What causes hormonal acne? Here are the 5 major hormones involved in acne.

What causes hormonal acne?

When it comes to hormonal acne, there are actually several hormones that can play a role. You’ve probably been wondering, ““What causes hormonal acne, and which of my hormones are actually triggering my acne?”

Your hormones are interdependent, so an imbalance in one hormonal system will inevitably affect the rest. This usually leads to symptoms of multiple hormonal imbalances–which can be confusing when you’re trying to figure out what’s causing your acne! 

Let’s talk about chronic stress for a moment, as an example of how multiple hormonal systems can be affected by a primary imbalance. Chronic stress primarily impacts your hypothalamic-pituitary-adrenal (HPA) axis, creating cortisol imbalances. However, this often leads to dysfunction in your hypothalamic-pituitary-ovarian (HPO) axis, disrupting your estrogen and progesterone levels. Prolonged stress and HPA axis dysregulation also affects your blood sugar balance and insulin sensitivity, which impacts sex hormone production as well.

See how all of your hormones are intricately interconnected?

This interconnectedness is why it’s important to look at and address all aspects of your hormonal system, because all of this can impact your skin and cause hormonal acne.

Let’s first take a look at the 5 main hormone imbalances that could be causing your acne, and then I’ll talk about why it’s so important to focus on just two of them first.

Hormone imbalance #1: Estrogen Dominance

Estrogen is responsible for “plumping up” your tissues (like your hips, butt, thighs, and breasts) and thickens your uterine lining every month in preparation for possible pregnancy.

Estrogen dominance is incredibly common and can be a hormonal cause of acne. Estrogen dominance occurs when there is too much estrogen in relationship to progesterone, either because of excess estrogen (due to extra adipose tissue or xenoestrogens like those found in plastics, conventional beauty products, and the birth control pill) or low progesterone.

Excess estrogen interferes with androgen metabolism, potentially leading to more sebum production and acne formation. Higher levels of estrogen also stress out your liver, making it less efficient at metabolizing and detoxifying hormones, and further perpetuating estrogen dominance. On top of that, your liver is responsible for clearing out all sorts of environmental toxins and cellular waste products. When your liver is taxed and can’t do its job properly, your skin suffers.

Hormone imbalance #2: Progesterone Deficiency

Progesterone starts to rise in the second half of your menstrual cycle following ovulation, which is why symptoms of low progesterone are typically worse leading up to your period.

Progesterone is responsible for regulating the conversion of testosterone to DHT. If you have low progesterone, you’ll have more acne-triggering DHT circulating around.

Progesterone metabolites also act on your GABA receptors, helping to keep you calm. Higher levels of stress and anxiety due to low progesterone can perpetuate and worsen acne.

Low progesterone levels are commonly due to a lack of ovulation, estrogen dominance, poor ovarian function, nutrient deficiencies, cortisol dysregulation, and blood sugar imbalances.

Hormone imbalance #3: Androgen Excess

Androgens (testosterone and DHT) promote sebum production, creating oily skin and an environment ripe for acne formation when these hormones are unopposed. Proper levels of testosterone promote a healthy libido and mood, but in excess, androgens can lead to hair loss, unwanted hair growth, and acne.

High androgens commonly occur in a condition called PCOS (polycystic ovary syndrome), but they can be elevated even in women without the condition, especially if insulin resistance is present. Certain conditions and other hormonal imbalances can cause a reduction in a protein called sex hormone binding globulin (SHBG), which increases the amount of circulating testosterone.

Hormone imbalance #4: High Cortisol

Cortisol is your body’s primary stress hormone, but it has a host of other functions including regulating your sleep/wake cycle. Cortisol release follows your circadian rhythm, with higher levels in the morning and lower levels in the evening. Cortisol is involved in blood sugar regulation, regulating blood pressure, and reducing inflammation. 

Prolonged elevation in cortisol levels can lead to inflammatory conditions like acne. Acne due to high cortisol levels is often worsened by stress.

High cortisol levels are associated with prolonged stress and HPA axis dysfunction. 

Hormone imbalance #5: Insulin Resistance & Blood Sugar Dysregulation

Insulin is released by your pancreas and is responsible for regulating blood sugar levels. High blood glucose levels (like after eating too much sugar) cause insulin levels to spike. Eventually your cells don’t respond as well to the insulin, causing your pancreas to secrete even more insulin to regulate your blood sugar levels. This leads to insulin resistance and blood sugar dysregulation.

Insulin resistance is a common trigger for acne. High levels of insulin increase androgens in the body, which can lead to acne. High insulin levels also reduce levels of sex hormone binding globulin (SHBG), which promotes estrogen dominance and frees up acne-triggering androgens. Insulin resistance is commonly seen in conditions like PCOS.

You don’t have to be overweight to have insulin resistance and blood sugar dysregulation, nor do you have to have PCOS. Your level of insulin resistance can vary, but even mild resistance can affect all of your other hormones. Causes of insulin resistance include certain eating and lifestyle habits, nutrient deficiencies, high blood sugar and blood sugar fluctuations, and stress.

So how do I know which hormone imbalance is triggering my acne?

Have you ever heard that you need to “balance your hormones” to clear your skin? Most of the time, practitioners are referring to your sex hormones: estrogen, progesterone, and androgens like testosterone.

While it’s true, it’s not the whole picture.

Yes, you do need healthy levels of estrogen, progesterone, and testosterone that fluctuate in a regular rhythm in alignment with your menstrual cycle. And yes, you want these hormones to be balanced in relationship to one another.

However, there are two hormones that form the foundation of hormone balance. If these hormones are dysregulated, then your sex hormones like estrogen and progesterone will be off too.

I’m talking about the hormones cortisol and insulin. These are the two hormone imbalances that you should focus on first if you’re looking to clear your hormonal acne!

To balance your cortisol levels, you have to take a look at your stress, sleep, diet, movement, and your daily routines. To balance your blood sugar and restore insulin sensitivity, you need to address stress, diet, sugar intake, and movement. When needed, herbs and key supplements can help, but your daily lifestyle choices ultimately make the most difference.

So before you go taking supplements for estrogen metabolism or to reduce testosterone levels, work on optimizing your blood sugar levels and stress response first! If you’re looking to clear your skin naturally and you live in Colorado, schedule a free 15-minute discovery call with our holistic acne doctor, Dr. Shannon Curtis.  If you are living outside of Colorado, contact our organization to find a qualified practitioner near you or search this directory.