Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 3/9/21
Hormonal acne is a type of acne that forms as a result of fluctuations in the levels of hormones your body produces.
It’s common. It’s also sometimes predictable, with hormonal acne outbreaks often occurring at the same time during your period. It’s also highly annoying, affecting everything from your appearance to your self-confidence.
Hormonal acne is so common that it’s usually just referred to as “acne” by healthcare providers. It’s usually the result of male hormones such as testosterone (yes, even as a woman, your body produces a small amount of testosterone) and other androgens.
Luckily, like other forms of acne, hormonal acne can be treated. Using a combination of safe, effective medications, over-the-counter products and small changes to your lifestyle, it’s very possible to take control of your hormonal acne and minimize the effects of outbreaks.
Below, we’ve explained everything you need to know about hormonal acne, from how hormonal acne occurs to the key symptoms of an outbreak.
We’ve also shared the best acne treatment options for hormonal acne, ranging from safe, everyday products to proven medications.
Simply put, all acne is hormonal. Acne occurs when your body produces an increased amount of certain hormones that stimulate the production of sebum (a form of oil that your body uses to lubricate your skin).
Normal sebum production keeps your skin fresh, smooth and healthy. However, when hormones signal to your body to increase its sebum production, the extra sebum can clog hair follicles and cause you to develop acne.
Everyone has a different sensitivity to certain hormones, meaning an increase in hormone levels that could cause one person to break out with acne could have no effect on a person with lower sensitivity to acne-causing hormones.
So, which hormones are responsible for acne outbreaks? The biggest culprit appears to be testosterone — an androgen hormone that can stimulate sebum production and increase clogging of your hair follicles.
Believe it or not, male hormones could be causing your hormonal acne. As a woman, you have small amounts of male hormones such as testosterone circulating throughout your body. These hormones are essential for everything from your energy levels to your strength and fitness.
Hormones exist in a delicate balance in your body. Even a small increase in one hormone can have a noticeable effect on your health and appearance.
Hormonal acne occurs when your body produces more androgens (male hormones such as testosterone) than it needs. Most of the time, this boost in androgen production occurs at the same time as your period.
Hormonal acne is also very common in puberty. During puberty, your body produces far higher levels of androgens such as testosterone, leading to an increase in sebum that can clog pores and trigger acne outbreaks.
Hormonal acne can vary between people. If you have high androgen levels during your period, plus a genetic sensitivity to androgens, you could experience worse acne outbreaks than your peers.
If you have a medical condition that affects your hormone levels, such as polycystic ovary syndrome (PCOS), this can also cause an overproduction of androgens and lead to hormonal acne.
Luckily, hormonal acne isn’t completely out of your control. From antibiotics to skin creams and topical retinoids, a variety of options are available for taking control of hormonal acne outbreaks.
Acne breakouts are a four-step process, with each step contributing to the development of a noticeable pimple:
Hormone production. Before your period, your body starts to increase its androgen production. Higher testosterone levels trigger your body to create more sebum, which can lead to oilier facial skin.
Clogged hair follicle. Sebum clogs one or several hair follicles. These clogged hair follicles are called “comedones.” Comedones can be completely blocked (closed comedones), forming a whitehead pimple, or partially blocked (open comedones), resulting in a blackhead.
Bacterial infection. Bacteria trapped inside the comedone causes an infection, resulting in a painful, irritated pimple.
Inflammation. In response to the bacterial infection, your immune system causes the clogged hair follicle to become red, swollen and uncomfortable. This inflammation can include acne cysts or cystic acne.
Hormonal acne outbreaks tend to happen in the T-zone — an area of your face that covers your nose, chin and forehead.
Pimples caused by hormonal acne can also affect other parts of your face. As an adult, it’s very common for hormonal acne outbreaks to affect your jawline, your cheeks and the areas around your lips.
Hormonal acne can range from mild to severe. Mild acne is usually characterized by non-painful whiteheads and blackheads that occur in smaller outbreaks. Most of the time, this type of hormonal acne resolves itself with no need for medication.
Moderate acne is characterized by larger outbreaks, which include infected, inflamed lesions. Hormonal acne outbreaks can advance from moderate to severe when most of the lesions are inflamed, red and painful to the touch.
As well as whiteheads and blackheads, hormonal acne outbreaks can also lead to acne nodules (large, deep-set pimples that sit beneath the skin) and pus-filled, cystic lesions. These are more common if you suffer from moderate to severe acne and can often require medical treatment.
