Hormonal Acne: What Hormones Cause Acne? Complete Guide

Hormonal acne is a specific type of acne triggered by fluctuations in hormone levels rather than external factors like dirt or skincare products. It typically manifests in areas such as the jawline, chin, and lower cheeks and is often persistent, painful, or cystic. Unlike standard acne, which may appear randomly across the face, hormonal acne often follows a cyclical pattern, correlating with internal changes in the body. Proper identification of the hormones involved is crucial for selecting effective treatment options and preventing long-term scarring.

Hormonal acne is particularly common in women during menstrual cycles, pregnancy, perimenopause, or menopause, though men can also experience it due to androgen fluctuations. Stress, diet, and lifestyle can exacerbate hormonal imbalances, intensifying acne severity. By understanding the key hormones that influence acne formation, individuals can target treatments more effectively, whether through lifestyle adjustments, topical therapies, or medical interventions.

Key Hormones That Cause Acne

Androgens (Testosterone and Dihydrotestosterone – DHT)

Androgens are primary hormones responsible for regulating oil production in sebaceous glands.

• Function: Stimulate sebaceous glands to produce sebum.
• Effect on Skin: Excess androgen levels cause overproduction of sebum, leading to clogged pores and increased risk of acne.
• Common Symptoms: Oily skin, deep cystic pimples, predominantly along the jawline and lower face.
• Triggers: Puberty, stress, polycystic ovary syndrome (PCOS), or hormonal medications can increase androgen activity.

Excess androgens are one of the most significant contributors to persistent acne in both men and women, often necessitating medical treatment such as anti-androgen therapy or hormonal regulation to control breakouts effectively.

Estrogen

Estrogen plays a protective role in skin health by regulating sebum production and maintaining skin hydration.

• Function: Maintains skin balance and regulates oil secretion.
• Effect on Skin: Low estrogen levels, especially during the premenstrual phase, menopause, or postpartum, can disrupt this balance and trigger acne flare-ups.
• Symptoms: Breakouts that appear cyclically, often before menstruation or during menopausal transitions.

A decline in estrogen removes the inhibitory effect on sebum production, allowing androgen activity to dominate, resulting in increased oiliness, inflammation, and acne lesions.

Progesterone

Progesterone works alongside estrogen to balance hormonal activity in the body.

• Function: Modulates estrogen and testosterone levels and influences oil production.
• Effect on Skin: Fluctuating progesterone levels, particularly in the luteal phase of the menstrual cycle, can lead to increased sebum secretion and inflammatory responses in the skin.
• Symptoms: Pimples that appear cyclically before menstruation or during times of hormonal imbalance.

Progesterone-driven acne is often subtle but can worsen when combined with high androgen activity, emphasizing the need for hormonal monitoring in treatment planning.

Cortisol

Cortisol, commonly known as the stress hormone, has systemic effects that influence acne development.

• Function: Regulates metabolic processes and stress response.
• Effect on Skin: Elevated cortisol levels during chronic stress stimulate sebum production and increase inflammatory responses, worsening acne severity.
• Symptoms: Acne flare-ups during periods of stress, poor sleep, or high-pressure situations.

Managing stress through mindfulness, meditation, adequate sleep, and exercise can significantly reduce cortisol-induced acne, complementing medical and skincare interventions.

Insulin and IGF-1 (Insulin-like Growth Factor-1)

Insulin and IGF-1 influence acne indirectly by affecting androgen levels and sebum production.

• Function: Regulate blood sugar, metabolism, and growth processes.
• Effect on Skin: High insulin and IGF-1 levels, often linked to high-glycemic diets or insulin resistance, stimulate androgen production, increasing sebum and the likelihood of acne formation.
• Symptoms: Acne associated with hormonal imbalance, particularly in individuals consuming excessive sugar or processed carbohydrates.

Dietary modifications that stabilize insulin levels—such as reducing sugar, refined carbs, and dairy—can help manage hormonal acne, especially when combined with topical or oral treatments.

Recognizing Patterns of Hormonal Acne

Hormonal acne often presents in distinctive patterns compared to other acne types:

• Location: Lower face, jawline, chin, and sometimes the neck.
• Appearance: Deep, cystic, or inflamed pimples that may be painful to touch.
• Timing: Frequently appears cyclically, coinciding with hormonal fluctuations in the menstrual cycle, pregnancy, or menopause.
• Persistence: Often resistant to over-the-counter treatments and requires a combination of targeted therapy and lifestyle adjustments.

