Hormonal Acne: How Hormones Affect The Skin

By Seppo | Cause

17

Getting diagnosed with a cancer is perhaps one of the most horrifying things. Often it means you are going to die slowly and there’s not much you can do about it. Similarly hearing a doctor describe your acne as hormonal can feel equally bad. Why? Because hormonal acne is often seen as something that’s out of your control.

But just because your acne is hormonal doesn’t mean it’s out of your control. Because acne formation relies heavily on two hormones: insulin and insulin like growth factor 1 (IGF-1), both of which depend heavily on what you eat. Similarly prudent application of topical treatments can mitigate the damage androgens do to your skin.

I hope that after reading this post you’ll understand the role hormones play in your acne, and what you can do about it.

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Acne formation process and the role of hormones

To understand the role hormones play let’s briefly walk through the acne formation process. I’ll point out which steps are affected by hormones and which are not.

Excessive sebum production is perhaps the key characteristic of acne. Sebum production in the skin is handled by cells known as sebocytes. They are a bit like water balloons in that they gobble fatty acids and grow bigger and bigger. Once they mature they make their way into the hair canal where they burst and spill the sebum. Hormones stimulate the growth of sebocytes and thus sebum production.

Blockage of the hair canal (follicle) by dead skin cells is another key characteristic of acne. Cells known as keratinocytes are the most common cells in the outer layer of the skin. They form the walls of the hair canal. In a healthy skin they die and separate and are pushed out of the skin by the growing hair. In an acne-prone skin this process goes haywire for two reasons.

  • Excess growth of skin cells.
  • Condition known as hyperkeratinization. Keratin is a protein that binds these cells together, and when you have too much of keratin the bonds between the cells are stronger. So when the cells die they are more likely to stick together and block the hair canal.

There’s a good reason to believe hormones affect both of those. It’s known that hormones accelerate the growth of skin cells (thus more dead skin cells to eliminate), and researchers suspect that hormones up-regulate keratin levels (and thus hinder separation of dead skin cells).

Once the hair canal is blocked by a sticky mixture of sebum and dead skin cells it starts to swell as more and more dead skin cells are pushed into the area. Oxygen levels plummet at the blocked pore, and this creates an ideal environment for P. Acnes bacteria to thrive.

Inflammation results as the immune system attacks the bacteria in the blocked pore. Acne patients have markedly stronger inflammatory response to P. Acnes bacteria than people with healthy skin. There’s good reason to believe this is regulated by hormones, especially in men.

To summarize, hormones affect all the primary causes of acne: sebum production, skin cell growth and separation and inflammation.

The culprits: Insulin, IGF-1 and androgens

Now that we understand how hormones affect acne, let’s see which hormones are to blame. This discussion could get very complicated very quickly, as different hormones have somewhat different effects on different cell types in the skin. But we don’t have to worry about what. So, in the interest of keeping things simple we can say that the primary hormones behind acne are:

  • Insulin is a storage hormone (among other things). It takes glucose (sugar) and amino acids (protein) from bloodstream to the cells. Eating carbohydrates and protein (to lesser extent) will cause insulin levels to increase.
  • Insulin like growth factor 1 (IGF-1) is a growth hormones. It often goes hand in hand with insulin, so anytime insulin increases so does IGF-1.
  • Androgens are male sex hormones, of which testosterone is the best known. Other acne-relevant hormones are dihydrotestosterone (DHT) and dehydroepiandrosterone (DHEAS).

Let’s review what these hormones do.

Insulin and IGF-1

While these are separate hormones I’ll clump them together as they go hand-in-hand. Studies have repeatedly shown a connection between acne and IGF-1 levels. There are also studies that show higher rates of insulin resistance in acne patients as compared to people with healthy skin. Insulin resistance means the cells don’t respond to insulin and the pancreas has to pump out more to compensate. And more insulin of course also means more IGF-1.

Here’s how these hormones affect the skin:

  • IGF-1 stimulates the growth of sebocytes and thus increases sebum production. One study demonstrated correlation between IGF-1 levels and facial sebum production.
  • Make skin cells grow faster
  • Stimulate the synthesis of androgens in the testes and ovaries
  • Make the skin more sensitive to androgens

So while insulin and IGF-1 act on the skin directly their primary effect on acne comes from the fact that they multiply the effect of androgens.

Androgens

Acne belongs to the group of hyperandrogenic diseases, which means conditions characterized by excessive production of androgens. Other such conditions are polycystic ovary syndrome and male pattern baldness, and that’s why they can appear together with acne.

