Some bodybuilders face a frustrating dilemma. Going to the gym messes up their skin, something known as bodybuilding acne. Unfortunately for acne-prone people bodybuilding and clear skin can be inherently opposing goals. The more gains you make on one front the more you slip back on the other.
In this post I’ll explain the surprising truth of why bodybuilding causes acne. We’ll also cover some tips on how to maximize your gains without wrecking your face.
Let’s start by looking at the most common explanation for bodybuilding acne, increased testosterone levels as a result of weight lifting.
Hormonal response to bodybuilding as cause of acne?
Contrary to popular perception bodybuilding doesn’t cause big hormonal changes. Weight training session causes short-term increases in testosterone, growth hormone and insulin like growth factor 1 (IGF-1) levels, but levels quickly return back to normal.
In contrast, bodybuilding alone doesn’t seem to cause any long-term changes in hormone levels. For example resting levels of growth hormone are more or less identical in Olympic weight lifters and normal people.
Increased testosterone levels can easily lead to acne. In a study where men were given testosterone as birth control about half developed mild acne (source). Similarly, both men and women with acne show elevated testosterone levels – as compared to those with healthy skin (source). And if you are thinking of taking steroids consider that a German study showed acne occurs in about 50% of people abusing steroids.
Testosterone is especially problematic since the skin converts it to dihydrotestosterone (DHT), a far more acne-stimulating hormone. Studies have shown that the higher T levels lead to higher DHT production and higher risk of acne. In The Ultimate Guide to Hormonal Acne I explained how these hormones lead to acne.
Weight training increases testosterone levels for about 30 minutes, after which the levels return to their pre-training levels. But it’s not at all clear whether weight training causes long-term changes in resting T levels. Some studies show weight lifting increases resting T levels, some show no change.
Very intense weight training, bordering or pushing into overtraining, may increase resting testosterone levels, but levels drop back to normal when training intensity reduces. At least one study showed no drop in resting T levels after stopping weight training for 6 weeks.
So a tentative conclusion from studies is that under normal training load resting testosterone levels remain stable.
And it’s hard to say whether the acute changes after workout make any difference to acne, probably not.
Dehydroepiandrosterone (DHEA) is a testosterone precursor, meaning the body converts it to testosterone. Because of this it’s commonly taken as bodybuilding supplement, but studies show it doesn’t actually improve muscle gain or strength.
Weight training session elevated DHEA levels and they remain elevated for several hours after the workout. This may increase the risk of acne as DHEA is one of the hormones found elevated in acne patients. The skin converts DHEA to testosterone and DHT that increase sebum production and lead to blocked pores and acne.
Insulin like growth factor 1 (IGF-1)
IGF-1 is another hormone bodybuilders are interested in. It’s important in protein synthesis and muscle growth. Animal studies show that blocking IGF-1 results in no protein synthesis (and thus also no muscle growth) after resistance training.
IGF-1 is one of the prominent hormones behind acne. Studies have shown correlation between sebum production and IGF-1 levels. IGF-1 also increases the sensitivity of skin to androgen hormones by increasing the conversion of T to DHT. To put it shortly, the higher your IGF-1 levels the higher the risk of getting acne.
Studies show resistance training has similar effect on IGF-1 than testosterone, short-term increase after workout but little to no long-term effects.
Exercise in general improves insulin sensitivity and reduces insulin and IGF-1 levels, especially in people who are not very fit. For those people weight training is probably good for acne. At least one study showed a drop in IGF-1 levels after 10 weeks or weight training in untrained men.
In summary, weight training alone doesn’t seem to lead to any significant hormonal changes that could lead to acne. It’s plausible that heavy training loads cause short-term hormonal fluctuations that are big enough to cause acne, but I wouldn’t bet my house on it.
Bodybuilding diet and supplements as the culprits?
If weight training itself doesn’t cause acne, then how can we explain increased acne in bodybuilders? I think it comes down to diet and supplements.
In my previous post about whey protein I looked at studies on protein powders. Compared to weight training alone or carbohydrate supplements protein powders increase both acute and resting IGF-1 levels. Whey protein is derived from milk, a food notorious for causing acne.
Much like carbohydrates, protein triggers insulin release from the pancreas. When it comes to acne, insulin is just as bad as IGF-1 as they both stimulate sebum production and increase sensitivity of the skin to androgens. These hormones are cited as the reasons why sugar and simple carbohydrates trigger acne is some people.
Given all this I can definitely see how taking protein powders increases the risk of acne – but dairy and soy-based protein powders are especially bad for acne.
Eat big to grow big. How many times you’ve read that advice on bodybuilding forums and book? And it’s good advice, eating more helps you to grow bigger. Unfortunately it also helps you to get more acne.
Insulin acts as storage hormone and is affected by both protein and carbohydrate intake, as intake goes up so do insulin levels. And IGF-1 levels usually follow insulin levels.