By identifying these patterns, individuals and dermatologists can develop a comprehensive treatment plan tailored to the specific hormonal influences affecting the skin.

Treatment Considerations for Hormonal Acne

Effective management of hormonal acne requires a multi-faceted approach:

• Topical Treatments: Retinoids, benzoyl peroxide, or topical antibiotics to reduce inflammation and prevent clogged pores.
• Oral Medications: Hormonal therapies such as oral contraceptives, anti-androgen medications (e.g., spironolactone), or isotretinoin for severe cases.
• Lifestyle Adjustments: Balanced diet, adequate sleep, stress management, and regular exercise to support hormonal balance.
• Natural Remedies: Aloe vera, tea tree oil, and green tea extracts can complement medical treatments by reducing inflammation and promoting skin healing.

Monitoring hormonal levels through blood tests or consultations with an endocrinologist can help identify underlying imbalances contributing to acne, ensuring that treatment addresses the root cause rather than just the symptoms.

Signs of Hormonal Acne

Hormonal acne presents differently from typical acne due to its internal triggers rather than just external factors. One of the most noticeable signs is breakouts concentrated on the lower face, jawline, chin, and sometimes the neck, often forming deep, painful cystic lesions. These breakouts tend to follow a cyclical pattern, especially in women, aligning with the menstrual cycle. Hormonal acne is typically resistant to over-the-counter treatments, including common cleansers and topical gels, requiring more targeted therapies to manage effectively.

Other distinguishing features include oily skin and, in some cases, hirsutism or excess hair growth, particularly in individuals with underlying hormonal imbalances such as polycystic ovary syndrome (PCOS). These symptoms often indicate that acne is influenced by internal hormonal fluctuations rather than lifestyle or hygiene alone. Recognizing these signs early can help in choosing appropriate treatments, minimizing scarring, and improving overall skin health.

Causes and Triggers of Hormonal Acne

Hormonal acne is primarily caused by fluctuations in hormone levels that affect sebum production, skin inflammation, and pore blockage. Understanding the root causes helps in both prevention and treatment. Common triggers include:

• Puberty: During adolescence, androgen hormones surge, stimulating sebaceous glands to produce more sebum. This increase in oil contributes to clogged pores, making teens particularly susceptible to hormonal acne.
• Menstrual Cycle: In women, cyclical hormonal changes cause premenstrual acne flare-ups. The drop in estrogen and progesterone levels just before menstruation allows androgens to dominate, increasing oil production and inflammation.
• Pregnancy: Fluctuations in progesterone and estrogen levels during pregnancy can trigger acne in some women, even if they previously had clear skin. Hormonal shifts can result in new breakouts or worsen preexisting acne.
• Polycystic Ovary Syndrome (PCOS): Women with PCOS often have elevated androgen levels, leading to persistent and severe acne that is commonly concentrated on the jawline and lower face. PCOS-related acne can be resistant to conventional treatments without hormonal management.
• Menopause: Declining estrogen and progesterone levels during menopause can affect skin oiliness, barrier function, and inflammation, sometimes causing adult-onset acne.
• Stress: High levels of cortisol, the stress hormone, stimulate sebaceous glands, increase inflammation, and slow skin healing, aggravating hormonal acne.
• Diet: Diets high in sugar, dairy, and refined carbohydrates can increase insulin and insulin-like growth factor-1 (IGF-1), which in turn stimulates androgen activity, promoting oil production and acne formation.

Additional factors such as genetics, sleep deprivation, and environmental influences (pollution, heat, or harsh skincare products) may also exacerbate hormonal acne. By identifying and mitigating these triggers, individuals can reduce flare-ups and complement medical or topical treatments more effectively.

Lifestyle and Home Remedies for Hormonal Acne

Managing hormonal acne effectively requires not only medical treatments but also lifestyle modifications and home-based remedies that address underlying triggers such as diet, stress, and skincare habits.

