Ultimate Guide to Hormonal Acne – Symptoms, Root Causes, Treatment

Ultimate Guide to Hormonal Acne – Symptoms, Root Causes, Treatment

ARTICLE OVERVIEW
There are a lot of myths floating around about the real causes of hormonal acne.  This article aims to outline the real, evidence-based causes of hormonal acne.

This is not your typical article on how to lower testosterone levels.

While testosterone is a factor in hormonal acne, it is not the only or most important hormone to lower for clear skin.  Lowering testosterone levels can have serious health consequences, especially in males.

In addition to testosterone, this article covers the major dietary-driven hormones that cause hormonal acne, and how you can lower them through diet, supplements, and exercise, for both men and women.

Please read the entire article before commenting below.

When most people talk about acne, they’re quick to blame hormones, and for good reason.

All acne is hormonal.

Every single step of the acne-creation process has something to do with hormones:

  • Hormones signal to your body to create too much sebum oil and skin cells
  • Hormones are what prevent skin cells from shedding properly
  • Hormones are what causes pores to become clogged and infected by acne bacteria
  • Hormones can trigger inflammation after an acne infection occurs (leading to a pimple)

When you first hear this, it might sound like you’re doomed to have acne forever.  I mean, after all, you can’t control your hormones, right?  Don’t they naturally fluctuate during puberty and eventually balance out?

I’m here to tell you that you can treat hormonal acne naturally, without dangerous side-effects.

When most people think of hormonal acne, they blame it on sex hormones, like high testosterone/DHT or low estrogen.  They take birth control medication, drink spearmint tea, or eat a low-protein diet in order to lower testosterone.

This is an extremely flawed approach to hormonal acne.

The truth is, while testosterone can be an acne trigger, there are much more important underlying hormones.

Most of these hormones are driven by your diet, lifestyle, and overall health.

This is not going to be your typical article looking at how to treat hormonal acne by lowering testosterone.  While some women may benefit from lowering testosterone levels (more on that later), the consequences of lowering testosterone can be drastic – lethargy, anxiety, depression, and lack of sex drive.

Instead of sacrificing your quality of life, this article is going to act as a comprehensive guide to naturally treating hormonal acne through your diet, lifestyle, and supplements.  This is a longer article, but it’s important to understand what really causes hormonal acne so that you can devise a strategy to beat it.

TABLE OF CONTENTS
  • Sex Hormones and Acne
    • Why High Testosterone Isn’t the Real Problem
    • Why Men Shouldn’t Decrease Testosterone
    • The Fix: How Women Can Decrease Testosterone
  • Dietary Hormones and Acne
    • Insulin 101
    • Carbs, Sugar, Insulin, and Acne
    • Dairy, Hormones, and Acne
    • The Fix: Low-Hormone, Acne-Free Diet
  • Stress Hormones and Acne
    • Cortisol 101
    • The Fix: Decreasing Cortisol Naturally

By the end of this guide, you’ll not only know why hormones are behind your acne but how you can change your diet and lifestyle to beat hormonal acne for good.

Sex Hormones and Acne (and why you probably shouldn’t lower them)

What do you think of when you imagine “hormonal acne”?  Acne around the jawline probably comes to mind, along with hormones like testosterone and DHT.

Traditionally, we think of hormonal acne as a product of androgens.

Androgens are sex hormones that promote “male” characteristics.  Testosterone is the primary androgen.  Testosterone creates several other hormones, including DHT.  DHT is the sex hormone that is most responsible for acne.

DHT is the underlying cause of several male characteristics, including a deepening voice, body hair, muscle growth, and, you guessed it, acne.

DHT is responsible for increasing the amount of sebum oil your sebaceous glands produce.  Too much sebum oil can lead to clogged pores, oily skin, and eventually acne.

It makes sense that we typically get acne when we’re in our adolescent years – DHT levels begin to rise and fluctuate during puberty.  This leads to extremely oily skin, and, when combined with an inflammatory diet, acne and pimples.

