Female hormonal acne is perhaps the most common form of adult acne. Doctors commonly prescribe birth control pills or anti-androgen drugs to help with hormonal acne.
Wary of side-effects or just want to avoid ‘messing up with hormones’, many women prefer to avoid prescription drugs and look for natural solutions. The net is of course full of ‘information’ and treatment options, but science shows that many of these touted solutions just don’t work.
In this post I’ll go over several herbs touted as solutions to female hormonal acne, and we’ll see if there’s any merit to the claims. I’ll show you one herbs that puts prescription drugs to shame (and I bet you haven’t heard of it before), a few that can work, and a long list that are better to be avoided.[am4show have=’p6;p7;’ guest_error=’guest’ user_error=’member’ ]
Insulin lowering herbs
Women with problems relating to excess male sex hormones (polycystic ovary syndrome (PCOS), hirsutism, acne) are often insulin resistant. Insulin resistant cells don’t respond to insulin well and the pancreas has to pump out extra insulin to compensate. Insulin stimulates the release of androgen hormones from the ovaries and increases their bioavailability, meaning high insulin level usually pumps up androgens to abnormally high levels.
Several studies have shown that treating these women with insulin lowering drugs improves hormonal profile and symptoms, including acne.
Studies have shown that berberine and cinnamon can be helpful in managing blood sugar and insulin levels.
Berberine is a substance found in Oregon grapes, Barberry and some Chinese plants. It’s used as treatment for diabetes in Traditional Chinese Medicine. Over the past decade scientific studies have shown that it can be as effective as prescription drugs in treating diabetes and blood sugar problems. It also has antibiotic and anti-fungal properties.
Earlier, I wrote about a study that showed almost 50% reduction in acne following Barberry supplementation.
In recent years two studies have tested the effect of berberine on PCOS patients, one in 2012 and another one in 2013. Why are we talking about PCOS studies? Because there are no studies with acne patients and, because both share similar hormonal disturbances, PCOS can serve as ‘proxy syndrome’ for hormonal acne – the things that help with PCOS are also likely to help with hormonal acne.
Yuan et al. gave 150 women with PCOS either berberine, metformin (a prescription drug for diabetes) or placebo.
I plotted the results into the graph below. The figures refer to improvements over baseline, i.e. beginning of the study.
Fasting blood sugar and insulin readings refer to levels after 12-hour fast, more or less what you would have first thing in the morning. Free androgen index is an estimate of free (or bioavailable) testosterone level and total testosterone refers to, well, total amount of testosterone. Most testosterone is bound to sex hormone binding globulin (SHBG) and is thus not active (or bioavailable).
Both insulin and bioavailable testosterone levels dropped by 50% from their levels before the study. This should have a big impact on acne. The women in this study had BMI of 24, which falls to the upper range of normal.
Wei et al. did a similar study in 2012. There were some confounding factors in that study, so I won’t talk about it here. I’ll just say that berberine worked just as well as metformin.
Other studies have shown berberine can be just as effective as metformin in diabetic patients in reducing blood sugar and insulin levels.
The subjects in both of these studies were insulin resistant. Many women who struggle with hormonal acne also have some degree of insulin resistance but probably not everyone. Berberine is likely to reduce your acne if you are insulin resistant.
The picture is quite not so clear for women who are not insulin resistant. Studies on metformin on PCOS patients often show improvements in androgen levels even in women who are not insulin resistant. Tan et al. also showed that metformin reduced acne also in non-insulin resistant women with PCOS. Most studies have shown berberine to be equal to metformin, so I see no reason why treatment with berberine wouldn’t get similar results.
According to WebMD, you should avoid berberine if you take cyclosporine (immunosuppressant), please see other warnings at WebMD.
Practitioners of alternative health methods often claim that cinnamon can help to regulate blood sugar levels and treat diabetes. There, indeed, is some evidence to suggest this could be true.
Wang et al. tested the effect of cinnamon on 15 women with PCOS. The participants received 1g of cinnamon for 8 weeks (or an equivalent amount of placebo capsules).
Results showed a significant reduction in insulin resistance in the cinnamon treated group, with no change in the placebo group. In fact, insulin sensitivity completely normalised in the cinnamon-group. Despite improvements in insulin levels, there were no changes in any of the other hormones linked to acne.
Several other studies have also showed that cinnamon can reduce blood sugar and insulin levels. A 2011 systematic review went over 16 studies on the effect of cinnamon on diabetes and concluded the following:
Although some studies with cinnamon did not show any effects, the majority of studies performed did consistently show beneficial effects of cinnamon on multiple parameters, especially decreasing fasting and postprandial glucose levels and improving insulin sensitivity.
