What Is Hormonal Acne + How Do You Treat It? A Functional Medicine Look At This Common Skin Problem

Hormonal Acne + How Do You Treat It

No one wants to look in the mirror everyday and see breakouts, especially if you are no longer in high school. However, that’s often a reality for many of my patients in my telehealth functional medicine clinic who are well beyond their teenage years.

See, acne has many causes, one of which being hormones. If your hormones are imbalanced it can result in a barrage of hormonal acne that will continue well past puberty until you fix what is going on beneath the surface.

So if you are still dealing with breakouts as an adult, let’s take a look at what hormonal acne is and exactly what you can do to achieve the clear skin you deserve.


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What is hormonal acne?

Hormonal acne is when acne continues past adolescence into adulthood and is characterized by an excess of sebum - the oil produced from your skin’s glands - leading to a variety of acne related problems

What does hormonal acne look like? The following may show up on your skin in the event of a hormonal acne condition:

  • Blackheads: small, dark bumps caused by clogged hair follicles open to the surface of your skin
  • Cysts: a type of inflammatory acne that causes, pus-filled pimples
  • Pimples: red, swollen oil glands
  • Whiteheads: small, closed bumps caused by clogged hair follicles and skin pores

All of these can occur on your face as well as your back, chest, neck, and shoulders. For the most part, this excessive oil production is a direct result of a hormone imbalance.

Who does it affect?

Affecting close to 80% of the population, acne is one of the most common skin conditions in America. (1) And while hormonal acne causes both men and women to experience symptoms, women between the ages of 20-40 tend to struggle the most with this problem due to the likelihood of fluctuating hormones during pregnancy and menopause.

Teenagers also struggle with hormonal acne before adulthood during puberty when hormones are rising and leveling out.

What are the main hormonal acne causes?

Acne can have a lot of different triggers, but hormonal acne is unique in that hormones are the main driving factor of the formation of acne in this condition. Here’s exactly what causes hormonal acne:

     1. Fluctuations of estrogen and progesterone

Hormonal imbalances of estrogen and progesterone - especially during pregnancy and menopause - have been shown to play a role in hormonal acne. For example, studies have shown that low levels of estrogen in menopause can trigger acne formation. (2) While more research needs to be done, this is believed to be because estrogen helps keep sebum levels in check. 

     2. Testosterone levels

Testosterone is responsible for the production of sebum. When testosterone levels are high, sebum production is going to be as well, leading to increased acne. This is why hormonal acne is more common during puberty when testosterone levels rise and in certain hormone imbalance-related health problems that increase testosterone levels, such as PCOS. (1)

     3. Clogged pores

Out of all the hormonal acne causes, clogged pores are usually the main culprit. Ultimately, acne happens when your pores are clogged due to this increase in sebum. This oil ends up trapping any bacteria or dead skin cells that are on your skin into your pore and clogging it, leading to inflammation and acne. This is why it is so important to keep your skin clean and exfoliated to minimize the amount of bacteria and dead skin cells on your skin that can contribute to acne.

How do you know if acne is hormonal?

If you are struggling with breakouts it can be frustrating to know how to treat it without knowing why you are dealing with it in the first place. Once you identify that you are struggling with hormonal acne, you’ll be able to start addressing the underlying cause and work toward finding the right treatment for your particular type of acne.

Chances are if you identify with one or more of these characteristics, you are dealing with hormonal acne. 

     1. You are no longer a teenager

Unfortunately, acne doesn’t just go away once you graduate high school and turn 20. Don’t we wish!? If you are dealing with breakouts well-into your 20s, it is most likely hormone related as hormone levels should balance out after puberty. Unless you are pregnant (which can also contribute to hormonal acne), acne that continues after high school can be a sign that your hormones are out of whack.

     2. You have acne on your chin and jawline

Location, location, location. Since a good chunk of your oil glands sit around your chin and jawline, excess oil production caused by a hormone imbalance can clog your pores and lead to breakouts. If the majority of your breakouts happen in these two places, it’s a telltale sign you are dealing with hormonal acne.

     3. You have cysts

Hormonal acne tends to appear more often in the form of painful cysts. This type of acne occurs deep under your skin’s surface caused by a large accumulation of oil leading to a more severe inflammatory response.

     4. You breakout when you are stressed

Every time you are stressed, your cortisol levels spike. And when you are chronically stressed, cortisol levels remain high and in turn, can throw off all of your other hormones - progesterone, estrogen, and testosterone included. Since all of these play a role in the formation of hormonal acne, it’s no surprise that you may be struggling with breakouts if you are in a season of extreme stress.

     5. You breakout consistently every month

If you notice that your breakouts occur around the same time each month - specifically correlating with your menstrual cycle - that’s a sure sign you are dealing with hormonal acne due to the fluctuations of estrogen, progesterone, and testosterone during this time of your cycle.

What can make it worse?

If you are dealing with hormonal acne, balancing hormone levels is a great first start to treating your breakouts. However, there are other factors that can aggravate acne and make breakouts worse if you aren’t aware. Keep these triggers in mind to help mitigate the frequency of any hormonal acne.

