‘Hormones’ often get blamed for acne, but that’s a classic case of shooting the messenger.

Yes, hormones play a key role in creating breakouts, but they don’t mean to. They’re merely responding to stimuli in the way they’ve been programmed.

These stimuli can come from the nutrients you eat, the chemicals you come into contact with and even the thoughts that flit through your mind [1]. The problem isn’t the hormones themselves—but what’s causing them to overreact.

Read on to discover which hormones are involved in hormonal acne, why they can go into overdrive, and how you can keep them in balance to promote clear skin.


Which hormone causes acne?
Conditions linked to hormonal acne
6 Hormonal acne causes
How to treat hormonal acne naturally
Is there a hormonal acne diet?
Takeaway points

Which hormone causes acne?

There isn’t just one hormone involved in hormonal acne. Several hormones play a role, including:

– Insulin, which is released every time you eat to regulate your blood sugar [2]

– Testosterone (and other androgens), a sex hormone produced in both men and women [3]

– Corticotrophin-releasing hormone (CRH), a hormone involved in your stress response [4]

– IGF-1, otherwise known as insulin-like growth factor 1, a naturally occurring growth hormone [5]

Other hormones such as progesterone and glucocorticoids may be involved to a lesser degree too [6]. They’re all intertwined, which means any one of them can cause problems if it gets out of balance—either because your body produces too much of it, or because your body can’t get rid of it effectively [7].

Think of your hormones as an orchestra. When all of the instruments keep to the tune, the effect is beautiful. If one instrument plays a duff note, the whole piece can sound out-of-whack.

The good news is that you can influence the stimuli that affect hormonal harmony. Before we get to that, let’s take a look at what can make them go awry in the first place.

Conditions linked to hormonal acne

Sometimes hormonal acne can be a sign of polycystic ovary syndrome, otherwise known as PCOS [8]. Other symptoms of PCOS include weight gain, excess hair growth and irregular periods.

The recommendations in this article are safe for everyone, but if you want to investigate PCOS or any other medical condition, make sure you speak to your doctor.

6 Hormonal acne causes

Hormonal acne can be driven by one critical imbalance, though it’s more often the culmination of lots of different factors. Some of these you’ll be familiar with, while others may surprise you:

1. A high-sugar diet

Overeating sugar and refined carbohydrates causes your body to release lots of insulin. Excess insulin ramps up the production of testosterone (I told you they’re all connected!), which kicks your sebaceous glands into overdrive [2]. We all know that oily skin = breeding ground for acne.

2. Too much milk

Research suggests that milk causes your liver to make more IGF-1 [9]. It makes sense when you consider that cow’s milk helps a calf double its birth weight in 40 days [10]—of course it’s going to stimulate growth pathways!

In human adults, those growth pathways can cause skin cells to turnover too quickly, and sebaceous glands to produce too much oil, leading to acne.

Large-scale studies consistently show that milk is the most acne-triggering form of dairy. Yoghurt, cheese and other forms of fermented dairy aren’t so problematic [11].

3. Poor gut health

Once your body has used hormones, it needs to get rid of them. One of the main ways it excretes them is through your poop.

Yes, you need to poop at least once a day to help your hormonal balance. A study from way back in the 1930s suggested a link between constipation and acne, and newer research backs this up too [12, 13].

Constipation and other gut issues can be caused by eating the wrong things, but they can all be driven by a bacterial imbalance in your gut [14].

4. Compromised detoxification

Your liver is continually working to help your body process unsavoury substances. These come from everywhere: from the chemicals in your cosmetics to the breakdown products created by your body cells [15]. It’s an enormous job, so your liver often ropes in your kidneys, lungs and skin to help too.

Your liver and other organs need a regular supply of nutrients to help them carry out their tasks. If they don’t have enough of the right nutrients, free radicals can be released—which lead to skin-damaging oxidative stress [16, 17].