So there seems to be reasonably good evidence to show cinnamon can be somewhat helpful in reducing blood sugar and insulin levels, and thus it could also be helpful in acne.
The positive studies used daily doses ranging from 3 to 10g of cinnamon.
Anti-androgens are substances that block or suppress the effect of male sex hormones in the body. Acne is an androgen-dependent skin problem, which explains why anti-androgens, such as birth control pills and spironolactone, work so well.
Research has shown that some herbs have anti-androgenic effects, but there’s very little research on this area and the studies we have are usually of poor quality. Meaning that it’s impossible to make reliable recommendations.
Anyhow, I’ll go over most of the herbs that have some degree of anti-androgenic effects and make brief recommendations concerning supplementation.
Out of all the anti-androgenic herbs I looked at, spearmint looks the most promising.
Grant assigned 42 women with hirsutism to spearmint and chamomile (placebo) tea groups. Both groups were asked to drink 2 cups of tea per day. Both total and bioavailable testosterone dropped in women drinking spearmint tea. The spearmint drinkers also reported that their hirsutism symptoms got better. There were no changes in the chamomile tea group.
Akdoğan et al. gave 12 women with PCOS and 9 with hirsutism a cup of spearmint tea for 5 days. Spearmint tea reduced the amount of bioavailable testosterone but had no effect on total testosterone levels.
While both of these studies show positive results, I would advice to take these result with a grain of salt. Both of these studies were too short and need to be replicated before we can really say whether these effects are real.
On the other hand, spearmint tea is quite delicious and there’s little downside to having a cup or two a day.
Licorice may have some anti-androgenic activity. The active ingredient in liquorice is called glycyrrhetinic acid.
I found 3 studies on the effect of liquorice supplementation on androgen levels in women. 1 study showed a nice reduction in testosterone through 2 menstrual cycles, but another study showed no changes. The last one treated PCOS patients either with spiro or spiro + liquorice. Addition of liquorice didn’t further improve androgen levels but it did reduce side-effects of spiro.
The best we can say is that liquorice may have some anti-androgenic effect, but it’s likely to be quite small and probably doesn’t warrant supplementation.
In earlier posts I covered the antioxidant and insulin lowering effects of green tea. Green tea catechins can inhibit conversion of testosterone to DHT and thus suppress the effect of androgens, however the few studies we have show the effect is modest, at best.
Chan et al. tested the effect of green tea supplements on 34 obese women with PCOS. The supplement delivered 540mg of epigallocatechin gallate (EGCG). After 3 months of supplementation there was no change in androgen or insulin levels.
Wu et al. showed that green tea supplementation improved cholesterol and insulin levels in women with PCOS but had no effect on androgen levels.
Black cohosh is another herb that’s claimed to have anti-androgenic properties, however I couldn’t find any studies that measured the effect of black cohosh on androgens.
Kamel showed that black cohosh supplementation worked just as well as a prescription drug in improving ovulation in women with PCOS. Unfortunately this study didn’t measure androgen levels.
Black cohosh can also improve menopausal symptoms.
Chaste tree (Vitex agnus-castus)
This herb is sometimes called as “the women’s herb” for it’s ability to improve premenstrual symptoms; one study showed it to be as effective as a prescription drug.
It hasn’t been tested on PCOS or hormonal acne, but the Wikipedia page says it could be helpful – whether it actually is, is another question and one we can’t answer yet.
I only mention saw palmetto because it’s hyped online as a powerful anti-androgen. I couldn’t find any research on how it affects sex hormones in women. It may have some effect in men, but more rigorous research is questioning these effects.
At the moment there’s no good human evidence to show saw palmetto has any anti-androgen activity. What we have is a big bunch of test tube and animal studies, but we cannot use those to say what happens in humans.
Conclusions and recommendations
The net is full of ‘information’ and treatments for female hormonal acne. Unfortunately science quite clearly shows that many herbs promoted for hormonal acne have little to no effect.
Evidence shows that berberine should be helpful in most women with hormonal acne.
If you are also insulin resistant (giveaways: abnormally high blood sugar levels after meals, you get acne from sugar, carbohydrates or dairy, you are above normal weight) then cinnamon could also be helpful. If you take berberine, then there’s probably no need to spend additional money on cinnamon supplements. I doubt that combining the two gives much, if any, additional benefit.
The data on anti-androgenic herbs is very limited. Based on currently available evidence, spearmint seems the most promising herb for hormonal acne, so you might consider having 2 to 3 cups of spearmint tea per day.
There are several anecdotal reports claiming chaste tree can reduce hormonal acne, but there’s no scientific data to support or refute these reports. However, both chaste tree and black cohosh have been shown to improve PMS symptoms and ovulation, so it’s plausible they could also help acne.
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