Hormonal Acne Treatment
- What is hormonal acne
- What causes hormonal acne
- How to treat hormonal acne
- Factors that contribute to hormonal acne
- How to get rid of hormonal acne
- Hormonal acne tests
- Menstruation cycle and hormonal acne
- Where does hormonal acne occur
- How to stop hormonal acne from returning
- How to treat hormonal acne topically
- Best treatments for hormonal acne
What is hormonal acne (acne vulgaris)?
Hormonal acne, or acne vulgaris, affects people of all ages, from teenagers to people in their 40s, and is characterised by superficial and cystic pimples around the face, shoulders, chest, and back.
Hormonal acne is pimples that come in all forms, from pus-filled whiteheads to stubborn and painful cysts that are hard to get rid of.
Use our guide to learn if your pimples are hormone-caused by other factors.
Hormonal pimples can start in the teenage years and continue into the 20s and beyond. But we find for many of our patients, their hormonal acne first develops in their 20s.
Hormonal acne is, as the name implies, caused by hormones, and for women, it is often tied in with their menstrual cycle. Acne breakouts most commonly occur in the days leading up to a period or mid-cycle at ovulation.
However, hormonal acne can also be constant and not fluctuate with the menstrual cycle, which is the case for hormonal acne in men.
Hormonal acne tends to be mostly located around the chin and cheeks but can also occur in other areas. When left untreated, hormonal acne can lead to scarring where lesions have formed.
Whether you have mild hormonal acne or severe cystic hormonal acne, this is a guide to help get you on the right track to treating hormonal acne naturally.
What causes hormonal acne (acne vulgaris)?
The underlying hormone imbalance that triggers hormonal acne is very different for everyone, but in all cases, hormonal acne is caused by the dominance of androgen hormones such as Testosterone.
Further reading can be found here: What Causes Hormonal Acne
This is not always due to excess androgens but is often the result of too little Estrogen and Progesterone compared to testosterone. This creates a relative excess of testosterone and produces hormonal acne, like when there is too much testosterone. This is why treating hormonal acne is not always straightforward, and testing hormone levels first is the best place to start.
A trained health professional can help you get your hormones tested.
One of the ways testosterone causes hormonal acne is via excess sebum production. Testosterone is a hormone responsible for increasing sebum production in our skin cells, so too much can lead to an increase that overwhelms the skin cells, leading to hormonal acne. Once excess sebum is produced, it increases the risk of acne-causing bacteria, dead skin cells, and dirt collecting in the oil glands, causing inflammation and hormonal acne.
Conventional medical acne treatments such as oral medications, antibiotics, and oral contraceptives seem effective in curing hormonal acne because they suppress your hormones and reduce acne-causing bacteria in skin cells. However, they don't truly correct the underlying hormone imbalance, and hormonal acne commonly returns once you stop using them.
In cases of mild hormonal acne, topical treatments and diet and lifestyle modifications can be effective. But mild to severe hormonal acne needs to be treated in a way that fixes the hormone imbalance, not just masks.
This is where naturopathic hormonal acne treatments can have the greatest effect because they get your body to produce balanced hormones by itself. And by doing so, hormonal acne is fixed permanently.
How to treat hormonal acne?
Many people we work with want to know how to cure hormonal acne. If you have been on a mission to treat hormonal acne, this will be very helpful for you, so listen up...
The key to getting to the bottom of what could be causing hormonal acne in an individual is to take a thorough health, lifestyle, and medical history and test hormone levels.
Our motto is... "Test, not guess".
This is because your hormones can become imbalanced in several ways.
Topical acne treatments and conventional medical and hormonal acne treatments don't usually consider this. They are a one-size-fits-all approach.
So, while you might be doing a lot to treat acne, you may not address the right factors or miss a factor or two. This could mean the difference between taking moderate to mild acne or getting rid of your hormonal acne for good!