Here’s how androgens directly affect acne:

  • Increase sebum production, much like IGF-1 does
  • Stimulate the growth of skin cells
  • Hinders separation of dead skin cells
  • Increase inflammation. Testosterone and DHT up-regulate inflammatory response to injury. This not only makes the pimple bigger and more painful but also slows down healing of the wound.

Androgens may affect acne also indirectly by weakening the skin barrier function. Healthy skin barrier retains moisture and prevents entry for bacteria and other pathogens. And weaker skin barrier function makes the skin just that much more prone to acne.

Studies have shown that acne-prone skin has markedly weaker skin barrier function than healthy skin, and it’s likely androgens play a role in this. Interestingly topical application of caffeine can correct this, and that’s probably the reason Exposed Skin Care includes caffeine in their products.

Multiplier effect: conversion of testosterone to DHT

The human skin is not just a passive organ. It actively processes and creates hormones. One example of this is the conversion of testosterone to DHT, which is up to 10 times more potent testosterone.

An enzyme called 5-alpha reductase is responsible for this conversion. Here comes yet another difference between acne-prone and healthy skin. In acne-prone this enzyme is much more active. IGF-1 further stimulates this conversion and makes a bad situation even worse.

Luckily there are substances known as 5-aplha reductase inhibitors. They inhibit the conversion and reduce sebum production. Green tea is an example of such substance, and that’s why one study showed 70% reduction in sebum production after applying green tea cream. See the green tea and acne page for more details.

Summary so far

Acne is a primarily androgen-mediated condition, but IGF-1 acts as an accelerant in this process. And while there’s not so much you can do to affect androgen levels, you can control hormonal acne by maintaining stable insulin and IGF-1 levels.

Genes

Studies measuring the levels of these acne-causing hormones have found similar levels between acne patients and those with healthy skin. So it’s not the absolute levels of these hormones that cause acne, but how acne-prone skin reacts to them. One example is the increased conversion of testosterone to DHT.

And this is where genes come into play. Because of genetic factors acne patients are deficient in nuclear transcription factor FoxO1. Sebum production and skin cell growth are out of control in acne patients. FoxO1 acts like a break to these processes, and it’s malfunctioning. It reduces sensitivity to androgens by suppressing androgen receptors and regulates cell growth and inflammation. Thus there’s a good reason to believe that the less FoxO1 is present in the skin the more prone to acne it is.

Insulin and IGF-1 can make the situation even worse by further reducing FoxO1 levels.

For more information, please see the genes and acne page.

Diet and hormonal acne

What you eat can show up on your skin, and one way this happens is through hormones. Studies link acne to Western-style diets (high in sugar and calories), and given what we know this is not a surprise. Eating sugar and refined carbohydrates causes the pancreas to release large amounts of insulin and IGF-1. Over time this type of diet leads to insulin resistance and chronically high levels of these acne-causing hormones.

Eating minimally processed low glycemic index foods can reverse the situation, and this has been now demonstrated in several studies.

But it’s not only sugar that gives you pimples; dairy products are also to blame. What’s the role of milk? To help baby cows grow. So it’s not a surprise milk has plenty of IGF-1 and other growth hormones. These hormones make their way into your blood and eventually to your skin where they stimulate sebum production and skin cell growth.

Summary and take-home messages

  • Hormones affect all the steps in the acne formation process. They increase sebum production and skin cell growth, hinder separation of dead skin cells and increase inflammation.
  • The hormones responsible are: insulin, insulin like growth factor 1 (IGF-1) and androgens.
  • Androgens have a more profound effect on the skin whereas insulin and IGF-1 multiply the damage androgens cause.
  • Acne patients may have higher levels of these hormones but that’s not always the case.
  • Genes make acne-prone skin more sensitive to these hormones.
  • There’s not much you can do about androgen levels, but you can control insulin and IGF-1 levels with proper dietary and lifestyle choices, and that’s the key to controlling hormonal acne.
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About the Author

Seppo Puusa, a.k.a. AcneEinstein shares rational advice about natural and alternative acne treatments. Read more about me and my acne struggles at the page.

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(17) comments

David L May 11, 2013

Im not sure what type of acne I have, I just know I have acne. Thing is, that my acne doesnt seem to be the regular acne filled with pus. Its like some little balls filled with a more solid content that float deepinside my skin and dont come out to the surface. This results in me trying to get the content out but nothin will come out. Not the wisest thing to do but just to inform you about the kind of acne I have. I dont have too much pus filled acne. I dont know if you will be able to answer this question as you are more of an expert in what happens inside our bodies and not the external appearance of the skin. These balls of solid like content, will fade in a few days and hide back inside my skin (not without leaving a scar) but they do come back. If you cant diagnose and digest any of this information, than you anyways.