Contrary to what you might think, both men and women have androgens.

That means that both men and women can have hormonal, DHT-driven acne.

Still, if both men and women have DHT, and both men and women’s DHT levels rise during puberty, why do some teenagers have acne and others don’t?  An even better question – why does upwards of half the adult population still have acne after puberty1http://www.dermalinstitute.com/us/library/13_article_Why_is_Adult_Acne_on_the_Rise_.html after puberty?

Why DHT Isn’t the Real Problem

Despite the fact that DHT can lead to more sebum oil on the skin, it doesn’t necessarily lead to more acne.  As we’ll see shortly, dietary-driven hormones, including insulin and IGF-1, are much more likely to create acne than DHT.

While you may be more likely to have acne if you have high levels of DHT, it’s not as simple as producing a large quantity of sebum oil.  In fact, sebum oil is a natural skin protectant and moisturizer of the skin.  Your skin needs some sebum oil to be healthy.

For acne to take hold, several things must occur:

  1. A pore must become clogged or blocked from the outside air – this occurs due to excess or oxidized sebum oil
  2. Acne bacteria must infect the clogged or blocked pore
  3. The immune system must fire an inflammatory response – the infected pore becomes red and swollen (a pimple)

Acne is created when a pore becomes blocked or clogged due to excess sebum oil or dead skin cells. Acne bacteria then infects the blocked pore. An inflammatory response is triggered, and the infected pore becomes a pimple.

Acne is a complex chain of events without a single root cause.

You can have extremely oily skin without having acne if your body has what it needs to prevent sebum oil from oxidizing and inflammation from taking place.  Sebum oil isn’t always bad, but if your body doesn’t have the antioxidants, nutrients, and anti-inflammatory compounds it needs, excess sebum oil is a lot more likely to cause acne.

While research regarding hormonal acne is still lacking, we have some evidence that higher levels of testosterone don’t automatically mean more acne…

  • Despite testosterone levels of males across the world being lower than they were in past decades, rates of acne appear to be at all-time highs.2https://www.healio.com/endocrinology/hormone-therapy/news/print/endocrine-today/%7Bac23497d-f1ed-4278-bbd2-92bb1e552e3a%7D/generational-decline-in-testosterone-levels-observed
  • Hunter-gatherer tribes, like the Kitavan and Ache, have no cases of child or teen acne despite the obvious fact that their adolescents also go through puberty and have fluctuating DHT levels.3https://www.ncbi.nlm.nih.gov/pubmed/124723464https://www.ncbi.nlm.nih.gov/pubmed/24203318

On a more basic level, imagine people with high levels of DHT, like body-builders who use weight training to routinely increase testosterone.  At least in my experience, it appears that while they may be more likely to get acne, not every body-builder or person with high DHT has acne.  The point is, you can have high DHT without having acne.

Still, you might be thinking that lowering DHT levels is in your best interest.  After all, less sebum oil means less of a likelihood that pores can become clogged, infected, and inflamed.

If you are a male, I would highly advise you to reconsider this strategy.

While women may benefit from decreasing testosterone levels, decreasing DHT in men can be physically and psychologically damaging.  For both men and women, there are more important causes of hormonal acne to tackle first.

While I think there are more significant hormonal factors to be taken into account, like insulin, IGF-1, and cortisol, I’ll outline how women can lower DHT and why men shouldn’t below.

Why Men Shouldn’t Decrease Testosterone Levels

If you’re a man considering lowering your DHT levels, you might want to think again.

Trust me, I know that acne is difficult to live with.  I can’t tell you the lengths I would go through to have effortlessly clear skin.  Still, one of the few things I wouldn’t do is purposely lower DHT and testosterone levels.

Why?