Persistent acne requires a thorough look into what the underlying drivers could be. This is important because they are not always obvious things. Here are some of the factors that we have found can contribute to hormonal acne:
Factors that can cause hormonal acne
- Blood sugar imbalances. Eating too much sugar, sugary foods, or refined carbs will cause your blood sugar levels to spike or become elevated. This then causes your blood sugar-regulating hormone insulin to be produced in excess. Excess insulin then triggers excess androgen (male hormone) production. excess androgens then cause hormonal acne. Blood sugar imbalance can also occur even if you have a low-sugar or low-carb diet due to not eating regularly, intentionally (intermittent fasting), or unintentionally. When you go for long periods without eating, your body releases the stress hormone cortisol. Cortisol's job is to raise blood sugar levels so if you live or eat in a way that triggers constant cortisol release, it will cause you blood sugar problems.
High androgens such as testosterone, androstenedione and DHT. Androgens are at the heart of hormonal acne and can become elevated for several reasons. This is why we take a thorough health, lifestyle, and medical history from our patients and refer them for appropriate testing so we can pinpoint with laser-like accuracy what the underlying reason is.
A diagnosis of polycystic ovary syndrome (PCOS). PCOS is a female hormone condition often triggered by insulin problems that lead to elevated androgens. However, insulin isn't always the cause. Chronic inflammation, genes, and stress can also trigger PCOS, which can elevate male hormones.
An increase in stress-related hormones such as cortisol and DHEAS. It's an unfortunate fact that stress is a constant part of our modern lives. Stress causes the release of stress hormones, cortisol, and DHEAS. As mentioned, cortisol can cause hormonal acne by elevating blood sugar levels, whereas DHEAS is an androgen. So, constant stress can push up DHEAS levels and cause hormonal acne.
An excessive amount of inflammation. This might seem unrelated to hormonal acne, but inflammation makes your cells less sensitive to insulin (insulin resistance). Insulin resistance leads to excessive insulin production, and as mentioned earlier, this triggers an overproduction of androgens.
Some foods, such as cow's milk dairy, can increase our risk of hormonal imbalances. Regarding hormonal acne, it's not the lactose in dairy's issue; it's the proteins. Dairy proteins can stimulate the production of Insulin-Like Growth Factor -1 (IGF-1). IGF-1 is like insulin, so if it is overproduced, it causes increased androgen production.
When treating hormonal acne, it's important to rule out all the most obvious things and treat the cause at its roots, particularly with persistent, severe acne.
This is why our starting point for new patients is to get their hormone levels tested, either by blood testing or saliva hormone testing.
If you've tried topical treatments (glycolic acid, retinoids, benzoyl peroxide), topical medications (antibiotics, skin needling), and been through just about every single cream and face wash on the market. If you still have acne, then it's because your problem is much deeper.
While topical retinoids can have some effect, they don't reach the root cause. So it's important to fix what is out of balance internally, not just work on the acne externally.
Once your root causes are addressed, it's a lot easier to prevent future breakouts and treat hormonal acne to minimise the risk of recurring inflammatory lesions.
How to get rid of hormonal acne (acne vulgaris)?
The key to this is first to understand what is causing your hormonal acne.
When you work with a naturopath like us, this means first having an in-depth discussion about your health history, menstrual cycle, how you have previously been treating acne, history of birth control pills use, topical treatments, digestive health, and any other current symptoms relating to your health.
Next, we'll refer you to testing your reproductive hormones and other general health markers that indicate how well your body makes and uses these hormones.
Getting these tests done on the right day of your menstrual cycle is very important. This is because women have many hormonal fluctuations throughout the month. So, if you don't test on the right days, then we won't get a clear enough picture of what your hormones are doing.
Once we get your test results back, it helps us pinpoint the underlying cause of your breakouts. Armed with this information, we can create an individualised naturopathic plan to treat your hormonal acne at its root cause.
Our natural treatment plans include herbal medicine, nutritional medicine, diet and lifestyle modifications, nervous system support, and tips to help you get the most out of your hormonal acne treatments.
Testing For Hormonal Acne
There are two main ways to test for a hormonal imbalance when you are treating acne: the first is blood testing, and the second is saliva hormone testing.
When doing hormonal blood testing, it is important to do it on the right day of your cycle.
Due to hormonal fluctuations, some hormones are made in higher amounts at particular times in your cycle and lower amounts at other times.
Your hormones are at their baseline levels at the start of your cycle, days 1-5 (when you have your period). Follicle-stimulating hormone (FSH), Luteinizing hormone (LH), and oestradiol (oestrogen) are very low. Then, from day 5, oestradiol begins steadily rising and rebuilds the lining of the uterus after it was shed during the previous period.
