We have all heard of hormonal acne but which hormones exactly are the culprits?

Let me introduce you to a class of hormones called androgens.

Androgens are “male type” hormones which contribute to male characteristics such as muscle development. Women also need androgens – they give us energy, strength and a good libido. However when they are too high or too low, they can cause problems.

The most common hormones which cause acne are the androgens testosterone and dehydroepiandrosterone (DHEA).

Testosterone is a hormone that we have all heard of. When levels in women are too high, it can cause acne, facial hair growth, excess body hair growth, male pattern hair loss (balding/hair thinning). It’s produced by the ovaries, and a small amount is produced in the adrenal glands and in muscle and fat tissue. Testosterone can convert to oestrogen via an enzyme called aromatase, so high testosterone can also cause high oestrogen and the associated symptoms. High levels of testosterone are also involved in polycystic ovarian syndrome (PCOS).

When testosterone levels are too low it can cause fatigue, low mood/depression, low libido and reduced muscle mass. Testosterone can be tested via a simple blood test. It is best tested first thing in the morning, before eating, drinking or exercising.

DHEA is another androgenic hormone which can contribute to acne. Unlike testosterone, DHEA is a stress hormone and is mainly produced by the adrenal glands. Chronic stress stimulates the production of DHEA; this is one of the mechanisms by which stress can cause acne.

DHEA is also involved in PCOS, specifically adrenal PCOS. DHEA can also convert to oestrogen as well as testosterone. Production peaks in the early 20’s and then starts to gradually decrease. After menopause, DHEA is responsible for creating all of our oestrogen (hence, if we have had lots of unmanaged stress throughout life and used up all of our DHEA, menopause symptoms can be a lot worse). Low levels of DHEA is associated with depression, panic attacks, low libido and cardiovascular disease.

Some medications can cause an increase in androgens, such as synthetic birth controls with a high androgen index. This includes the morning after pill, implanon (rod), mini-pill (progestin only pill) and the mirena intrauterine device (IUD)/coil.

Insulin is another hormone which can drive hormonal acne, because it stimulates the production of both androgens and sebum (oil). Production of insulin is triggered by refined carbohydrates, sugar, stress and environmental toxins. Fasting insulin can be tested via a simple blood test and you can find the ideal levels that yours should be here.

You can now see how skincare and skin treatments can be ineffective at completely resolving acne and skin complaints – because they are not addressing the underlying root causes of excessive hormone levels. Of course a facial isn’t going to do any harm, but treatment for acne driven by high DHEA needs to focus on the nervous system and adrenal health, and treatment for testosterone driven acne needs to first identify what is driving the high testosterone and focus on treating that. If insulin is driving hormonal skin, treatment must focus on reducing insulin and managing blood sugar levels, which can be achieved very effectively through diet, herbal medicine and lifestyle interventions.

Holistic and individualised treatment, preferably based on blood hormone testing, is my preferred way of treating hormonal acne and yields the best clinical outcomes. If hormone levels appear normal, then the driver of acne is commonly the digestive system – good gut health is imperative for good skin; small intestinal bacterial overgrowth (SIBO) is a very common cause of acne when hormones are not involved.

Whether your acne is hormone driven or gut driven, to get to the bottom of your acne and treat it once and for all, email for a 1:1 consultation.

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