Balanced Diet

Nutrition plays a critical role in regulating hormones and reducing acne flare-ups. A diet rich in leafy greens, colorful fruits, lean proteins, and healthy fats supports hormonal balance and promotes skin health. Antioxidants and omega-3 fatty acids help reduce inflammation, while fiber-rich foods stabilize blood sugar and insulin levels. Conversely, high-glycemic foods, sugary snacks, and excessive dairy consumption can elevate insulin and insulin-like growth factor-1 (IGF-1), stimulating androgen production and increasing sebum, which may worsen acne. Gradual dietary changes, such as replacing refined carbohydrates with whole grains and limiting processed foods, can have a significant impact on hormonal acne over time.

Stress Management

Stress is a major trigger for hormonal acne due to its effect on cortisol levels and sebaceous gland activity. Integrating stress-reduction practices into daily life can help minimize breakouts. Techniques such as meditation, yoga, deep breathing exercises, and mindfulness can reduce cortisol levels, calm inflammation, and improve skin healing. Ensuring adequate sleep is equally important, as poor sleep disrupts hormone balance and increases susceptibility to acne flare-ups. Establishing consistent sleep schedules and incorporating relaxation routines before bedtime contribute to long-term skin health.

Gentle Skincare Routine

A proper skincare routine tailored for hormonal acne can prevent clogged pores and reduce irritation. Cleanse the skin twice daily with gentle, non-comedogenic products to remove excess oil, dirt, and impurities without over-drying. Exfoliation using ingredients like salicylic acid or benzoyl peroxide helps unclog pores and control inflammation. Moisturizing with lightweight, oil-free creams maintains the skin barrier and prevents excessive dryness. Daily application of broad-spectrum sunscreen is essential to protect skin from UV damage, which can worsen post-inflammatory hyperpigmentation caused by acne. Avoiding harsh scrubs, hot water, and irritating skincare products is key to minimizing flare-ups.

Home Remedies

Several natural remedies can complement lifestyle adjustments for hormonal acne. Tea tree oil, when diluted, acts as a potent antibacterial spot treatment that can reduce inflammation and prevent bacterial colonization in clogged pores. Aloe vera gel soothes irritated skin, promotes healing, and reduces redness. Green tea extract offers anti-inflammatory and antioxidant properties, helping to reduce sebum production and oxidative stress. Combining these remedies with a consistent skincare routine enhances their effectiveness and supports long-term skin health.

Medical Treatments for Hormonal Acne

For persistent or severe hormonal acne, medical interventions may be necessary. Dermatologists can prescribe treatments that regulate hormone levels, reduce inflammation, and target acne-causing bacteria.

Oral Contraceptives

Combination oral contraceptives that include estrogen and progesterone help regulate hormonal fluctuations in women, thereby reducing androgen activity that drives excess sebum production. They are particularly effective for women who experience cyclical acne related to the menstrual cycle. Benefits may take a few months to appear, and close monitoring by a healthcare provider is recommended.

Anti-Androgen Medications (Spironolactone)

Spironolactone works by blocking androgen receptors, reducing the effect of male hormones on sebaceous glands. This medication is effective in women and adolescent girls with persistent hormonal acne unresponsive to conventional therapies. Side effects may include changes in menstrual cycles or breast tenderness, so medical supervision is essential.

Topical Retinoids

Topical retinoids, derived from vitamin A, increase skin cell turnover and prevent clogged pores. They also improve skin texture and reduce post-inflammatory hyperpigmentation. Common retinoids include tretinoin, adapalene, and tazarotene. Regular use as prescribed can significantly reduce the frequency and severity of hormonal acne lesions.

Oral or Topical Antibiotics

Antibiotics help control bacterial growth and reduce inflammation, particularly in cases where acne is inflamed or cystic. Combining topical antibiotics with retinoids or benzoyl peroxide is often recommended to prevent antibiotic resistance. Oral antibiotics, such as tetracyclines, are used for moderate to severe cases under professional supervision.

Hormone Therapy

For women with PCOS or menopause-related acne, hormone therapy may be required to correct underlying imbalances. This can include anti-androgens, estrogen therapy, or other hormonal interventions tailored to the individual's needs. These treatments aim to regulate hormone levels, reduce sebum production, and improve long-term skin health.

By integrating lifestyle modifications, home remedies, and professional medical treatments, individuals with hormonal acne can achieve clearer skin, reduce inflammation, and prevent scarring. Consistency, patience, and close monitoring of triggers are essential for long-term success.