During the first 14 days, small follicles grow on your ovaries in response to FSH. Magically, one of the growing follicles will become dominant, which will be the one in which that month's egg will grow.
Then, at the halfway point of your cycle (for most people, this is days 14-16), Oestradiol peaks, signalling LH and FSH to surge and trigger the dominant follicle to release the egg (ovulation). After the follicle ovulates, the empty follicle turns into a temporary hormone-producing gland called the corpus luteum.
The corpus luteum's job is to make progesterone. Progesterone's job is to hold the newly grown lining of your uterus in place over the next two weeks so that if the released egg is fertilised, it has enough time to implant and grow.
Oestradiol also rises at this time so that if you become pregnant, both oestradiol and progesterone can help maintain the pregnancy. Because oestradiol and progesterone are at higher levels in the last two weeks of your cycle, it is the perfect time to test them and assess your peak hormone production.
What should I test & when
Baseline hormone levels on day 2, 3, or 4 of your cycle:
And peak hormone levels on day 21 of your cycle:
In addition to your reproductive hormones, there are some other factors to test for that can influence your skin and menstrual cycles.
Other markers to test for using blood testing
Fasting insulin and glucose
Our brain operates an interrelated feedback system between our hypothalamus, thyroid, adrenals, and ovaries. So, your thyroid function impacts your ovaries and vice versa. Therefore, if your thyroid develops a problem, it will affect your reproductive hormones.
Here is what to check when looking at your thyroid function.
Thyroid-stimulating hormone (TSH) tells us how much thyroid hormone your body asks for. TSH stimulates the release of the thyroid hormone Thyroxine (T4)
Thyroxine, or T4, is the hormone produced by the thyroid. If it is low, it means your thyroid isn't making enough, but it can sometimes be high, which is when we have hyperthyroid issues. It is important to look at TSH and T4 together to see how much thyroid hormone your body is asking for and how much thyroid hormone is being made. This is important because if there is a discrepancy between how much TSH and T4 are being made, it could affect your hormone levels and switch off ovulation.
Finally, Triiodothyronine or T3. This is the active form of thyroid hormone. T3 is made from T4. To convert T4 to T3, we need co-factors like zinc, selenium, iodine, vitamin C, amino acids, and B vitamins. So if we have plenty of T4 but not enough T3 the first place to start is to make sure you are getting enough of these cofactors, but other investigations might be warranted if it turns out you are.
Cortisol and DHEAS are made by the adrenal gland in response to stress.
Cortisol has a diurnal (night/day) rhythm, which means it's naturally higher in the morning to help to rouse us, and gradually drops through the day to be low by night time. When looking at cortisol on a blood test it is good for telling you if you have an adrenal disease. For example, a higher than usual or lower than usual cortisol level may indicate a pituitary gland tumour.
A blood test for cortisol however is not a good way to assess non-disease adrenal issues such as the impact of chronic stress. This is best assessed with a saliva cortisol test.
DHEAS is the brother of cortisol and is also an indication of how the adrenal glands are performing. It is a stress hormone but it doesn't damage the body like cortisol, it is a repair and renewal hormone. However, it is the 'brother' of cortisol because it is considered an androgen.
This means it's similar to testosterone in its function but is made in the adrenal gland rather than the ovaries. If DHEAS is high it can contribute to PCOS and hormonal acne because of its androgenic effect.
Additional reading: Is Blood Testing The Best Way To Check Your Hormones?
Saliva hormone testing
This is a better way to look at hormones throughout the month because it is easy to collect. You do it at home not at a lab. (read more about why saliva testing is better than blood testing for hormones here)
Saliva hormone testing gives us an idea of how your hormones are affecting your cells, not just what is circulating in your bloodstream. It also allows us to look at your hormones on day 21 of your cycle in relation to your stress hormones. This gives us an overall picture of how your stress levels or lifestyle are affecting your reproductive hormones.
Collect a saliva sample four times throughout the day to do this test. This determines how much cortisol you make in the morning, afternoon, and night and whether you are producing cortisol in the optimal daily rhythm.