The treatment options for hormonal acne vary depending on the severity of your outbreaks. If your hormonal acne is mild and manageable (for example, a few small pimples in the weeks leading up to your period), there’s a good chance you’ll be able to treat it without medication.
If your hormonal acne is more severe, the best option could be the use of an acne medication such as tretinoin, isotretinoin or an antibiotic.
Below, we’ve covered all of the treatment options for hormonal acne, ranging from changes to your lifestyle and habits (which are usually enough to manage mild outbreaks) to topical and oral hormonal acne medications.
While small changes to your lifestyle and hygiene habits usually won’t be enough to deal with severe acne outbreaks, making a few modifications to the way you take care of your skin can usually help to improve mild to moderate hormonal acne.
From a hygiene and skincare perspective, you can:
Avoid scratching, scraping or picking pimples. This can open pimples to the air and allow bacteria to enter into the pore, increasing your risk of dealing with an inflamed and infected acne lesion.
Wash your face no more than twice daily, unless you need to after excessive sweating. Excessive washing can irritate your facial skin and make acne outbreaks more severe. Try to limit your facial washing to twice a day, usually after you’ve been active and sweating.
Avoid harsh, chemical-laden face washes. Unfortunately, many over-the-counter facial washes are packed with chemicals that can irritate your skin. During an acne outbreak, it’s best to avoid exfoliating face washes and other harsh skincare products.
Limit your makeup usage. During an outbreak, it’s best to completely avoid using any makeup that isn’t water-based. We know this is practically impossible, so just try to limit your makeup usage to occasions when you really need it.
From an environmental perspective, you can:
Avoid sweaty weather. Hot day? Try to avoid spending extra time outside if the weather is hot and humid, as excessive sweating can worsen your outbreaks and make inflamed, infected pimples worse.
Shower right after working out. Just finished a serious gym sesh? Try to shower right after you finish your workout to reduce the amount of time your bare skin is exposed to sweat.
From a natural treatment perspective, you can:
Drink a cup or two of green tea every day. Studies show that green and black tea both may have mild anti-inflammatory properties, making them potentially useful if you have mild to moderate hormonal acne.
In general, the results you can expect from green tea and other natural treatments are fairly mild, meaning this probably won’t be useful if you have anything more than a few small pimples.
Try a face mask. Anti-acne facial masks usually contain alpha hydroxy acids — a classic of naturally-occurring compounds that can produce improvements in your skin. Like green tea, natural face masks are unlikely to have any major positive effects on your acne, but the small boost in skin health they can provide could help to bring your hormonal acne under control.
Eat more antioxidant-rich foods. A lack of antioxidants can make inflammation worse, potentially worsening your hormonal acne outbreaks. Plant-based foods rich in natural antioxidants, while not as effective as medicine, can potentially decrease skin irritation.
Natural products like green tea may have some positive effects on mild acne. However, they’re usually not powerful enough to produce any improvement in moderate to severe outbreaks of hormonal acne.
Retinoids, on the other hand, can be powerful tools for controlling your hormonal acne. Made using a derivative of vitamin A, retinoids work by speeding up your skin’s growth process and causing your skin to turn over more quickly than normal.
This faster turnover process means sebum doesn’t have as much time to build up inside your pores, resulting in fewer pimples and milder hormonal acne outbreaks.
Retinoids can be applied topically or taken orally. The most common topical retinoid is tretinoin, a retinoic acid that you can find in our acne and other skincare products.
Using tretinoin is simple — all you need to do is apply it daily. Studies of tretinoin for acne usually show that it takes three to six months to control most acne, making topical retinoids like tretinoin a mainstay of medical acne treatment.
Antibiotics (drugs that fight against bacterial infections) can be highly effective for controlling outbreaks and making your hormonal acne less severe. Oral antibiotics are usually prescribed for moderate to severe inflammatory acne.
Healthcare professionals often prescribe antibiotics in combination with retinoids like tretinoin. The retinoid works by speeding up your skin cell turnover process, making blockages less frequent.
If a blockage does occur, the antibiotic stops it from becoming infected, reducing your risk of inflammation.
As well as clindamycin, some of the most commonly used antibiotics for acne are tetracycline, doxycycline, erythromycin and minocycline.