Prevention Tips for Hormonal Acne

Preventing hormonal acne requires a multi-faceted approach that combines proper skincare, lifestyle management, dietary considerations, and medical guidance. A consistent and strategic routine can help reduce flare-ups, improve skin health, and prevent long-term damage.

Maintain a Consistent Skincare Routine

Consistency is crucial in managing hormonal acne. Cleanse your face twice daily with gentle, non-comedogenic cleansers to remove excess oil, dirt, and makeup without stripping your skin. Incorporate exfoliating agents like salicylic acid or glycolic acid 1–2 times per week to prevent clogged pores and promote healthy cell turnover. Moisturize daily using lightweight, oil-free products to maintain the skin barrier and prevent overproduction of sebum. Applying broad-spectrum sunscreen with SPF 30+ helps protect skin from UV damage, which can worsen post-inflammatory hyperpigmentation.

Avoid Over-Washing or Harsh Scrubs

Excessive washing, abrasive scrubbing, or the use of harsh products can irritate the skin and exacerbate hormonal acne. Gentle cleansing removes impurities without triggering inflammation or increasing sebum production. Avoid aggressive treatments that strip the skin of natural oils, as this can lead to rebound oiliness and worsening acne. Instead, focus on mild, targeted products designed for sensitive or acne-prone skin.

Use Non-Comedogenic Cosmetics

Cosmetics and skincare products can contribute to pore blockage if they are comedogenic. Selecting non-comedogenic makeup, moisturizers, and sunscreen ensures that pores remain clear. Properly removing makeup at the end of the day is equally important to prevent trapped oils and bacterial growth that can worsen breakouts. Regularly cleaning brushes, sponges, and applicators also helps reduce contamination and acne risk.

Manage Stress and Prioritize Sleep

Stress significantly influences hormonal acne due to its effect on cortisol production, which can increase sebum and inflammation. Implementing stress management techniques such as meditation, yoga, deep breathing, or journaling can help lower cortisol levels and minimize flare-ups. Additionally, getting 7–9 hours of quality sleep per night supports hormonal balance, skin repair, and immune function, which are essential for acne prevention.

Monitor Diet and Avoid High-Sugar, High-Dairy Foods

Dietary factors can influence hormonal acne, particularly foods that raise insulin and IGF-1 levels. Limiting high-glycemic foods, refined sugars, and excessive dairy can help reduce androgen stimulation and sebum overproduction. Incorporate antioxidant-rich fruits and vegetables, lean proteins, whole grains, and healthy fats like omega-3s to reduce inflammation and support skin health. Staying hydrated by drinking sufficient water daily is also essential for maintaining healthy skin function.

Seek Medical Advice if Acne Persists or Worsens

Even with careful prevention, some cases of hormonal acne may require medical intervention. Consulting a dermatologist or healthcare provider ensures access to treatments like oral contraceptives, anti-androgen medications (e.g., spironolactone), topical retinoids, or antibiotics, which can address the underlying hormonal imbalances. Early intervention prevents worsening of acne, reduces the risk of scarring, and provides tailored strategies based on your skin type, hormone profile, and acne severity.

Managing Hormonal Acne

Hormonal acne is complex but highly manageable when addressed through a combination of lifestyle changes, proper skincare, natural remedies, and medical interventions. By understanding which hormones—such as androgens, estrogen, progesterone, cortisol, insulin, and IGF-1—trigger acne, you can target underlying causes rather than just treating surface symptoms.

A comprehensive approach allows you to:

• Reduce severity and frequency of breakouts by balancing hormone levels and controlling triggers.
• Achieve clearer, healthier skin through consistent skincare, non-comedogenic products, and sun protection.
• Prevent scarring and long-term skin damage by treating acne early and avoiding aggressive picking or irritation.
• Support overall skin health through a balanced diet, adequate hydration, and stress management.

Consistency, awareness of triggers, and professional guidance are the cornerstones of effective hormonal acne management. Combining preventive measures, home remedies, and medical treatments ensures long-term control over breakouts, promotes skin regeneration, and maintains confidence in your appearance.

By following these strategies, individuals with hormonal acne can achieve lasting improvements, minimize flare-ups, and enjoy healthier, clearer, and more resilient skin at any age.