Ask 100 people what causes acne and you’ll get 100 different answers, ranging from your diet, and skincare habits to your genetics, your everyday environment, and your total amount of sun exposure (ever wondered if sun acne is a thing?).
There’s even a persistent myth that chocolate causes acne. Thankfully, it’s not true -- feel free to enjoy chocolate without worrying too much about your skin.
The reality of acne is that the vast majority of pimples, breakouts and other acne issues aren’t a result of your diet or lifestyle, but your body’s levels of key hormones that affect your production of natural skin oils.
As we discussed in our guide to hormonal acne, acne in both men and women is almost always triggered by increase production of androgens.
Androgens are male sex hormones. The most well-known androgen is testosterone, which is a vital hormone for the development of male sex-specific features. Beyond its role as a male sex hormone, testosterone also plays a major role in regulating your skin’s oil levels.
But wait -- testosterone is a male hormone, right? So how could it possibly be responsible for your acne as a woman?
Despite frequently being labeled as a male-specific hormone, both men and women produce testosterone. On average, men produce 10 to 25 times as much testosterone as women, but both sexes need testosterone for optimal physical, mental and reproductive health.
The same is true for men, only in reverse. Estrogen, which most people think of as a female hormone, is also present in the male body in small quantities and plays a vital role in sexual health, bone density and other important aspects of wellbeing.
Making things even more complicated is hormone sensitivity. Because the female body has a fraction as much testosterone as the male body, it’s more sensitive to its effects. This means that even a small increase in androgen levels can have major effects on your skin.
Explained simply, both female and male bodies are all about hormonal balance. Balanced hormones, good; hormonal imbalance, bad. When one hormone gets out of sync with other hormones, things that wouldn’t normally happen can suddenly start to happen.
Testosterone's role in acne is simple. When your body starts to produce more testosterone than normal, it can trigger an increase in your skin’s production of sebum.
Sebum is a natural oil that your body secretes from the sebaceous glands. It flows out from your hair follicles onto your skin. Think of it as your body’s natural source of hydration for your skin -- an oily, waxy substance that’s responsible for keeping your skin moist, soft and healthy.
Normally, sebum production is a good thing. However, when your testosterone levels increase, your body can produce too much sebum. This sebum then clogs inside your hair follicles and causes either whiteheads (closed blockages) or blackheads (open blockages) to develop.
For the most part, more testosterone equals more sebum production. Testosterone's effect on sebum production is more obvious in people sensitive to the hormone, meaning some people will get more severe hormonal acne than others.
If your skin is sensitive to androgens, you’ll normally notice acne in the days leading up to and during your period. This is because your body’s production of androgens tends to peak during your period.
At the same time, your body’s production of progesterone -- a hormone that maintains optimal skin hydration and elasticity -- declines to its lowest level.
The end result is a major vulnerability period for your skin. With androgens at their peak and progesterone at its lowest, your skin is far more susceptible to acne than usual, resulting in a monthly outbreak that affects anywhere from 29 to 49 percent of women.
By the way, this is also why you might notice an increase in your sex drive before your period. Not only do testosterone, estrogen and progesterone affect your skin -- they also regulate your sexual desire and function.
Want to learn more about how testosterone affects your skin? Our guide to hormonal acne goes into greater detail on how testosterone can trigger outbreaks, especially in the week leading up to your period.
Testosterone isn’t the only androgen affects your skin. There’s also dihydrotesterone (DHT) -- a more potent androgen that, while not as closely linked to acne development as testosterone, is also associated with acne breakouts.
DHT’s role in hormonal acne isn’t as firmly established as that of testosterone. However, it can affect your production of elastin -- an important structural component of healthy skin that’s vital for managing the aesthetic signs of aging.
In general, there’s no need to worry too much about DHT. Since it’s a byproduct of testosterone, the same treatments that limit excess testosterone and prevent hormonal acne will also limit the effects of DHT on your skin.
There are several options available for treating androgen-induced acne. For women, one of the most popular and effective options is a simple combined oral contraceptive pill (COCP, or birth control pill), which typically contains ethinylestradiol and a progestin.
These estrogenic hormones are often enough to manage the effects of excessive testosterone production.
Like all hormonal medication, oral contraceptives do have potential side effects. As always, if you have acne that you think is being triggered by androgens, the best approach is to discuss the use of an oral contraceptive with your doctor.
Other treatments for hormonal acne include topical retinoids such as tretinoin, oral retinoids like isotretinoin and antibiotics. These medications are often used in combination to more effectively suppress hormonal acne.
Want to know more about the most effective treatments for androgen-induced acne? Our guide to hormonal acne explains how you can use antibiotics, retinoids and other medication to keep hormonal acne under control.