If your cortisol levels are high, it can suppress your female (oestrogen and progesterone) levels because it indicates you are in survival mode and your body doesn't think it is safe to reproduce.
If your cortisol levels are low, it can be because your adrenal glands can no longer keep up cortisol production to match the stress you are under. This is what we naturopaths call adrenal fatigue. It isn't a disease but a state the body falls into when it's been under stress for a prolonged period of time. Or put more, you're burnt out.
Testosterone, oestrogen, and progesterone need to be examined in the context of one another. This helps determine whether there is a true or relative imbalance.
If your progesterone levels are low, this can cause a 'relative imbalance' where your body is more sensitive to the amount of testosterone and estrogen you have. You experience the symptoms of excess testosterone (hormonal acne), but your testosterone isn't high. It is just high relative to progesterone.
A true imbalance is when one of your hormones is much higher than it should be. For example, your testosterone is above the high end of the test range.
What confuses many people, including doctors, is that the symptoms of hormonal acne don't always indicate a true imbalance. More often than not, the issue is a relative imbalance.
This fact often results in you getting a doctor to check your hormones because it looks like you have high testosterone (hormonal acne), only for the test results to come back 'normal' and you get told that you don't have a hormone problem.
Learn here also "What to do when your doctor won't check your hormones"
Clues from your menstrual cycle to look for when treating hormonal acne
A typical menstrual cycle is 21-35 days long and varies greatly between individuals. If your cycle is a lot longer or shorter than that, it might give us a clue about how to treat your hormonal acne. Longer or shorter cycles can indicate that you aren't ovulating, an important factor in your hormonal acne.
Ovulation is important because it is how women make progesterone. Progesterone is an important aspect of treating acne because low progesterone can make you more sensitive to testosterone.
Ovulation & the birth control pill
When you are on oral birth control, your ovulation is suppressed. This is why they work so well to stop women from getting pregnant. However, oral birth control pills don't just suppress ovulation; they also suppress your natural production of hormones.
This is why they work while you are on them, but your acne returns once you use them. When you stop taking the pill, your male hormone levels are initially low because the pill has been suppressing them.
But 3-6 months after stopping birth control, your testosterone can surge with a vengeance, triggering acne worse than ever.
Plus, ovulation may stay suppressed for many months after you stop the pill, so your progesterone will be low while your testosterone rises.
So, if you have long or short cycles or irregular periods, then you can be guaranteed something wrong with your hormones.
Do you have any of these period symptoms?
Heavy or light period?
Cramping or pain that you need to manage with pain relief medications?
PMS - moodiness, irritability, sadness or teariness before your period?
You break out at a certain time in your cycle?
Blood clots in your menstrual flow?
What can these symptoms tell us about hormone levels?
Heavy periods and period pain
When all other causes have been ruled out (endometriosis, uterine fibroids, bleeding disorders), heavy and painful periods can sometimes be caused by an imbalance in estrogen and progesterone levels.
Estrogen is, by nature, proliferative; that is, it makes things grow. It's what stimulates the growth of the uterine lining in preparation for either a pregnancy or a period. But if oestrogen levels are too high, it causes the uterine lining to grow thickly.
Conversely, Progesterone is excellent at thinning the lining out so periods aren't too heavy. Some people have low progesterone and high estrogen, which can cause an extremely heavy and painful period.
Menstrual blood clots?
These can also indicate that progesterone is low or estrogen is high. Any blood clots bigger than a small coin should be investigated.
The way to reduce excess oestrogen is to make sure your body is properly detoxifying estrogen. You do this by working on the colon and liver.
To boost progesterone, you must ensure you are ovulating each month.
If you have these 'estrogen dominance' symptoms, paying attention is important, particularly if you have a family history of breast cancer.
In the week or so before your period, do you experience breast tenderness, moodiness, cramping or pain, extreme emotions, spotting, or an increase in appetite?
All of these symptoms give us clues about your hormone levels. In the week before your period you should have high levels of progesterone which helps to reduce these symptoms. If your progesterone levels are insufficient then you'll experience PMS.
Breaking out before your period
This is a classic sign that your acne is hormonal because as your hormones fluctuate, so does your acne.
