Hormones get a bad rap, especially during puberty. From mood swings to newfound body odor to acne, every uncomfortable thing that happens in our teen years gets blamed on the non-stop raging hormones in our bodies. So when we’re still getting breakouts long after our teen years, it’s easy to believe we should’ve grown out of this skin-irritating phase. But, here’s an unfortunate news flash: Hormones never stop affecting our bodies and skin and hormonal acne doesn’t care how old you are.
According to cosmetic dermatologist Dr. Michele Green, when hormones are out of sync, “they can wreak havoc on our skin.” While that might sound a bit harsh and unforgiving, hormones can also be a really positive thing. “When our hormones are in sync, it creates harmony [without our bodies].” Either way, hormones play a vital role in our bodies, so it’s not so much about the hormones themselves, but the factors that disturb their balance.
For many of us, factors that cause hormonal imbalances like stress, menstruation, and birth control prescriptions are common and cyclical, and often overlap. And dealing with breakouts on top of stress and period cramps is a punishment equal to, well, being sentenced to puberty again. So to get to the bottom of this issue, we talked with experts to breakdown these factors and learn how to better manage them in order to keep hormonal breakouts at bay.
How hormones can affect your skin
To better understand how hormones affect our skin, we first need to talk about “sebaceous glands.” Those two sexy words simply refer to glands and hair follicles within our skin that produce oil, or sebum. These glands have receptors that respond to different hormones. When hormone levels are normal, the glands go about business as usual and help keep our skin healthy, hydrated, and protected. However, a rise in androgens, like testosterone, has been shown to trigger increased sebum production, changes in skin cell activity, inflammation, and bacteria colonization of the hair follicles, all of which can lead to hormonal acne.
Dr. Green further explained that hormonal acne is “caused by changes in estrogen, testosterone, and progesterone levels,” and these fluctuations can all cause “disruptions in the skin’s oil production.” Although testosterone has been identified to have the most direct effect on triggering acne, these fluctuations are what cause the rise in testosterone—so it’s really a group effort. And unfortunately, for us, because hormonal acne is triggered by these internal fluctuations, managing these breakouts requires more than just a topical change of skin-care products. It requires more understanding of the hormones at play and why they’re being disrupted in the first place.
As previously mentioned, familiar factors like stress, birth control, and menstruation can all be a part of that “why.” However, New Jersey-based endocrinologist from Omnicare Medical Grishma Parikh pointed to another common yet uncommonly known factor that could be behind your hormonal acne: Polycystic ovary syndrome. So before moving on to the factors we all know, we wanted to bring more awareness to PCOS.
What is PCOS and how does it affect your skin?
PCOS is a metabolic disorder in which, as Dr. Parikh explains, the “ovaries behave with insulin resistance which leads to overproduction of [androgens], which gets manifested as acne, an increase in facial hair (called hirsutism), and hair loss for some.” PCOS has been found to affect one in 10 people with uteruses who are of “childbearing age.” And someone who unknowingly has PCOS may try various acne or laser hair-removal treatments, but Dr. Parikh explains that if the underlying hormonal issues aren’t addressed, these remedies likely won’t work.
While the cosmetic concerns, like hormonal acne, may be reason enough for someone to seek treatment, Dr. Parikh says the metabolic risks are why the disorder needs more awareness. “Patients with PCOS might have pre-diabetes, which might eventually progress to diabetes,” she says. The hormonal imbalances can also cause irregular periods which can lead to irregular ovulation and fertility issues.
So, if you have persistent acne, facial hair, hair loss, or irregular periods, be sure to ask your doctor about PCOS. “The earlier we diagnose can have a huge impact later on in [someone’s] life,” Dr. Parikh says.
How do stress hormones affect your skin?
As if the negative impact on your mental well-being weren’t enough, stress can cause many physical responses as well, even including the ability to make you sick. The body responds to stress by releasing stress hormones (aka cortisol) as a way of compensating for the extra pressure your body is undergoing. Cortisol is most commonly known as the primary stress hormone, and it’s the main culprit behind stress-related breakouts.
"The rise in cortisol sends our sebaceous glands into overdrive resulting in an over production of sebum, [which] causes acne," Dr. Green says.
Basically, when you’re under stress, your skin starts overproducing oil, which can get clogged in your pores and cause breakouts. Fun.
Dr. Green explains that stress itself doesn’t cause acne, but because the resulting hormonal imbalance can mess with your skin, it’s important to work to identify your stressors.
How does birth control affect your skin?
According to medical journalist and OB-GYN Dr. Jennifer Conti, the estrogen that’s present in many combined hormonal contraceptives work to temporarily inactivate testosterone in your body. “It’s the testosterone that’s responsible for acne, so with less of it actively functioning, you see less acne,” Dr. Conti says. “This happens with any method that has estrogen in it, but especially with oral birth control pills.” Because of the presence of acne-controlling hormones, birth control is most often known to help clear your skin, rather than make skin conditions worse. However, there are a couple situations where this isn’t the case.
First, your body may need time to get used to a new birth control prescription. If you experience breakouts upon trying out a new method, or introducing a contraceptive to your system for the first time, your body may need time to adjust and “find the right hormonal balance,” which Dr. Green says can result in initial breakouts. “It can take one to two cycles for the body to equilibrate to the birth control pill,” she says.
Another way that birth control could harm more than help your skin is if you’re using a method that contains only progestin. Dr. Conti says that this method of birth control has the opposite effect of estrogen-based contraceptives, because progestin causes more testosterone to be active in the body, which contributes to more acne.
How does menstruation affect your skin?
Dr. Greenhormonal irregularity
During your period, all your hormones get a little out of whack, but estrogen is an important one to focus in on. While hormones like cortisol and testosterone can increase excess oil production, we have estrogen to thank for keeping that oil under control. However, estrogen drops during the second half of your cycle, so that balance is thrown off.
So, how can you determine the cause of your hormonal acne?
No one ever wants to get their blood work done, but if you’re consistently struggling with hormonal acne, then this might be the route for you. Dr. Green says that testing your hormone levels can help determine which hormones might be contributing most to your breakouts. Gaining a better understanding of your hormone levels can also help your doctor advise you on which birth control prescription could work best for you and your body, if this is something you are looking to adding into your everyday lifestyle routine.
Dr. Parikh also emphasized the importance of providing your physician with a thorough history of your symptoms and being as detailed as possible. This way, the tests are more narrow and specific to your concerns. These tests, Dr. Parikh says, can look at anything from your hormone levels at different times of the day to your hormone levels during a particular timeframe of the menstrual period.
How can you balance your hormones and treat hormonal acne?
Maintaining a healthy lifestyle by managing stress and getting sufficient sleep can certainly help control how hormones can affect your body—but that’s not always as simple as it sounds. Luckily, there are other hormone-managing methods to rely on even when everything else feels out of your control. As mentioned before, the right kind of birth control for your body can be an effective way to regulate your hormone production and, in turn, help keep your skin clear. Dr. Green also recommends Spironolactone, which works similarly to lower testosterone and clear acne—and the medication can be used in tandem with birth control.
However, Dr. Parikh strongly emphasized the importance of talking to a medical professional before trying to take matters into your own hands, especially if you’re thinking of taking over-the-counter medication geared toward hormone adjustment. Because these medications aren’t well-regulated, she says it’s far safer and more beneficial to get your hormones tested and develop a plan that’s specific to your needs. Also, make sure to consult your doctor if you’re thinking of making changes to your overall diet or wellness routine. Because while these tips are there to aid your hormonal acne journey, it’s important to find ways that will work well for your personal lifestyle.