Finally, if your hormonal acne doesn’t respond to retinoids, antibiotics and other widely used treatments, your healthcare provider might recommend a hormonal medication.
For women, the most common hormonal acne prevention medication is a simple birth control pill.
Hormonal contraceptives contain ethinyl estradiol — an estrogen that can help to balance the effects of androgens and prevent your skin from breaking out with acne.
In short, there’s a good chance you can manage your hormonal acne and your contraception with one treatment — score one for convenience.
As always, the best way to begin using hormonal medication to control your acne is to talk to your healthcare provider. They’ll be able to recommend the best oral contraceptive for you based on your health history, needs and lifestyle.
Already taking an oral contraceptive? If your current contraceptive isn’t controlling your acne, you might be able to improve your skin and stop breakouts by changing to a different type of oral contraceptive. Again, this is something that you’ll need to talk to your healthcare provider about.
If hormonal medications and antibiotics aren’t cutting it, there are a couple other options for more severe forms of acne.
Spironolactone, which is used to treat several medical conditions like hyperaldosteronism, can be prescribed off-label to treat severe hormonal acne. This drug can help to block some hormones in oil glands, thus reducing oil production.
Another severe acne treatment is isotretinoin. Like tretinoin, isotretinoin is a vitamin A derivative, but it is more powerful than prescription tretinoin or over-the-counter retinol.
Both spironolactone and isotretinoin can cause serious birth defects, so it is important to use a very effective birth control method while taking the drug. Talk to a healthcare provider if you think spironolactone or isotretinoin will help your acne.
Once you have treated the root cause of your hormonal acne with lifestyle changes, hormonal medications or antibiotics, you may start focusing on preventing hormonal acne from returning.
While it isn’t possible to eliminate acne-causing hormones without disrupting essential body functions like the menstrual cycle, it is possible to establish a consistent skincare routine as a method of preventing acne flares.
Luckily, most of the treatments for hormonal acne double as prevention methods, including:
Gentle Cleansing. Using a non-comedogenic cleanser to clear away dead skin cells and excess oil on a daily basis can help keep acne at bay. Consistent cleansing and moisturizing can help your skin regulate oil production in your oil glands.
Don’t Overdo the Acne Products. Using products like benzoyl peroxide or salicylic acid can be very useful for acne treatment, but using too many acne products or changing products every few days can actually have a negative effect on your skin. Try to stick with one skincare routine for a couple of months.
Moisturize. If your skin is oily, this may seem counterintuitive, but moisturizing your skin can actually help keep acne from developing.
Wear Sunscreen. While sunscreen has no effect on your hormones, it helps to protect your skin from the irritating and drying effects of the sun. The American Academy of Dermatology recommends apply a broad spectrum, water resistant, SPF 30+ sunscreen daily when out in the sun.
See a Dermatologist. Just like it is a good idea to have a yearly checkup for your health, visiting a dermatologist can help you develop a personalized skincare routine that works for you.
Entering menopause causes a normal, natural reduction in your body’s production of female reproductive hormones such as estrogen. For some women, this can lead to an increase in hormonal acne outbreaks.
Like hormonal acne for non-menopausal women, menopause-related hormonal acne is the result of fluctuations in your body’s hormone levels.
As your estrogen levels decrease, your balance of androgens to estrogenic hormones can cause your body to create more sebum.
If you’re acne prone, this can lead to everything from a few occasional pimples to severe and regular acne outbreaks.
Menopausal hormonal acne can even occur if you use HRT (hormone replacement therapy) to deal with the symptoms of aging.
HRTs use an artificial hormone, progestin, to replace estrogen and progesterone, which can cause your skin to go awry.
As always, if you’re experiencing menopause-related hormonal acne, the best approach is to talk to your healthcare provider about retinoids, antibiotics and hormonal medications to limit outbreaks and control your body’s sebum production.
Acne is one of the most common skin conditions, affecting around 50 million Americans every year. While all acne is hormonal, it can be triggered by a variety of factors, from androgens to stress, medication and more.
Interested in learning more about acne? Our guide to androgen hormones that cause acne goes into more detail about how testosterone and other androgens can trigger an acne outbreak. You can also learn more about common acne triggers in our guide to what causes acne breakouts.
Want to solve your acne breakouts as quickly as possible? Our guide to getting rid of acne fast covers the most effective acne treatments available, as well as the amount of time required for you to see results.
This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your healthcare provider about the risks and benefits of any treatment.
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