A second classic time for hormonal acne to flare up is mid-cycle. This is when you ovulate and experience a major hormone fluctuation.
Some women develop menopausal acne because once ovulation stops oestrogen and progesterone levels drop so there is nothing to counterbalance the effect testosterone on their skin.
Clues other than hormonal acne that signal you have a hormone imbalance are hair loss, excess oil production, and hair growth on your chin and neck.
Where does hormonal acne (acne vulgaris) occur?
When investigating hormonal acne symptoms, it's important to check where the acne is occurring. When acne is due to hormonal changes in the hair follicles, hormonal acne presents around the chin and jaw.
This is why it's important to consider the location of acne as well as acne severity when creating an acne treatment plan because some hormonal treatments target the hormonal changes in hair follicles better than others.
However, the main cause of hormonal acne is excess sebum causing clogged pores. Which means adult hormonal acne isn't always restricted to the chin and jaw but can appear anywhere on the face and body.
Common areas of hormonal acne on your body:
- Shoulders & Head
- Oily Hair
- Dry Itchy Skin & Scalp
- Red & Burning or Stinging
Common Signs of Hormonal Acne:
How to stop hormonal acne (acne vulgaris) from returning
The best way to cure hormonal acne and eliminate breakouts is to treat the hormonal imbalances that trigger acne.
The reason birth control pills and topicals like retinoid creams don't work long-term is that they don't fix the underlying causes of either teenage hormonal acne or hormonal adult acne.
If you're on them, oral contraceptives will suppress hormonal acne, but many people find that their persistent acne returns once they stop birth control. So, in the end, what's the point?
Clinical research tells us that certain lifestyle factors are important when you want to stop hormonal acne from returning.
Holistic hormonal acne treatment needs to consider your stress levels, your sleep patterns and duration, your diet, and the type of exercise you do.
This is because, for some people, excessive or chronic stress, lack of sleep, or too much high-intensity exercise can cause teenage and hormonal adult acne.
In some women, dietary factors such as dairy and/or sugary foods can cause inflammatory acne that can range from mild to moderate. So, the elimination of these foods can be important.
We find hormonal acne affects every aspect of your life, so when you suffer from severe acne, it's hard to imagine a time when you won't. But once your underlying causes are pinpointed and corrected, hormonal acne can be prevented from returning.
How to treat hormonal acne (acne vulgaris) topically
While not our area of expertise, as we focus more on what is happening internally, years of working with people with hormonal acne have taught us that simple is best. Because when you have hormonal acne, your skincare routine can become stressful.
You can find yourself forever trying new creams and face washes, especially those for sensitive skin and clogged pores. Then, topical retinoids and serums with salicylic acid, glycolic acid and vitamin C.
The number of products is overwhelming, and when you use a lot, it becomes hard to understand whether your sebaceous glands are overproducing or underproducing oil.
Plus, when using many skincare products, some might be causing skin inflammation rather than reducing it. Because for some people, ingredients like salicylic acid can worsen skin inflammation!
So, while topical hormonal acne treatments have their place, internal treatments are the ones that fix acne at its root cause.
We must work from the inside out to prevent future breakouts and scarring.
The Best Treatment For Hormonal Acne (acne vulgaris)
The best hormonal acne treatment for adults and teenagers focuses on the root causes, not just simply treating the symptoms.
Women have a complex hormonal cascade of fluctuating hormones and hormonal spikes, and it isn't easy to put an accurate picture together without a thorough investigation.
This is the issue with most natural hormonal acne treatments you read about online. They are generic, one-size-fits-all solutions. They recommend that if you have hormonal acne, take it or do it, and your acne will improve.
But how do they know what will fix your hormonal acne if they don't know your specific hormone imbalance?
They don't, so their recommendation can be completely off the mark.
Hormonal acne treatment for adults & teenagers
When you want to treat acne, whether it's adult or teenage female acne, you need to uncover what hormones are out of balance in that woman.
Is it high testosterone, high DHEA, high cortisol, low progesterone or low oestrogen? It could be any of these; the only way to know is to test, preferably with saliva hormone testing.
Once the testing is done and the results are known, plenty of herbs and nutrients can be used. Some help balance hormones, and others reduce inflammation. But testing and a thorough case history guide us on what ones will be best to use.
