How Do Hormones Cause Acne?
Acne that first appears in people aged twenty-five or older is often called post adolescent or adult acne. Females tend to be more susceptible to it than males, and it affects between ten and twenty percent of adult women. It commonly occurs along the jawline.
This is the age when I started to get pretty depressed about acne (It started when I was ten, so I’d had more than a decade of breakouts by then) . When I didn’t “grow out of it” and I saw my angst-ridden teenage years come and go and went into my twenties and thirties with acne as a constant passenger, I was not happy to say the least.
Research shows that acne rates for women gradually decline as they become older. Thank goodness, this was the case for me into my forties and now fifties, but it’s not the case for everyone, sadly.
Acne in adult women is caused by a combination of genetic and environmental factors. These breakouts can be traced back to four key reasons.
The Three Key Causes of Adult Acne:
- Endogenous (naturally occurring) or exogenous (from outside, e.g. hormonal contraception) androgens(male hormones)
- The menstrual cycle
- Cosmetic usage(acne cosmetica).
The good news is that women are generally highly motivated to seek medical attention from dermatologists or other skin specialists as acne persists. I give my experience of “bad skin” credit for why I moved into learning all I could about acne, developing Science Skincare, writing this book, and in my mid-fifties having my best skin ever!
Women, Hormones, and Acne
We’ll have to get a little technical in this section to develop a good understanding, so bear with me. Androgens (male steroid sex hormones e.g. testosterone and DHEA) are hormones that may have a role in the development of breakouts by encouraging the expansion of sebaceous glands (which make oil for the hair follicles to lubricate skin and hair) and increasing the production of sebum (lubricating oily matter).
Acne in women has been connected to hormone imbalances from both internal (e.g. polycystic ovary syndrome) and external (e.g. hormonal contraception) sources of androgens. Furthermore, antiandrogenic medication is typically successful in reducing the severity of acne in female patients. An example is spironolactone or the combined oral contraceptive pill.
Polycystic ovary syndrome (PCOS) is the most common cause of endogenous androgen hormonal excess in women, although late-onset adrenal gland issues, ovarian dysfunction, and ovarian or adrenal cancers may also be causative factors. Anabolic drugs and testosterone supplements may both lead to hyperandrogenism.
Acne may also become worse when using progestin-only contraceptives (e.g. mini-pill, some intrauterine devices) because of the pro-androgenic progestins (progesterone) they contain and the absence of the balancing anti-androgenic estrogens. Despite this, most adult women who suffer from acne do not use any kind of exogenous androgens—and their androgen levels are typically normal. How annoying!
WISE WORDS: For this reason, the value of hormonal blood tests for acne is in question. In my opinion, in nearly all cases, they cannot reliably identify hormonal imbalance as the cause of acne. Blood tests are often valuable, though, to exclude pathology such as polycystic ovary syndrome.
The Menstrual Cycle
Hormones are recognised to have a role in acne, although it is unclear exactly how, and it isn’t always predictable. Countless studies have shown that women with acne have normal levels of androgens, while numerous other studies have shown that women with acne have higher production of androgens.
Confusing, isn’t it? That’s why I’ve written this blog.
Studies indicate that up to 85% of women have premenstrual acne flares, but why remains unexplained, and it seems to be more common in women over thirty (Zeichner et al, 2017).
Some researchers believe that the narrowing of the oil duct contributes to the reduced production of sebum leading up to menstruation, and that, because of this, excess sebum forms, leading to acne. Good theory, but we will still be kept wondering for a while, I think. Meanwhile a majority of us will have a monthly reminder on our faces that our period is due.
I am a week away from my period and have gained about seven cystic pimples in two days. ~ Cassie, 24