  • DHT is necessary for proper sexual functioning, libido, etc.
  • Healthy levels of DHT and testosterone are helpful in preventing anxiety and depression5https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1622749/
  • Improves mood and cognitive function6https://www.ncbi.nlm.nih.gov/pubmed/22242144

I don’t know if you’ve ever had low testosterone, but as someone who has, it feels horrible.  You constantly feel groggy, slow, and blue.  In my own personal experience, healthy levels of testosterone are truly necessary for happy day-to-day life as a male.

Obviously, you’re free to do as you wish, but ask yourself this: Why decrease your quality of life by lowering testosterone levels when there are other, more important hormones to tackle first.  Not only will you decrease acne, but you’ll feel better too.  It’s just not worth decreasing testosterone levels to fight acne when you don’t have to.

I outline how to lower these hormones later in the article – click here to jump to it.

How Women Can Decrease Testosterone and DHT Levels

Women with higher levels of testosterone are considerably more likely to have not just acne, but also conditions like Polycystic Ovary Syndrome (PCOS).

Hormonal imbalances can be an acne trigger in men and women.  While men with low testosterone levels can experience a wide array of negative side-effects, women require much less testosterone to be healthy.  For this reason, women may want to consider lowering testosterone levels in order to relieve hormonal acne symptoms.

Best of all, lowering testosterone levels naturally through your diet also tackles some of the largest dietary-driven causes of acne.

Quick note: This is not medical advice and should not be taken as such.  Consult your doctor or physician before making any health, diet, or lifestyle changes.  

Birth control

Taking a birth control pill or contraceptive can increase estrogen levels and rebalance hormones.

Some women may not have easy or affordable access to birth control or may experience side effects that actually make acne worse.

Don’t worry, if you can’t obtain or take birth control, there are other alternatives to treating high testosterone in women.

Eat a low-carb diet

One of the single largest factors of testosterone production in women is insulin resistance.

Insulin is the hormone your body releases to help utilize carbs.  Every time you eat a meal, your body releases insulin to help it transport sugar from your bloodstream to all the muscles that need it.  This process works great if you’re eating an appropriate amount of carbs and exercising enough to burn them off.

Unfortunately, many of us are eating way too many carbs and not exercising nearly enough.  This means the body needs to produce more and more insulin just to make a dent in your blood sugar.

This cycle of producing more and more insulin is called insulin resistance.

Nearly 70% of women with PCOS, a condition where testosterone levels are elevated, have an increased risk for insulin resistance7https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3083905/.

There is a very strong link not just between insulin resistance and testosterone, but also insulin resistance and acne (more on that later in this article).

How can you lower insulin resistance?  Eating a low-carb diet or experimenting with intermittent fasting is a great way to start.

A pilot study on using diet to treat PCOS found that individuals on a low-carb diet lost 14% of the body weight, cut insulin levels in half, and decreased free testosterone levels over a 6 month period8https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1334192/.

Not only does a low-carb or ketogenic diet improve decrease testosterone levels in women, but it also leads to decreased inflammation, another key factor in acne.

With a low-carb diet you hit three key factors with one simple change:

  • Lower testosterone levels
  • Lower insulin and IGF-1 levels (acne-causing hormones)
  • Less inflammation

Both men and women can benefit from eating a low-carb diet to treat hormonal acne.  Later in this article, I’ll explain in detail how to eat a low-carb diet for acne (click here to skip to this section).

Natural remedies

While there are dozens of natural remedies out there to lower testosterone, not all of them are great for your health or your skin.  Furthermore, there’s conflicting evidence on what exactly actually decreases testosterone levels in women.

For instance, some studies find that ECGC, the compound found in green tea, decreases testosterone levels9https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3693613/.  Meanwhile, there’s evidence that green tea actually increases testosterone levels in mice10https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2683253/.

Long story short: your mileage may vary with these natural remedies:

Regardless of your sex, dietary and stress-related hormones are really what you should be aiming to control in order to get rid of hormonal acne.  Plus, you might find that your testosterone and DHT levels naturally become lower in the process.