     1. Stress

Since stress can spike cortisol levels and throw off the balance of other hormones involved in hormonal acne, it’s vital to keep stress levels under control. Breathwork, meditation, and other mindfulness practices are great tools for alleviating stress.

     2. Humidity

Thank goodness for air conditioning. Humidity and sweat can result in your skin being the perfect sticky surface for dust and other bacteria to cling to, leading to clogged pores and increased breakouts.

     3. Picking

Not only does picking or popping your acne cause permanent scars and dark spots, it can also lead to further acne as the force of popping pushes the bacteria deeper into your hair follicle and other surrounding areas of your skin.

     4. Poor diet

A poor diet filled with inflammatory foods can directly impact your hormone levels and cause imbalances in estrogen, testosterone, and progesterone. The food you eat on a daily basis also contributes to chronic inflammation of your gut and other areas of your body, directly impacting your body’s ability to detox leading to even more breakouts.

     5. Menopause

During menopause, estrogen levels drop and testosterone levels rise. While these hormonal changes can be managed, even a minor fluctuation of these hormones can increase the occurrence of breakouts.

How to get rid of hormonal acne?

In conventional medicine, hormonal acne can be treated in a few different ways including:

      1. Topical cream

The most common topical cream prescribed for hormonal acne is Tretinoin - a generic form of Retin-A. While this does not work to rebalance or address your hormones, it can help reduce inflammation and the appearance of acne and scars over time. 

     2. Birth control

These daily pills contain hormones that balance the circulation of estrogen, progesterone, and testosterone in the body.

     3. Antibiotics

Antibiotics such as types of tetracycline are commonly prescribed for acne. While they can help fight acne-causing bacteria, they don’t work to help rebalance hormones that are driving hormonal acne breakouts.

     4. Isotretinoin

A form of vitamin A, this medication works to lower surface inflammation, the buildup of dead skin cells, and decrease the production of oil by reducing the size of your sebaceous glands.

In functional medicine, we aim to treat hormonal acne by addressing the root cause and focus on more natural remedies such as:

     1. Daily cleansing

Daily cleansing with gentle, natural products can soothe inflammation, get rid of bacteria and dead skin cells, and reduce the production and buildup of oil.

     2. Rebalance hormones

By getting hormone levels under control that play a role in hormonal acne, we are able to mitigate the occurrence of breakouts. This is done through running labs to look at hormone levels, making dietary adjustments, and incorporating lifestyle changes like supplements and stress management techniques.

     3. Supplements

Certain supplements have been shown to help improve the appearance and occurrence of hormonal acne:

     4. NAC

N-acetyl cysteine (NAC) is a powerful antioxidant that can promote cellular health and help fend off oxidative stress. But why is that helpful for hormonal acne? Studies have shown that oxidative stress plays a role in acne and NAC is also being studied for its potential benefits for endometriosis and PCOS. (3)

     5. DIM 

DIM, which stands for diindolylmethane, is a compound found in cruciferous vegetables like broccoli, cauliflower, and Brussel’s sprouts. DIM has shown an ability to metabolize excess estrogen, which can be helpful for people with estrogen dominance or other hormone imbalances.

When to see a doctor for hormonal acne?

Even if you struggle with hormonal acne, the severity of your acne can look very different than someone else’s. Some people may only get a pimple every now and then around their cycle, and while that is hormone related, it doesn't necessarily mean there is cause for concern or that there is a major underlying hormonal imbalance. 

However, if you are dealing with any of the following, it may be time to seek out professional help in treating your acne:

  • Multiple, consistent acne breakouts that cover larger areas of your skin
  • Severe lesions
  • Scarring
  • Pigmentation

In functional medicine, our goal is to treat hormonal acne but getting to the root of the problem. By balancing your hormones through diet and lifestyle changes, we can help you achieve the clear skin you deserve naturally, without the side-effects that often coincide with antibiotics, birth control, and other conventional treatment methods.

If you are ready to leave acne behind alongside your teenage years, as one of the first functional medicine telehealth clinics in the world, we provide webcam health consultations for people around the globe.

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  1. Zeichner, Joshua A et al. “Emerging Issues in Adult Female Acne.” The Journal of clinical and aesthetic dermatology vol. 10,1 (2017): 37-46.
  2. Ebede, Tobechi L et al. “Hormonal treatment of acne in women.” The Journal of clinical and aesthetic dermatology vol. 2,12 (2009): 16-22.
  3. Bowe, Whitney P, and Alan C Logan. “Clinical implications of lipid peroxidation in acne vulgaris: old wine in new bottles.” Lipids in health and disease vol. 9 141. 9 Dec. 2010, doi:10.1186/1476-511X-9-141

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Dr. Will Cole, DNM, IFMCP, DC is a leading functional medicine expert who consults people around the globe, starting one of the first functional medicine telehealth centers in the world. Named one of the top 50 functional and integrative doctors in the nation, Dr. Will Cole provides a functional medicine approach for thyroid issues, autoimmune conditions, hormonal imbalances, digestive disorders, and brain problems. He is the host of the popular The Art Of Being Well podcast and the New York Times bestselling author of Intuitive Fasting, Ketotarian, The Inflammation Spectrum and the brand new book Gut Feelings: Healing the Shame-Fueled Relationship Between What You Eat and How You Feel.

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