Researchers have found that acne patients have evidence of greater oxidative stress than those who don’t suffer from acne [16, 18]. This burden is compounded by the fact that oxidative stress can also develop in the skin from external sources, such as UV rays and pollution [19, 20].

You can bet that if you have oxidative stress coming from both the inside and the outside, your skin is going to let you know.

5. Too much stress

We all know that stress is linked to acne, but for a long time scientists weren’t sure exactly why.

Now we have answers. New research suggests that your skin cells have a stress-response system all of their own. This means that they don’t have to wait for stress hormones to reach them via your general circulation—as soon as something stressful happens, they start producing their own CRH and ramping up sebum production [3, 21].

Add to this the fact that chronic stress (hello, modern life) leads to the body-wide release of cortisol and low-grade inflammation [22], and you have the perfect acne storm.

Remember that stress can be mental, emotional and spiritual. An overbearing boss, a lack of purpose or even too much exercise can have an impact on your skin.

6. Too little sleep

A 2011 study asked 1,236 acne sufferers about what made their breakouts worse, and a whopping 75% said lack of sleep often leads to a flare [23].

There are a couple of reasons for this:

a) Tiredness amps up your body’s stress response. Your stress hormones not only increase sebum production, but they also disrupt your gut bacteria—both of which contribute to acne [24, 25].

b) Feeling tired makes you much more likely to reach for sugary and starchy food [26]. As you learnt above, too much sugar is a risk factor for acne due to its effect on insulin.

As you can see, ‘hormonal acne’ is about so much more than your hormones. But that’s a good thing! You can change the stimuli your hormones are reacting to, which means you have the power to enhance your skin.

How to treat hormonal acne naturally

Now, let’s get something clear: hormonal acne is not your fault. You’ve been dealt a genetic hand you had no control over, and the way those genes are interacting with your environment is leading to breakouts [27]. Another person could have the exact same lifestyle and not get breakouts, so there’s no reason to beat yourself up.

But that’s not to say you can’t take steps to help your hormones and your skin. The key is to incorporate gentle habits that keep your hormones at a happy level.

Here’s what to do:

a) Eat plenty of colourful vegetables and fruits

These are rich in fibre, which helps to keep you regular (remember you need to poop!). They also contain antioxidants, which helps to reduce skin-damaging oxidative stress [28].

Prioritise vegetables over fruit (they’re lower in sugar), and eat as many different colours as possible. Seven to ten heaped handfuls a day is a good goal.

b) Enjoy probiotic foods daily

Probiotic foods contain naturally occurring good bacteria, which help to keep your gut bacteria in balance. Remember: healthy gut bacteria are essential for good digestion [29].

Probiotic foods include sauerkraut, kimchi, kefir, kombucha and natural yoghurt. Read labels to make sure these are unpasteurised and have no added sugar.

c) Cut down on sugar

You should always make room for the occasional treat (no one wants to be the person refusing birthday cake!), but your complexion will thank you if you reduce daily sugar consumption. Less sugar makes your skin less oily [30].

Fizzy drinks and juices are some of the worst offenders, so make an effort to cut those out. Sweets, pastries, cookies, shop-bought cakes and condiments are best eaten rarely too.

The good news is that it doesn’t take long for your palate to reset, which means you’ll soon stop craving those sweet flavours.

d) Be selective about dairy

As you learnt above, cow’s milk can trigger acne in some people. Skimmed milk seems to be the worst culprit [31].

While you’re helping your skin to clear, it makes sense to cut out cow’s milk. Some people will be fine with goat’s or sheep’s milk instead, while others will do better with a plant-based variety such as almond milk.

When it comes to other forms of dairy, you may need to do a little detective work. Some people will break out after cheese, while others will be fine. Most of us are fine with a little natural yoghurt. The goal is always to keep your diet as diverse as possible, so experiment and see what works for you.

e) Get smart about screen time

Your whole body benefits from good sleep, not least your skin. The trouble is, it’s easy to forget that when you want to watch just one more episode on Netflix.