The Largest Causes of Hormonal Acne: Dietary-Driven Hormones

It’s easy to blame acne on high testosterone levels during puberty and genetics.

Truthfully, dietary hormones are the biggest culprit for acne, not high testosterone.

In particular, the hormones insulin, IGF-1, and IGFBP-3.

What do these hormones have in common?

They’re all triggered by the consumption of carbohydrates, sugar, and dairy.

How carbs, sugar, and dairy trigger hormonal acne

If there’s one master hormone behind dietary-driven acne, it’s insulin.

Before we get into why insulin causes hormonal acne, we need to understand exactly what insulin does…

Carbs & Insulin 101

Insulin is a hormone your body releases in order to use the sugar found in carbohydrates.

Every time you eat a meal with carbs in it, those carbs get converted into glucose and enter the bloodstream.  Then, the body releases insulin to transport the sugar from the bloodstream to all the muscles and cells that need it.  In other words, insulin is the hormone that helps turn carbs into usable energy for your body.

Just like testosterone and DHT, insulin isn’t necessarily a bad thing.  Insulin only becomes problematic for acne when insulin levels in the body are constantly elevated.  This is known as insulin resistance.

Insulin resistance occurs when you consistently consume more carbs than you burn.  Insulin resistance can occur due to a lack of activity, a diet high in certain carbohydrates, or because of genetic factors.

Think of it like this – your muscles are already full of glycogen (usable blood sugar), but you keep eating carbs.  Your body needs to do something with that blood sugar, so it releases insulin.  But then, 3 hours later, you eat even more carbs without burning any more glycogen.  So, what does your body do?  It releases even more insulin.

Pretty soon, your body is releasing a very large amount of insulin anytime you eat carbs.

This, in a nutshell, is insulin resistance, and it can be a nightmare for acne.

Why high levels of insulin cause acne

Insulin, just like testosterone and DHT, triggers the sebaceous gland to produce tons of sebum oil.  This sebum oil is capable of blocking and clogging pores.  This can lead to acne infections and eventually inflammation that leads to pimples.

As you probably remember, we went over how sebum oil isn’t necessarily a bad thing for your skin. It’s only when sebum oil becomes oxidized, skin cells block pores, or inflammation takes hold that acne is created.

So why is insulin so much worse for acne than testosterone or DHT?

Because insulin is a master hormone that triggers the release of several other acne-causing hormones and compounds, including IGF-1, IGFBP-3, and IL-1.

Why carbs cause ance, how insulin resistance works, what foods have the most carbs
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Together, these three compounds contribute to every step of the acne-creation process:

  • Insulin-Like Growth Factor 1 (IGF-1) increases sebum oil production and causes the body to produce too many skin cells.  These skin cells can eventually block pores and make them more prone to acne infection.
  • Insulin-like growth factor-binding protein 3 (IGFBP-3) prevents dead skin cells from shedding off the skin properly.  These dead skin cells end up clogging and blocking pores, which leads to acne infections
  • IL-1 is a compound that promotes inflammation.  Inflammation is the process that takes a simple acne infection and turns it into a bright, red, protruding pimple.

That’s a pretty deadly combination for your skin.

Not only does insulin and it’s linked hormones lead to an increased chance for acne infections to take hold, but they also contribute to the inflammation that makes the appearance of acne so damaging.

Worst foods for hormonal acne – High GI carbs

There are two main types of food groups that trigger or contain insulin and other insulin-like hormones that cause acne:

  • High Glycemic Index (GI) Foods
  • Dairy

We’ll cover dairy in a bit, but for now, let’s cover why certain foods high in carbohydrates trigger a large insulin response.

The glycemic index is a ranking system that helps you identify the foods that spike blood sugar levels the most.  These foods, in theory at least, are the ones that should trigger the largest and most rapid insulin response.