Natural acne treatments work for mild, moderate, severe, and cystic acne. We have helped over 1,000 women eliminate breakouts and would like to help you, too.
Here is a list of the best hormonal acne treatments in our clinic.
This powerful acne treatment works in various ways. One way is paeony helps to promote healthy estrogen production. This corrects the effects of low estrogen if picked up on testing.
Paeony will also rebalance a high LH:FSH ratio. Elevated LH (luteinizing hormone) triggers the ovaries to overproduce testosterone.
Licorice helps minimise the effect testosterone has on skin cells. And it also can be used to lower high DHEA levels.
Combining these two herbs has been studied and shown to help polycystic ovary syndrome, a condition for which hormonal acne and cystic acne are common symptoms.
This herbal combination helps to promote ovulation, therefore increasing progesterone and regulating the menstrual cycle. It is an advanced treatment, so it shouldn't be used without testing hormone levels first.
Other causes of acne
What about if your acne isn't hormonal? Some other things that are rare but can cause acne:
Fungal acne occurs when there's an overgrowth of fungus on the skin. It can be treated with topical antifungals and diet and lifestyle modifications.
Food intolerances: Some people notice that certain foods can cause a breakout for them. The most common are dairy, wheat, soy, peanuts and sugar. Avoiding these and working on gut health and integrity can often have a great effect.
Gut dysbiosis: Our gut microbiome has billions of bacteria species that can cause positive or negative symptoms. Over our lifetime, our gut microbiomes can be affected by illness, medication use, antibiotics, travel and foods. If this is something you suspect, doing some comprehensive microbiome test is what we recommend to get to the bottom of the problem. (Further reading: How do you know if your acne is hormonal or bacterial)
Rosacea: At times, rosacea can be mistaken for acne and vice versa because they can both present as inflammatory acne and redness. If you are experiencing mild to moderate acne, it might be rosacea, so this is where hormone testing helps clarify the situation.
Autoimmune conditions: Some autoimmune conditions like Lupus can come with a face rash that can be mistaken for acne. The rash accompanying Lupus won't respond to external treatments such as benzoyl peroxide or salicylic acid, which could indicate that you are not experiencing adult acne.
Menopausal acne: While this is also considered hormonal acne, the treatment can be very different as it considers a natural decline of hormones during perimenopause. Adult women begin to go through perimenopause approximately ten years before menopause. So hormonal imbalances can start for women in their late 30s, which is something to be aware of.
Hormonal acne specialist
Working with a hormonal acne specialist is integral to treating hormonal acne. Without help, some people go for years treating their hormonal acne symptoms without success because they don't get to its root cause, and so never reduce the acne severity.
Treatments that don't fix the underlying cause might relieve some for a while, but before you know it, the hormonal acne returns. And this becomes very disheartening.
So whether you are suffering from mild to moderate acne or severe to cystic acne, it is important to pinpoint the underlying driver of your acne. This is almost impossible to do on your own if you lack medical training or experience.
Eliminating adult and teenage female acne requires advanced treatment because it requires advanced hormone testing and rebalancing. You need practitioners who specialise in this field and have the experience of successfully treating thousands of women.
Working with someone who treats adult and teenage acne by only using topical treatments such as salicylic acid, topical retinoids and peels or scrubbing off dead skin cells only prolongs your issue.
So, who is the best hormonal acne specialist to see? A board-certified dermatologist?
There's a good chance you've already seen one and been disappointed with the options they gave you... topical antibiotics, oral contraceptives, Accutane.
Nothing natural, that's for sure.
So if you've had enough of Band-Aid fixes like salicylic acid, glycolic acid, benzoyl peroxide, topical retinoid, dermatological treatments, antibiotics, oral contraceptives and Accutane, then it's time to get to the bottom of what is causing your acne!
We can help you get your hormones tested and your hormone imbalances pinpointed and create a personalised natural supplement program for you, as we have for over 1,000 other women in Australia and worldwide.
Additional resources in regards to supplements can be found here:
And this includes social media icons Sarah Stevenson (Tilse) from Sarah's Day and Louise Aubery from MyBetterSelf.
Click the Book Now button to organise a consultation with one of our hormonal acne specialist naturopaths.