It may seem radical, but why not try making your bedroom a screen-free zone? Keeping away from the blue light emitted by devices can help you to sleep better [32], and you’ll naturally turn in earlier too.

Treat yourself to a good, old-fashioned book to read instead, and buy yourself an alarm clock if necessary.

f) Let yourself relax

Remember the study that found lack of sleep aggravates acne? That same study suggests that stress makes acne worse in more than 80% of us [23].

You can’t eliminate all sources of stress from your life, but you can change how you react to them. And that usually starts with giving yourself the time to decompress.

Whether it’s meditation, reading, playing tennis or simply chatting to a friend on the phone, find out what works for you and make it a non-negotiable part of your day. No exceptions. Relaxation is a requirement for great skin.

Is there a hormonal acne diet?

There’s no single perfect diet to clear hormonal acne, as everyone responds differently to food.

Studies do show that a low-glycaemic diet (meaning low sugar and refined carbohydrates) can help to clear acne [33]. A Mediterranean diet can be a good approach too [34].

But food is personal, which means the key to long-term success is to follow principles rather than diet plans. The habits listed above—lots of veg, low sugar, regular probiotic foods and minimal dairy—will give you the foundations for clear skin. Use these as a baseline and experiment to find your ideal way of eating.While you’re resetting the balance from the inside-out, you can also take steps to calm your complexion from the outside. Try these:

a) Be gentle

Don’t treat your skin as the enemy. Treat it as you would a wounded friend.

This means no harsh approaches. Instead, use as few products as you feel comfortable with and make sure they’re pH-balanced.

Remember, your skin has its own stress-response system, and overly aggressive treatments can set it off. Be kind.

b) Use topical antioxidants

One product it may be worth keeping in your regimen is a vitamin C serum. One study found that applying vitamin C twice daily was more effective than benzoyl peroxide at clearing acne lesions [35].

That’s right: humble vitamin C is a powerful antioxidant, and it can help to combat oxidative stress on the skin.

The form of vitamin C that’s particularly effective is called sodium ascorbyl phosphate, so read ingredients labels.

Hormonal acne can feel relentless, but it doesn’t have to be. Little actions, made consistently, can help your hormones and your skin to behave.

Takeaway points

Let’s recap what we’ve learnt:

– There are several hormones involved in hormonal acne, including insulin, testosterone, CRH and IGF-1. Their functions are all intertwined.

– Hormones can’t cause breakouts all by themselves. Hormonal acne occurs when internal and external stimuli cause these hormones to go into overdrive.

– Hormonal acne-driving stimuli include a high sugar diet, too much milk, poor gut health, compromised detoxification, too much stress and too little sleep.

– To combat hormonal acne from the inside, you can increase your intake of colourful vegetables, fruits and probiotic foods, and decrease your intake of sugar and cow’s milk. You can also prioritise sleep and engage in active relaxation.

– To help hormonal acne from the inside, you can use gentle, pH-balanced products and incorporate a vitamin C serum into your skincare routine.

Fiona Lawson is a former national magazine editor turned registered nutritionist and skin specialist. She holds an MSc in Nutritional Medicine and a BANT-registered post-graduate qualification in Nutritional Therapy.

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Dr Thivi Maruthappu


Dr Thivi Maruthappu is the UK’s first and only dual-qualified Consultant Dermatologist and Nutritionist, and the pioneer of the (much-needed!) Nutritional Dermatology field. She runs busy NHS dermatology clinics, conducts academic research and delivers lectures worldwide. She’s also recently authored her first book, Skin Food, which aims to make holistic skincare accessible for everyone.



Porter magazine called her a ‘Global Skincare Expert’, and Caroline Hirons described her as ‘one of the best facialists in the world’. In the skincare industry, Marie Reynolds is in a league of her own. I had the privilege of experiencing one of Marie’s facials as a young journalist—and I can still remember every exquisite detail more than a decade later.

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