Remember: More Insulin = More Acne

Carbs found in some foods are digested at a much slower rate than others.  They’re converted into glucose over the course of several hours.  Because of this, they don’t spike your blood sugar nearly as much as other foods and therefore don’t spike insulin levels either.  These foods are called low glycemic index foods, and they’re usually much safer for your skin.

On the other hand, high glycemic index foods rapidly spike blood sugar levels and are quickly digested by the body.  Pound-for-pound they usually trigger a much larger insulin response than low glycemic foods.

Low glycemic index carbs trigger a small insulin response. High glycemic index carbs trigger a large insulin response

Even if you have no idea what the glycemic index is, you’ve probably noticed that after binging on cupcakes or sweets, you’ll find yourself extremely tired and hungry again within a few hours (or sometimes minutes).  That’s insulin and the glycemic index at work.  On the flip side, you can eat all the leafy green vegetables in the world and not experience the post-lunch afternoon dip.  Again, that’s because leafy green vegetables don’t trigger a large insulin response.

Foods to avoid for acne-prone skin

Given this information, there are two components we want to be mindful of when eating for clear skin:

  • How many total carbs are in a particular food or drink
  • Whether the food is a high or low glycemic index food

If you combine these two factors together you get a simple little formula called glycemic load.

Glycemic load is just like the glycemic index, but it adjusts its rating depending on how many carbs are in a food.  For instance, watermelon has an high glycemic index (76), but generally very little carbs per serving.  Therefore it has a low glycemic load – even though it the carbs in watermelon will spike insulin levels, there’s not enough of them to be all that dangerous.

Basically, stick to foods with a low glycemic load.  Below is a table of foods sorted by glycemic load.

FoodGlycemic IndexServing SizeNet CarbsGlycemic Load
Blackberries251 cup (144g)6.2g1.6
Strawberries411 cup (152g)8.7g3.6
Full-fat Milk391 cup11.7g4.6
Orange431 orange (131g)12.3g5.3
Kidney beans241 cup (177g)28.3g6.8
Chickpeas281 cup (164g)26.4g7.4
Apple361 apple (182g)20.7g7.5
Watermelon761 cup (152g)10.9g8.3
Lentils321 cup (198g)28.3g9.1
Sweet corn521 cup (164g)20.2g10.5
Pineapple591 cup (165g)19.3g11.4
Banana511 banana (118g)23.9g12.2
Popcorn6530g18.9g12.3
Ice cream511 cup30.3g15.5
Cornflakes811 cup (30g)23.5g19.0
White bread752 slices (54g)26.2g19.7
Sweet Potato631 potato (180g)31.4g19.8
Spaghetti491 cup (140g)40.8g20.0
Soda (Cola)591 can (12 oz)35.2g20.8
White rice731 cup (158g)40.0g29.2
White potato781 potato (173g)32.9g25.7
Brown rice681 cup (202g)48.5g33.0
Instant oat porridge791 cup (81g)46.6g36.8

In addition to these foods with a high glycemic load, there’s one particular food group that also triggers hormonal acne: dairy.

Dairy and hormonal acne

Dairy is one of the single worst food groups when it comes to hormonal acne.

Why?

The purpose of dairy is to help babies grow.  It makes sense that most dairy is extremely high in both IGF-1 and insulin.

Cow, sheep, and goat dairy all have significant amounts of growth hormones (IGF-1) in them.

On top of the hormones already found in dairy, many forms of high-lactose dairy, including milk, yogurt, and some cheeses, are extremely insulinogenic, which means they trigger a large insulin response from the body.  Even though that slice of cheese might look like a great low-carb option, it’s actually very likely to trigger a large insulin response from the body.

How dairy causes acne by increasing levels of acne-causing hormones, damages the gut, and prevents nutrient absorption

This means that dairy is double trouble when it comes to hormonal acne: not only does it contains a large amount of IGF-1, it also triggers a spike of insulin when you eat it.

