Acne. For many of us, it was the scourge of our teenage years. All those hours we spent in front of the mirror agonizing over the newest set of pimples. Tubes of creams and face washes cluttering our bathroom sinks, the stash only growing bigger with each new skincare trend. As an adult woman, your skin health remains dependent on your hormones. This means blackheads, zits, and other “teenage” skin problems can still be a regular occurrence in your life. So why does acne persist, and what can you do to finally achieve that no-filter, Instagram-worthy complexion? Read on to find out ways hormones impact skin.
What is Acne?Your skin contains tiny glands called sebaceous glands, which secrete an oily substance called sebum. The production of sebum reaches its peak during puberty, which is why up to 80% of teenagers and young adults of both sexes experience breakouts.1 Pores in your skin are naturally capable of cleaning themselves. However, the excess sebum, combined with dead skin cells and bacteria, can quickly clog them up. From there, bacteria begin to multiply, causing your immune system to release pro-inflammatory chemicals in an effort to fight the infection. This perfect storm leads to the eruption of what we call “pimples,” medically known as acne vulgaris. So what causes the overproduction of sebum? There’s one major contributor: your hormones. Sebaceous glands, like many other parts of your body, have receptors that are influenced by various signals, including hormones. Acne that is the result of fluctuating hormone levels is aptly called “hormonal acne.” A few hormones implicated in acne development include:
- Androgens: The major player of all hormones involved in sebum production. Potent androgens include testosterone and dihydrotestosterone (DHT). Your adrenal glands and ovaries are sources of androgens dehydroepiandrosterone (DHEA) and androstenedione production.
- Progesterone: This hormone blocks the enzyme 5ɑ-reductase, which is needed to convert testosterone to DHT.
- Estrogen: Research is still unclear on exactly how estrogens affect sebaceous glands. Estrogen is associated with increased skin thickness and hydration, improved barrier function, better wound healing, and increased collagen production.2,3 High doses of estrogen can result in the reduction of sebaceous gland size and reduced sebum formation.4 The fluctuations in estrogen levels throughout the menstrual cycle may be the reason behind hormonal acne in many women.
- Insulin: Insulin stimulates the growth of sebaceous glands by increasing the number of growth hormone receptors on sebocytes, the major type of cells in sebaceous glands.5
- Corticotropin-releasing hormone: This is the hormone responsible for being the main driver of your body’s response to stress.6 Corticotropin-releasing hormone enhances androgen bioavailability and stimulates the conversion of DHEA to testosterone.7
- Melanocortins: Higher levels of melanocortin receptors 1 and 5 (MC-1R and MC-5R) are expressed by sebocytes in people with acne.8
5 Top Ways Hormonal Imbalances Impact Your Skin
1. Estrogen-Androgen ImbalanceAs mentioned above, androgens are the major culprit in hormonal acne. And it makes sense that it’s mostly teenagers who suffer from hormonal acne, since androgen levels spike during puberty.9 With more androgens binding to receptors on sebaceous glands, more sebum is produced, often leading to acne. Sebum production can also change throughout the menstrual cycle, which is also why women tend to experience hormonal acne more than men. Specifically, you may notice that you have more breakouts a few days before your period begins. One study also found that about 42% of women have increased skin sensitivity around the start of their period, which could also be due to low estrogen levels.10 The exact reason behind this is still unclear. One theory is that falling levels of estrogen a few days before the start of menstruation means there aren’t enough to counter the “pro-sebum” effects of androgens.11 High levels of androgens, referred to as hyperandrogenism, in women can be caused by other factors, such as polycystic ovarian syndrome (PCOS) and ovarian tumors. Individuals with these conditions may experience more hormonal acne in addition to thinning hair, infertility, excessive hair growth in male-like patterns, etc.
2. Chronic StressYou may have noticed that you experience more breakouts when you’re under a lot of stress. Say a big presentation for work. Or a wedding. But does chronic stress actually cause acne? Not necessarily. Stress isn’t a direct cause of acne, but scientific evidence suggests that it can disrupt your hormonal balance by causing elevations in cortisol and androgens. In turn, these hormones lead to a rise in sebum production.12 More sebum means more clogged pores, and more clogged pores mean more acne. To determine whether your acne is due to stress, try tracking your stress levels. If your breakouts tend to match the times you were feeling highly stressed, there may be a link.
3. High Blood Sugar LevelsAcne vulgaris tends to be seen as a condition of the Western populations. This is due to the fact that high insulin levels are closely correlated with a diet high in starchy carbohydrates, milk, and dairy products – all of which is common in the standard American diet.13 One study compared glycemic load, dietary glycemic index, milk consumption, and other parameters in patients with acne to healthy patients. The results showed that glycemic index and glycemic load levels were significantly higher in those with acne, demonstrating the relationship between blood sugar levels and acne.14 Chronic consumption of high glycemic foods leads to chronic high blood sugar and insulin resistance, which can lead to metabolic syndrome. Metabolic syndrome is a multisystem disorder that increases one’s likelihood of developing cardiovascular diseases, stroke, diabetes, and more. In a study published in 2022, investigators compared 65 patients with acne to 65 patients without acne. They found that patients with acne have a greater chance at developing metabolic syndrome.15
4. High Toxic BurdenToxic burden is the accumulation of toxins within your body. Toxins can come from just about anywhere, including:
- Personal care products
- Medications and supplements
- Electromagnetic frequencies (EMFs)
- Herbicides and pesticides
5. Lack of SleepSleep is critical for good health. Research shows correlations between poor sleep quality and many health conditions, including diabetes, psychiatric conditions, high blood pressure, etc. And while lack of sleep may not be a direct cause of acne, evidence suggests that it also impacts our skin health. One research study found that poor sleep is associated with the following:20
- Increased intrinsic skin aging, which refers to the natural aging process determined by your genetics
- Poor skin barrier repair
- Poor perceptions of appearance and physical attractiveness
Natural Tips for AcneMultiple factors can impact the development of hormonal acne. There are different ways hormones impact skin. I’m a firm believer that achieving clear, healthy skin requires a look at one’s lifestyle, including diet. Here are my recommendations for long-term freedom from hormonal acne:
- Eat a nutrient-rich diet that includes omega-3 fatty acids
- Prioritize stress reduction and relaxation
- Support phases 1 and 2 of liver detoxification using foods, natural supplements, and herbs (should be done under a medical professional’s guidance)
- Avoid things that increase your toxic burden, such as alcohol, drugs, etc.
- Exercise regularly. According to the American Academy of Dermatology, exercise can improve your skin’s appearance and give it that healthy glow we all strive for.21
- Stay hydrated with water
- Have sex regularly. Not only does sex help lower stress, a 2009 study showed that having an orgasm may raise estradiol levels.22
- Sleep 7 to 9 hours every night
Help for Hormonal Acne From a Naturopathic Women’s Health Specialist in BostonAcne can cause so much emotional distress. Many women suffer for years on end without any real solution. Not only is acne emotionally stressful, it can affect you financially, too, as you spend hundreds (if not thousands) of dollars on skincare products to cover up your blemishes. But it’s important to remember that you’re more than your skin. And yes, it’s possible for you – yes, you – to have healthy, glowing skin. I can help you reach your skin health goals. As a naturopathic physician and women’s health specialist, I have the knowledge and experience to help clear away the blemishes on your skin naturally. Want to learn more about the ways hormones impact skin? Schedule a free consultation with me today.