Reply
    Seppo May 16, 2013

    I’m sorry but I can’t say much about this. This is the sort of stuff you have to talk with a dermatologists as they are much more skilled at diagnosing problems than I am.

    Reply
ISha January 16, 2014

Hi Seppo ,
I am Indian with very fair complexion .since i came to other state for job my acne got started.before nothing was there that time i was 25th when it happend first .I am suffering this problem from last 2 years. I will take medicine treatment it will go if i ll stop then after 1 ,2 months acne will start again So few days back i have done couple of tests regarding my acne problem In report all hormones was fine but my(after meal) insulin was high.so can u pls suggest me what should i do to get rid of this very big problem .I am very much hopeless now .pls Seppo do some favour to guide me .
Thanks

Reply
    Seppo January 19, 2014

    Studies on hormone levels in women with acne show that the hormones related to acne can still be within normal ranges but are still higher than in women without acne. It’s possible to have hormone-related acne without overt abnormalities in hormone levels. A part of the equation is the fact that acne-prone skin is more sensitive to those hormones.

    Insulin can make things worse and it increases the sensitivity of skin to androgen hormones. It can also trigger the release of androgens from the ovaries. That’s why I talk a lot about keeping insulin levels stable.

    Exercise and restricting carbohydrate intake (you don’t need to go as far as low carb diet for this) are one of the best ways to reduce insulin and blood sugar levels. I recommend that carbs make up for 30 – 40% of your total energy intake.

    In the herbs for hormonal acne post I talked about some herbal remedies that can help hormonal acne. You can also talk to your doctor about trying Metformin, which is a diabetes drug. There are some studies on Metformin in acne patients, but these are done in patients with acne and PCOS. Metformin seems exceptionally safe anyway, so it might be worth talking to your doctor about it.

    Reply
Roberto Gonzalez March 15, 2014

I have noticed that recently (2 weeks), when I have started to juice leafy greens every few times weekly; 60% Greens 40% Fruit (Quart size 2-3x/week) my jawline acne tends to subside, I have noticed this and now taking note. Sadly, I am left with the hyper-pigmentation and red marks and a few indented scarring from it. The key to ultimate face healing is complete shut down of acne and it’s not so easy and I guess I am close? BUT I am glad I purchased membership with you and hope to one day get their. I’m also 19 so I have high hopes of my hormones calming calming down completely, thus rarely/never having to break out again. Is that possible? What’s your input on that?

I have also added this past week a 60 day supply of Vibrant Health Greens w/ Probiotics and ‘vegan’ D3..http://www.amazon.com/gp/product/B000NDME6C/ref=oh_details_o00_s00_i00?ie=UTF8&psc=1

What do you think?

Also, do you have any articles regarding Retin A, Initial Purging/Assimilation breakouts and or Led Topicals?

Offtopic: Check this out – http://goldengoddess.info/pdf/green.pdf – regarding green and and Red Light Therapy or LEDs. Seems promising!

Reply
    Seppo March 17, 2014

    Glad to hear that your skin is doing better. I haven’t talked about juicing in my book since it’s one of those things that could help but I can’t really say for sure. And I do my best to keep the advice as simple as possible, I don’t want to complicate your life too any more than is absolutely necessary. If juicing works, I think it’s because is supplies the body with plenty of antioxidants and nutrients. Nobody has ever studied the effect of eating vegetables on acne, but there are hints in the research that anti-inflammatory diet and supplements are helpful.

    I can’t comment much on the green powder, for the above mentioned reasons. It could help but I wouldn’t be too surprised if it didn’t.

    Can you still grow out of acne? Yes, it’s not uncommon for people to have ‘teen acne’ at your age. But nobody can say for sure whether you grow out of it or not.

    I don’t have anything on Retin A, I prefer to leave those discussions to dermatologists. As to the initial purging reaction, there’s really no such things as a ‘purging reaction’. Your skin doesn’t need to purge or get rid of anything. Though it’s common for the skin to go through an adjustment period when you change your skincare routine. And this is what people call as the purging reaction, but it’s misleading to call it purging.

    Thanks for linking to the PDF regarding the combined effect of green tea and red light therapy. It seems quite promising and along the lines in what I’ve seen in other papers. I have yet to look into light therapies, but different topical antioxidant treatments have been shown to reduce the signs of aging.

    Reply
Brian June 8, 2014

Very interesting post, as always. Could you please point towards the study that linked IGF-1 with increased skin sensitivity to androgens? Thanks.

