What Is Hormonal Acne and How To Address It?

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Dr. Khoshaba

March 27, 2023

Acne is normal. It is a common skin condition that occurs when hair follicles become clogged with oil (sebum) and dead skin cells. 

The appearance of acne usually occurs during the teenage years, when hormone surges are associated with secondary sexual characteristics. However, you may be wondering why you're still breaking out as an adult. It is because our hormones are frequently still active in the background.

Hormonal acne is the term given to acne that is typically brought on by fluctuating hormone levels, particularly androgens such as testosterone. It is most common during puberty, menstruation, pregnancy, and menopause, as well as in those with polycystic ovary syndrome (PCOS) or other hormonal imbalances. 

To learn more about hormonal acne, its characteristics, and ways to get rid of them, delve further into this article. We’ll talk about the following:

What is Hormonal Acne?

Hormonal acne is a type of acne that is primarily caused or exacerbated by hormonal fluctuations in the body. It commonly affects adolescents going through puberty, as well as adult women experiencing hormonal changes due to menstruation, pregnancy, or polycystic ovary syndrome (PCOS). 

The primary hormones involved in hormonal acne are androgens, such as testosterone. Androgens stimulate the sebaceous glands to produce more sebum, an oily substance that lubricates the skin. Excess sebum can clog hair follicles, leading to the growth of acne-causing bacteria and the formation of pimples, blackheads, and whiteheads.

What Are the Characteristics of Hormonal Acne?

Hormonal acne has several distinct characteristics that differentiate it from other types of acne. These characteristics include:

  • Type of breakouts: Hormonal acne often presents as deep, tender, and inflamed cysts or nodules that can be painful to touch. These types of breakouts are more challenging to treat and may last longer than other acne types, such as blackheads and whiteheads.
  • Location: Hormonal acne typically appears on the lower half of the face, such as the chin, jawline, and cheeks. It may also affect the neck, chest, and back in some cases.
  • Age of onset: Hormonal acne can affect individuals at different stages of life, but it is more common during periods of significant hormonal fluctuations, such as puberty, menstruation, pregnancy, and menopause. Adult women may be more likely to experience hormonal acne, even if they did not have acne during their teenage years.
  • Fluctuations with hormonal changes: Hormonal acne breakouts tend to be cyclical, often worsening before or during menstruation, pregnancy, or other hormonal changes. This pattern is a strong indicator that hormonal imbalances may be the primary cause of acne.
  • Resistance to conventional treatments: Hormonal acne can be more resistant to over-the-counter acne treatments, such as benzoyl peroxide or salicylic acid, as these treatments do not address the root cause of the acne, which is hormonal imbalance.

Identifying these characteristics can help determine whether hormonal imbalances contribute to acne breakouts. Consulting a dermatologist or healthcare professional is crucial for proper diagnosis and treatment, as addressing hormonal imbalances may require a different approach compared to conventional acne treatments.

Factors That May Contribute to Hormonal Acne

Several factors can contribute to hormonal acne, as they influence hormone levels in the body or exacerbate existing hormonal imbalances. Addressing these factors can help manage hormonal acne and improve overall skin health. These factors include:


Puberty is a critical period of growth and development characterized by significant hormonal changes in the body. These hormonal fluctuations, particularly in androgens (male hormones like testosterone) and estrogen (a female hormone), can contribute to the development of acne during puberty.

During puberty, the increased levels of androgens stimulate the sebaceous glands in the skin to produce more sebum, an oily substance that lubricates the skin and hair. Excessive sebum production can clog hair follicles, leading to the formation of acne. When sebum, dead skin cells, and bacteria accumulate within the clogged follicle, it creates an environment that promotes inflammation and acne breakouts.


Hormonal acne also occurs during the menstrual cycle due to fluctuations in hormone levels, primarily estrogen and progesterone. In the week leading up to menstruation, estrogen levels drop, while progesterone levels rise. This hormonal shift can lead to increased sebum production, which can clog pores and result in acne breakouts. 

