exercise, and genetics. If dealing with hormonal acne the two most important things you can do is follow an anti-inflammatory diet and use a gentle facial cleanser.