Reply
    Seppo Puusa June 10, 2014

    I remember a cell culture study that showed both insulin and IGF-1 increase androgen sensitivity in skin cells, but I can’t for the life of me find it now. However, you can take a look at these two papers:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3408989/

    The relevant bit is under the subtitle: Signaling of Puberty Superimposed by Signaling of Western Diet

    And here’s a cell culture study that shows IGF-1 greatly increases 5-AR enzyme activity in skin cells, meaning greater conversion of testosterone to more potent DHT.

    http://www.ncbi.nlm.nih.gov/pubmed/8344190/

    While not completely relevant to your question, here’s another paper that showed acne does not exists in people with IGF-1 deficiency and that interaction between androgens and IGF-1 is required for acne.

    http://www.ncbi.nlm.nih.gov/pubmed/21054577

    Reply
Robert Taylor July 2, 2014

Hi Seppo, I have a question that probably can’t be totally answered but I had a weird reaction to something I probably ate that made me breakout like never before. I’ve mentioned before to you about being cautious about what to eat to gain weight and being careful not to eat anything with too many carbs or sugar to avoid skin problems. Last week for 3 or 4 days, to get more calories in me, I was snacking with some Triscuit Crackers and with the main ingredients of Long Grain Brown Rice, Whole Grain Soft White Wheat, Soybean Oil, and some other less important ingredients. By the way, I am not allergic to wheat. I had some organic jack cheese along with the crackers. In the same days I started drinking daily an 8oz. Ensure Plus nutrition shake which has 350 calories which contains 0 grams of fiber, 20 grams of sugar, 11 grams of fat, 50 grams of carbs,The fat mostly comes from Canola Oil and Corn Oil (4.5grams of PUF and 5 grams of MUF. My question is if you broke out like never before after consuming these things which one or ones would you suspect caused the bad breakouts? My guess is since I don’t recall ever having bad acne when having some cheese and crackers in the past it would have been the Ensure drink because of its no fiber-high sugar content along with the vegetable oils. Would this be a good guess in your opinion? Needless to say I stopped eating/drinking these things and am trying to come up with a better way to get more calories without affecting my skin.

Reply
    Seppo Puusa July 6, 2014

    I’m sorry but there’s really no way for me to give a meaningful answer to this question. One possibility is you are eating too many omega-6 PUFAs and perhaps not enough omega-3 fats. The whole omega-3:6 balance and how it affects health is very controversial and by no means settled. I have heard from some people who swear that eating too much omega-6 fats causes acne for them. So perhaps that’s something you can look into.

    Reply
Robert Taylor July 6, 2014

I do realize it was sort of a dumb question but I think what gave me a breakout was more than likely the Ensure product which really is pretty much like drinking pure glucose! Anyway, thanks Seppo.

Reply
    Seppo Puusa July 7, 2014

    There are no stupid questions :) There are just to what we know and can say with any degree of certainty. Yes, the Ensure shake is certainly a possibility. It looks like a mixture of sugar and high omega-6 vegetable oils. More or less the two worst foods to eat. Amazed it’s even legal to sell that, lol.

    Reply
Linda Moen July 8, 2014

Hi seppo, i am a 27 year old woman from norway, i have had acne since my teens but once i hit my 20s they were localised in different areas of my face, mostly chin and around mouth. I started tanning as i heard it could help, but it did not. Made my acne worse and now its also on my cheeks, my forhead is mostly clear. What do you think about supplements like saw palmetto to stop the conversion from testosterone to dht?

Reply
    Leili August 10, 2014

    I’ve tríed saw palmetto before and I’m a male I took a course of these for month but they never lowered the oil coming out of my sebaceous glands. I’d say don’t bother but you should try, it didn’t work for me though.

    Reply
Esther October 9, 2014

I’m really interested in reversing androgen sensitivity. My acne has finally cleared up when I started washing my face with just water, eating more fat (low GI foods) etc. But I still deal with excess hair (although I can see it’s reduced, or at least stopped getting worse). I feel like I’m on the right track, like I indeed did build a stronger skin barrier?

Reply
    Seppo Puusa October 13, 2014

    Glad to hear you are doing better Esther. I think the key in your case is to maintain moderate carb intake (aim to get 20 to 30% of your calories from carbs) and emphasize low GI carbs. It’s also a good idea to avoid dairy and dairy-based protein powders. Green tea could also help.

    I don’t think your improvements have really anything to do with skin barrier. Reducing insulin reduces androgen levels and thus there’s less ‘pressure’ on your skin. This most likely would also lead to stronger skin barrier.

    Reply
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