If you suffer from hormonal acne, you are not alone. Up to 23% of adult women experience acne! Now there are many different factors that affect acne. Inflammation is very important. Gut health is important. Anti-oxidant status is supremely important! But hormones make all the difference for women.

Below are the 7 steps I use with patients to resolve their frustrating and embarrassing hormonal acne.

Step 1 – Is your acne actually hormonal?

How do you know if your acne is hormonal or not? This is a very important question to ask. You don’t want to try to fix something that isn’t broken.

 Here are some things to look out for to determine if your acne is hormonal:

• if your acne fluctuates with your monthly cycle
• if your acne is cystic and located around your chin, mouth, and jaw
• if your acne has also spread to your shoulders, upper back, and buttocks
• If you experience other hormonal symptoms like irregular menstrual cycles, male pattern hair growth (facial hair), balding, PMS, mood swings, hypothyroidism, or difficulty maintaining or losing weight

Step 2 – Know the causes

This is the hardest part of hormonal acne treatment, but it is the most important, and the aspect that makes your healing the most effective in the long run.

Hormonal acne is caused by an underlying hormone imbalance. Period, that’s it, no questions about it! The only questions remaining are: what type of imbalance is it, and what caused the imbalance?

Hormones can become imbalanced a number of different ways. The fastest way to heal is to figure out why your hormones are imbalanced, and then correct that problem.

The most common hormonal imbalances contributing to the development of acne include:

Elevated Testosterone

Testosterone is one of the primary causes of female acne. Testosterone causes oil production in the pores of your skin to increase. Excess oil causes pore-clogging. This in turn creates more food for bacteria to eat, and therefore more possibilities for infection.

How does testosterone get elevated?

Insulin signals to the ovaries to produce testosterone. Testosterone often becomes elevated as a result of insulin spikes and insulin resistance. This means that insulin-related problems are one of the primary causes of hormonal acne for women!

Elevated DHEA-S

DHEA-S is another male sex hormone, so it has the same oil-enhancing effects on the skin as testosterone does. DHEA-S is unique however because it is produced by the stress glands, instead of reproductive organs.

DHEA-S rises in response to all different kinds of stress, from the mental to the physiological.

Reduced Estrogen

Estrogen is important for clear skin because it provides a counterbalance to testosterone. It is one of the best molecules out there for creating dewy, radiant skin.

Estrogen levels can fall for any number of reasons. Menopause is one big reason. Low body fat percentage, extreme weight loss, excessive dieting, calorie restriction, and excessive exercise are some others. Estrogen levels may also fall as a result of birth control pill usage (especially when you come off of the pill).

Estrogen Dominance (elevated estrogen and low progesterone)

Just as too little estrogen can contribute to the development of acne so can a relative excess. Excess estrogen is extremely common for adult women and contributes to an array of issues such as acne.  Stress and aging cause testosterone and progesterone levels to decline, while estrogen levels increase, leading to estrogen dominance.

Too much estrogen alone is not solely responsible for hormonal acne. Estrogen dominance is a more accurate term, as it’s not necessarily about having high estrogen levels as it is about having a higher amount of estrogen compared to progesterone. Having low progesterone in relation to estrogen is usually the cause behind pre-menstrual breakouts and the acne that some women experience when going off birth control. Low progesterone levels are a big problem because of the protective mechanism that progesterone exhibits against acne. A balanced amount of progesterone helps regulate the production of 5 Alpha Reductase, preventing testosterone from turning into DHT.

Hypothyroidism

Hypothyroidism is not a hormone problem in the sense that sex hormones are produced by the reproductive cycle, but it is a hormone problem in the sense that thyroid function is intimately tied to reproductive function. The components of the thyroid system that are the most important for effective thyroid function are considered hormones, too.

Hypothyroidism causes cells to weaken and be susceptible to DNA damage and inflammation. It can be caused by a low carbohydrate diet, by stress, or by an autoimmune condition called Hashimoto’s Thyroiditis.

Step 3 – Don’t guess, test

Which of the forementioned causes of hormonal acne is yours? It could be just one of them, or it could be all four.

You could simply guess which problem is your own based on the information I provided, but I recommend having appropriate testing done to get the most accurate assessment of your hormone levels. In my practice, I often recommend either salivary hormone testing which tests estradiol, progesterone, testosterone, DHEA and cortisol or the DUTCH test (dried urine test for comprehensive hormones), which provides a more detailed assessment of hormone levels and metabolites as well as adrenal function.

Other valuable tests to consider running to get a better estimation of the underlying cause of your acne include:

• Fasting insulin (indicative of blood sugar imbalance as well as a cause of elevated testosterone)
• Thyroid function tests (TSH, T3, T4 and Anti-TPO)

Step 4 – Restore balance

Once you know which hormone imbalance issue you have, you can work on correcting it.

This may include making dietary modifications to support appropriate hormone production, support healthy blood sugar balance or reduce exposure to certain toxic chemicals, which may be contributing to your concerns. Additional treatments recommended by your Naturopathic Doctor may also include targeted supplementation with nutrients and botanicals, bioidentical hormones, lifestyle changes and/or acupuncture.

Step 5 – Address other factors

Hormones are a big factor in acne, but they are not the only one. At the beginning of this post I mentioned a number of other contributing factors to the development of acne.

Acne is impacted by stress, UV ray exposure, heat, dairy, inflammatory foods, phytoestrogens, topical irritants, sleep, and low carb diets.

This step can be challenging to navigate alone so I highly recommend consulting with a Naturopathic Doctor to help guide you.

Step 6 – Smart skincare

While you heal your underlying hormone imbalances, it is also important to attack acne from other angles. One is to use the best topical regimens, treatments and products possible.

Check out my list of pore clogging ingredients that may contribute to the development or worsening of acne.

Step 7 – Practice patience

Overcoming acne takes time. Many different things can affect acne, so it will take you a little while to figure out which ones are the most important for you to address. Each person has their own unique combination of causes and triggers so I encourage patients to be patient with the process.

If you are struggling with acne, I highly recommend that you book a free 15 minute consultation to learn more about your options for treating it and getting the clear, healthy skin you want.

Dr. Jen Newell, ND is the founder of the Naturopathic Skin Care Clinic at the Integrative Health Institute. She is committed to helping others resolve frustrating skin issues because she struggled with hormonal cystic acne and mild rosacea for over 10 years. Dissatisfied with the results from oral contraceptives, antibiotics and other conventional treatments, Jen decided to take matters in her own hands and find a safer and more sustainable solution to achieve healthy, glowing skin. She is now a leader in her field and a pioneer for a holistic approach to skin care.

Dr. Newell has extensive experience in skin, hormonal and digestive health. She understands how the health of these systems is often integrated and the impact these issues can have on quality of life. She is passionate about helping people look and feel their best by combining her knowledge and expertise to develop customized and comprehensive plans for optimal health.

Dr. Jen Newell is a graduate of the Canadian College of Naturopathic Medicine and the University of Ottawa. She is a member of the Ontario Association of Naturopathic Doctors, the Canadian Association of Naturopathic Doctors and International Association of Corneotherapy. Jen has additional certification in Collagen Induction Therapy/Microneedling, Facial Rejuvenation Acupuncture, and Culinary Nutrition.