While some dairy, like ghee, is great for acne-prone skin, most dairy is not.

See the Definitive Guide to Dairy and Acne or our Guide to Dairy-Free Milk Alternatives for Acne-Prone Skin for more information.

Diet, Acne, and Hormones

Before we move onto the final portion of the article related to stress hormones, it’s helpful to go over what we’ve talked about so far with regards to diet and hormonal acne.

First of all, that insulin, not DHT or testosterone, is usually the culprit behind adult hormonal acne.  Insulin is a master hormone that works together with IGF-1, IGFBP-3, and IL-1 to clog and block pores due to sebum oil and dead skin cells, and then triggers the inflammatory response that creates pimples.

What foods trigger large insulin spikes?

  • High glycemic index/glycemic load carbs
  • Dairy

Together, these two foods groups can be a nightmare for hormonal acne.  Avoiding them can really help clear up hormonal acne in both men and women, without the negative health consequences that come with lowering testosterone.

In order to prevent this article from being even longer than it is, I won’t go into all the foods you can and can’t eat if you want to avoid diet-driven hormonal acne.  If you want a one-page guide to eating a diet optimized for clear skin, you can download our free GoodGlow Diet Blueprint.

Now, let’s move onto the final factor in hormonal acne… stress.

Cortisol, Stress, and Acne

Stress acne is a real thing, and it should be taken a lot more seriously than it is.

Cortisol is the body’s stress hormone.  You release cortisol anytime you’re under stress, whether it’s a real physical threat (your life being in danger) or a psychological one (a tough day at work).

Stress contributes to acne for a few reasons:

  • Chronically high levels of cortisol can lead to insulin resistance (leading to even more hormonal acne)
  • High cortisol levels makes the skin weaker by damaging its proteins
  • It slows the healing of existing acne and scars
  • Stress can decrease the amount of healthy bacteria you have in your gut
  • Dehydration, dry skin, and even hair loss

Just like insulin and carbs, cortisol and stress isn’t all bad – it puts your body into fight or flight mode and allows us to be more aware and physically capable of dealing with threats.

Cortisol, just like insulin, only becomes a problem when we have too much cortisol too often.  This is called chronic stress.

When we have chronic stress, the body is always in fight-or-flight mode, and the hormonal consequences are huge.  High, constantly elevated levels of stress can very easily lead to stubborn acne.

For this reason, try to keep stress and cortisol levels under control with things like meditation, getting enough sleep, and exercising on a regular basis.

You can also make dietary changes to reduce the likelihood of developing chronic stress, including:

I know it’s easier said than done when it comes to reducing stress, but it’s one of the most important factors in hormonal acne.

Putting it all together

If you’re anything like me, you probably thought you were doomed to hormonal acne for life.  No matter what you tried, it always came back worse than before.  And worst of all, if you’re a guy like me and tried to treat your it by lowering testosterone levels, you probably found yourself with significantly decreased energy, libido, and mood.

Luckily, for both men and women, there are more efficient and safe ways to treat hormonal acne naturally.

Instead of lowering DHT levels, insulin and cortisol are the real hormones you should try to tackle.

By eating low-glycemic load carbs in moderation and avoiding dairy, you can prevent dietary-driven hormonal acne.  Cutting out bread, sweets, juices, sugar, and dairy is a great start for preventing hormonal acne.

On top of cleaning up your diet, doing your best to lower stress hormones is another effective strategy.  Cortisol, the body’s stress hormone, can weaken the skin and cause insulin resistance, leading to more acne.

Overall, both men and women can benefit and clear hormonal acne from within, by focusing on their diet and lifestyle.

If you have any questions about hormonal acne, let me know in the comments below.

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FREE DIET BLUEPRINT

Everything you need to start eating an acne-free diet, all on one page.  Get permanently clear skin from within.

  • Quick, simple, understandable
  • The best foods to eat for clear skin
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