Additionally, higher progesterone levels may cause the skin to become more sensitive and inflamed. Menstruation-related hormonal acne typically appears around the lower face, jawline, chin, and neck. It often manifests as inflammatory acne, such as papules, pustules, nodules, or cysts.


Hormonal acne during pregnancy is common and occurs due to fluctuations in hormone levels, particularly progesterone. Increased progesterone levels stimulate the sebaceous glands to produce more sebum, an oily substance that lubricates the skin and hair. Excessive sebum production during pregnancy, along with dead skin cells and bacteria, can clog hair follicles and lead to inflammation and acne breakouts.

Pregnancy hormonal acne typically appears on the face, particularly around the lower half, such as the chin, jawline, and cheeks. It can manifest as various types of acne, including blackheads, whiteheads, papules, pustules, nodules, and cysts.

Polycystic ovary syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a common hormonal disorder affecting women of reproductive age. It is characterized by an imbalance in reproductive hormones, leading to various symptoms, including hormonal acne.

The hormonal imbalance in PCOS often results in elevated androgen levels (male hormones), such as testosterone. These increased androgens stimulate the sebaceous glands to produce more sebum, an oily substance that lubricates the skin and hair. Excessive sebum production can clog hair follicles, leading to acne breakouts. When combined with dead skin cells and bacteria, the clogged follicle creates an environment that promotes inflammation and acne formation.

Hormonal medications

Certain hormonal medications can indeed lead to acne or exacerbate existing acne in some individuals. These medications can affect hormone levels in the body, which may influence sebum production and inflammation, leading to acne breakouts. Some examples of hormonal medications that can potentially contribute to acne include:

  • Hormonal contraceptives
  • Androgen-based medications
  • Corticosteroids
Pro tip: If you suspect that a hormonal medication is causing or worsening your acne, it's essential to discuss your concerns with your healthcare provider. They can help determine whether the medication is the culprit and discuss potential alternatives or adjustments to your treatment plan. Do not discontinue or alter your medication without consulting your healthcare provider, as this can lead to unwanted side effects or complications.


Stress can play a significant role in the development of hormonal acne. When the body is under stress, it produces increased levels of a hormone called cortisol, often referred to as the "stress hormone." Cortisol can, in turn, stimulate the production of androgens (male hormones like testosterone) that increase sebum production in the skin.

The excess sebum, when combined with dead skin cells and bacteria, can clog hair follicles, creating an environment that promotes inflammation and acne breakouts. Stress can also impair the immune system, making it harder for your body to fight off acne-causing bacteria and prolonging the healing process.

Furthermore, stress can lead to other behaviors that can indirectly contribute to acne development, such as poor sleep, unhealthy eating habits, and neglecting skincare routines.


Diet can influence hormonal acne in some individuals, although the relationship between the two is complex and not yet fully understood. Some research suggests that certain dietary factors may contribute to hormonal acne by affecting hormone levels, inflammation, and insulin sensitivity. Here are some diet-related factors that may be associated with hormonal acne:

  • High-glycemic food
  • Dairy products
  • Processed foods and trans fats
  • Chocolate


Hormonal acne development can be influenced by genetics. While the exact genes involved are not yet fully understood, research has shown that there is a strong hereditary component to acne. If your parents or close relatives experienced hormonal acne, you may be more susceptible to developing it as well.

Genetic factors can influence various aspects of acne development, including:

  • Sebum production
  • Skin cell turnover
  • Hormone sensitivity
  • Inflammatory response
  • Skin barrier function

While you cannot change your genetic makeup, understanding the role genetics play in hormonal acne can help you be more proactive in managing your skin. 

Lifestyle factors

Certain lifestyle factors can also contribute to hormonal acne or exacerbate existing acne. Factors such as inadequate sleep, lack of exercise, or smoking can affect hormone levels and contribute to hormonal acne. While these lifestyle changes may help to manage hormonal acne, it's essential to consult with a dermatologist or healthcare professional for personalized advice and treatment options, especially if your acne is severe or persistent.

How To Get Rid of Hormonal Acne?