It’s not uncommon for bodybuilders to eat 4000 to 5000 calories per day during bulking phase. Such massive caloric intake causes significantly elevated insulin and IGF-1 levels, which translate into increased sebum production and skin cell growth in acne-prone people.
Simple sugars and pre- and post-workout drinks
Aside from dairy products, studies have also linked sugars, simple carbohydrates and other high GI foods to acne. Glycemic index measures how quickly a food increases blood sugar levels. Sugars and simple carbohydrates that are digested in a snap make their way into the bloodstream within minutes of digestion and thus score high on GI. Complex carbohydrates have much gentler impact on blood sugar levels.
Foods with high GI often stimulate higher insulin and IGF-1 release than low GI foods, and that’s why they cause acne in some people.
Some bodybuilders take pre- and post-workout drinks that are high in simple sugars. The rationale is that this increases insulin and IGF-1 levels and helps to drive more protein into the muscles. As we’ve covered many times already these same hormones also lead to acne.
Muscle building shakes are yet another possible cause for acne. They are often high in calories, protein and simple carbohydrates, and that’s 3 strikes for the skin.
Studies have shown acne patients are under higher inflammatory burden than those with clear skin. While there are no studies linking omega-3:6 balance to acne, too much omega-6 in relation to omega-3 has been speculated to increase inflammation and contribute to many health problems (source). That’s why I err to the side of caution and list omega-3:6 imbalance as one of the factors that contribute to acne.
The problem is that many bodybuilding staple foods, like chicken, meat and eggs, are excessively high in omega-6 fats but low in omega-3. Without omega-3 rich foods to balance this you run the risk of increasing inflammation in the body with its associated health problems (increased risk of acne, heart disease and many other inflammatory health conditions).
One easy way to balance things is to switch to omega-3 eggs, which have far healthier omega-3:6 balance. See my article on omega-3 eggs for more on these eggs and omega-3:6 ratio in general. Fish and sea food is another good source for omega-3 fats.
In summary, diet and supplement practices that increase your risk of acne are protein powders, muscle building shakes (high in carbohydrates, protein and calories), eating excessive calories and sugars and simple carbohydrates with high glycemic index. Imbalanced omega-3:6 ratio increases inflammation in the body and possibly also contributes to acne.
One thing that confuses people about acne is how it doesn’t strike everyone doing the same thing. I’ve lost count of the times somebody tells me about a person who they know who eats nothing but junk and still remains clear.
That’s because genetics determine how likely you are to get acne. Genes don’t cause acne as such, but they make acne-prone skin excessively sensitive to androgen hormones. So that they can trigger acne even at normal levels.
How to clear bodybuilding acne
Let’s switch gears and talk briefly about how to fix bodybuilding induced acne.
Switch to acne-safe protein powder
Dairy and soy-based protein powders are the most likely to cause acne. Consider plant-based, non-soy proteins as a safer alternative.
Take a zinc supplement
Studies have shown zinc works almost as well as oral antibiotics – read more how zinc treats acne here.
Topical DHT blockers
Certain substances can hinder the conversion of T to DHT. When applied to the skin they can reduce sebum production and acne. These include green tea extract and saw palmetto.
Please see the skincare for hormonal acne page for more details and recommendations.
- Solid topical treatment regimen. A good topical treatment regimen can undo lot of the damage genes cause. In addition to normal face wash (don’t use soap on acne-prone skin) you should use morning and evening creams that contain benzoyl peroxide, salicylic acid or tea tree oil. Benzoyl peroxide can be drying and harsh on the skin, so it’s a good idea to follow it up with a soothing moisturizer.
- Don’t over wash. If washing 2 times per day is good then 4 times must be better. Not quite. Washing too often or using too many products on your skin usually does more harm than good. Wash twice a day, and use plain water if you have to clean your face more often than that.
- Mind your diet. Minimize dairy and simple carbohydrates from your diet.
- Switch to omega-3 eggs and include other omega-3 rich foods into your diet.
- Test common acne trigger foods. Gluten, soy, peanuts and citrus fruits are known to trigger acne for some people. It’s worth it to eliminate these from your diet for 2 to 3 weeks to see if they have any effect.
- Balance gains with clear skin. For people prone to acne big gains and clear skin may be inherently opposing goals. Protein powders, mass building shakes and overeating all help you to gain muscle but may also trigger acne. Consider if the boost you get from these is worth the price paid by your skin.
- Prescription drugs. Accutane is a decent option for those with severe acne. The side-effects are generally overhyped and only amount to minor irritations for most people. Oral antibiotics often cause more harm than help.
Bodybuilding triggers acne for some people. One possible mechanism is increased testosterone and hormone levels. Though this is unlikely, as research shows levels return to normal within 30 minutes of the workout. Taking supplements and overeating to increase gains is a far more likely cause. All of these are known to increase insulin and IGF-1 levels, hormones that can stimulate sebum production and cause acne.
The implication is that acne shouldn’t be a problem for recreational bodybuilders eating normal diet. However going beyond that increases your chance of getting acne, and you have to judge whether the boost in gains is worth the risk.