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  • Writer's pictureDr. Cassandra Paiano, ND

Hormonal Acne - Which type do you have?


Hormonal imbalances are a common cause of acne, and treating it can be a difficult task. 


Most solutions available on the market tend to provide temporary relief, without addressing the root cause


I often hear from my acne patients that they have "tried everything" - topicals, supplements, dietary strategies, serums, cosmetic treatments - but the acne just doesn't budge. 


At its core, acne is an inflammatory condition, and understanding the role of certain hormones in order to identify the root cause is the one way ticket to success when it comes to treating acne. 


Did you know, there are four different types of hormonal acne? 


  1. Androgen (Testosterone) Related Acne 💪

Testosterone is a male sex hormone (androgen), that is present in both males and females, although it is higher in males.  The relationship between testosterone and acne is primarily through its influence on the sebaceous (oil-producing) glands, and sebum (skin oil) production. 


Testosterone, specifically its more potent form, dihydrotestosterone (DHT), stimulates sebaceous glands to produce sebum.  While sebum is essential for maintaining skin hydration, an excess amount can lead to clogged follicles, which combine with dead skin cells, contributing to the development of acne lesions. 


This type of acne typically affects areas with a high concentration of oil glands (face, neck, chest, and back). 


Women with this pattern of acne may also experience irregular periods, and hair growth ( located on the chin and/or chest).  This type of acne is also associated with polycystic ovarian syndrome (PCOS). 



2. Estrogen Related Acne 🌸

Estrogen and progesterone levels fluctuate throughout the different phases of the menstrual cycle. 



During the follicular phase (the phase following menstruation), estrogen levels begin to rise.  Estrogen has a sebum-suppressing effect, and helps to maintain clear skin.  During this phase of the menstrual cycle, some women may experience an improvement in their acne. 


During the ovulatory phase (middle of the menstrual cycle), estrogen levels peak. 


When estrogen levels are too high, the balance between the anti-inflammatory, and pro-inflammatory effects can become disrupted.  This can contribute to inflammatory processes within the skin = acne lesions. 

Since estrogen is metabolized in the liver, the balance between different metabolites is crucial.  If estrogen is not effectively metabolized, it can contribute to the development of acne lesions. 


Women with this type of acne may experience flares during the ovulatory phase of their cycle.  They may also experience breast tenderness, and a heavy flow



3. Progesterone Related Acne 🥚

Similar to estrogen, progesterone levels fluctuate throughout the menstrual cycle.  


Progesterone levels surge during the ovulatory phase, and stay elevated throughout the luteal phase (phase before menstruation).  Levels then sharply drop just before ovulation. 


Both high, and low levels of progesterone can cause acne. 


Progesterone has the ability to stimulate the production of sebum by the sebaceous glands.  High levels (during the luteal phase) may lead to an increase in sebum production.  


Low levels of progesterone often co-exist with high levels of estrogen.  This imbalance can contribute to an increased sensitivity to androgens, leading to an overstimulation of the sebaceous glands and sebum production.  The end result = acne. 


Women with progesterone related acne typically experience acne on the chin, cheeks, or forehead during the luteal phase, or premenstrually. They may also experience spotting between cycles, short cycles, and, intense sugar cravings



4. Insulin Related Acne 🍭

Insulin is a hormone produced by the pancreas, that plays a central role in regulating blood sugar levels.  While insulin itself does not directly cause acne, there is a connection between insulin levels, and the development of acne - particularly in the context of insulin resistance


Insulin resistance occurs when cells in the body become less responsive to the effects of insulin.  As a result, the pancreas produces more insulin to maintain blood sugar levels.  High levels of insulin increases the production of androgens (such as testosterone), which stimulate the sebaceous glands to produce more sebum. 


Insulin resistance also increases inflammation in the body - an important role in the formation of acne lesions. 


Diets high in refined and processed foodssugar, and dairy also contribute to increased levels of insulin, influencing the development of acne. 


It is important to note that the interplay of these hormones, and their impact on acne can vary among individuals.  Genetics, lifestyle factors, and overall health can also play a role in the development and severity of acne.  If you have concerns about acne, or hormonal imbalances, consult with your healthcare professional for personalized guidance and treatment options. 






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