Getting rid of hormonal acne involves addressing the underlying hormonal imbalances while following a consistent skincare routine and maintaining a healthy lifestyle. 

It's essential to consult a dermatologist or healthcare professional for an accurate diagnosis and appropriate treatment plan tailored to your specific needs. Here are some steps you can take to help treat hormonal acne:

Hormonal treatments

Depending on the cause of your hormonal acne, your doctor may recommend hormonal therapies, such as oral contraceptives, anti-androgen medications (e.g., spironolactone), or other hormone-regulating treatments. 

You can begin consulting a medical doctor who specializes in endocrinology, a field of medicine that studies conditions related to your hormones. An endocrinologist can diagnose endocrine conditions, develop treatment and management plans for them and prescribe medication.

Oral medications

Addressing hormonal acne may include the following oral medication treatments:

  • Hormonal therapy: Oral contraceptives or anti-androgen medications like spironolactone can help regulate hormone levels and reduce acne in women.
  • Antibiotics: In cases of severe acne, a dermatologist may prescribe oral antibiotics to help reduce inflammation and bacteria in the skin.
  • Isotretinoin: For severe, recalcitrant acne, a dermatologist may recommend isotretinoin (Accutane), which can be highly effective but also has potential side effects.

Topical treatments

Although they may not address the underlying hormonal imbalances directly, your dermatologist may recommend over-the-counter and prescription topical treatments, such as retinoids, benzoyl peroxide, salicylic acid, or azelaic acid, to help unclog pores, reduce inflammation, and manage acne breakouts.

Keep in mind that the effectiveness of topical treatments can vary depending on the individual and the severity of hormonal acne. It is essential to consult with a dermatologist or healthcare professional to determine the most appropriate treatment plan for your specific needs. 

They may recommend combining topical treatments with hormonal therapies, such as oral contraceptives or anti-androgen medications like spironolactone, for a more comprehensive approach to managing hormonal acne.

Skincare routine

Establish a consistent skincare routine that includes gentle cleansing, exfoliating (with an appropriate chemical exfoliant), moisturizing, and using sunscreen daily. Avoid using harsh scrubs or over-washing, as these can exacerbate acne.

It’s important to adopt a gentle skincare routine using non-comedogenic, oil-free products. Cleanse, moisturize, and apply sunscreen daily. Avoid harsh scrubs and over-cleansing, which can irritate the skin and worsen acne. 

Remember to also resist the urge to pick or squeeze acne lesions, as this can lead to further inflammation, scarring, or infection.

Diet and lifestyle changes

Adopt a balanced diet that includes whole foods, plenty of fruits and vegetables, lean protein, and healthy fats. Limit your intake of refined carbohydrates and sugars, which can contribute to insulin spikes and hormonal imbalances. 

Also, ensure you get adequate sleep, engage in regular physical activity, manage stress, and stay hydrated.

Consider non-hormonal treatments

In some cases, non-hormonal treatments such as antibiotics, light therapy, or chemical peels may be recommended by your dermatologist as part of a comprehensive acne treatment plan.

It's important to remember that treating hormonal acne can take time, and results may not be immediate. Be patient and consistent with your treatment plan, and consult your healthcare professional or dermatologist if your acne does not improve or worsens over time.


Hormonal acne can present several challenges that may affect a person's emotional well-being, self-confidence, and social interactions. However, it's important to remember that hormonal acne is normal, and as we covered above, there are several ways to address and manage it. 

Managing hormonal acne typically involves addressing the underlying hormonal imbalances, as well as following a consistent skincare routine, maintaining a healthy lifestyle, and using acne treatments.

All in all, it's essential to be patient with hormonal acne treatment, as it may take several weeks or months to see significant improvements. Hormonal acne may require different approaches compared to conventional acne treatments. 

Always consult with a dermatologist or healthcare professional before starting any new treatment, as they can help determine the most appropriate course of action for your specific situation.

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Dr. Linda Khoshaba is the Leading Integrative Health and Hormone Doctor in Scottsdale, Arizona. She has extensive experience working in the field as a Hormone Specialist and Natural Endocrinologist.

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