01 Nov WHAT IS THE CAUSE OF HORMONAL ACNE? (45+ STUDIES): THE ULTIMATE GUIDE (2021)22 minute read
Spoiler alert: your ‘hormonal acne’ isn’t caused by hormones.
Yes, hormones play a role, but they’re not causing your breakouts. Instead, something else is making your hormones misbehave, which in turn wreak havoc on your skin.
So, if you’ve googled, ‘What is the cause of hormonal acne?’, you’ve come to the right place—but you may be in for a few surprises. This article covers the root causes of hormonal acne, and what you can do about them.
What hormonal imbalance causes acne?
How do you know if your acne is hormonal?
What is the cause of hormonal acne? 5 root causes
Is the pill causing your hormonal acne?
Hormonal acne home remedies
How long does it take to clear hormonal acne?
Hormonal acne supplements
Hormonal imbalance does contribute to acne, but there are two important caveats:
a) It’s probably not the hormones you think, and
b) It’s not the hormones’ fault.
Let’s look at a) first:
It’s not the hormones you think
Most people—especially if they’re trying to work out what causes hormonal acne in females—presume that it’s caused by sex hormones such as oestrogen, testosterone and other androgens.
That’s only half true.
The hormonal acne cascade is kicked off by another pair of sister hormones: insulin and IGF-1. High levels of insulin and IGF-1 cause your body to ramp up androgen activity—which causes the oily skin and inflammation that leads to acne [1,2]. Put more simply:
Stress hormones can also start the hormonal acne cascade, though this is a less significant pathway than the insulin one.
Knowing how to control your insulin, IGF-1 and stress hormone levels is the secret to managing hormonal acne. Don’t worry—we’ll get on to that below!
So, first fact: sex hormones are involved, but they’re not the instigators of hormonal acne.
Moving on to b):
It’s not the hormones’ fault
Insulin and IGF-1 don’t decide to ramp up all by themselves. Neither do your stress hormones.
Your hormones don’t have a mind of their own. All they know is that they must respond to your environment, so that’s exactly what they do. It’s not their fault if the environment makes them respond in a way that stresses out your skin.
In this context, your ‘environment’ isn’t just the trees outside (although that’s part of it). Your environment is everything that makes up your body’s day-to-day reality: the food you eat, the way you sleep, your activity levels, how you respond to stress and more.
The good news? You can change your body’s environment, which means you can change how your hormones behave.
So, second fact: your hormones aren’t driving acne all by themselves. You have the power to change how your hormones behave.
Acne has lots of contributing factors, but here are some clues that hormonal imbalance is a key driving factor of your acne:
Your parents or siblings also have acne. Studies show you can be genetically predisposed to develop acne , possibly because of the way you and your hormones are programmed to react to certain foods [2,4]. But that does NOT mean you’re destined to have acne forever. You can shape your environment so that it switches those pesky acne-driving genes off.
Your acne gets worse just before your period. Pre-menstrual flares are a clue that hormones are involved, and these flares tend to get worse after age 30 .
Your acne clusters around your mouth, chin and jaw. Rather than the classic T-zone, your acne shows up on your ‘U-zone’ . This is the typical pattern for hormonally driven acne, though it’s not the only pattern. Lots of people can develop acne on their upper bodies too .
You’ve been diagnosed with PCOS. If you have PCOS, you’re even more sensitive to the hormonal fluctuations that can drive acne . All the advice on this page will help, and you can also read about PCOS acne in more detail over at PCOS Acne (35+ Studies): Natural Solutions.
You know that hormones don’t cause acne on their own. But what causes levels of those acne-driving hormones to shoot up?
Let’s look at the main culprits:
1) Too much sugar
No surprises here: eating too much sugar can contribute to hormonal acne.
This is because when you eat sugar or refined carbohydrates (think anything that’s white, sweet or fluffy), your insulin levels shoot up. Remember that flow chart from above?
This not only makes your skin more oily and acne-prone, but it also changes the composition of your skin oil. That’s right: eating too much sugar can make the natural oil on your face go from being nicely moisturising to intensely irritating to your skin. As one researcher puts it, “Sebum is the oil of the acne flame” .
The solution here is pretty simple: eat less sugar and refined carbohydrates, and eat more fibre-rich carbohydrates instead. But don’t worry—it’s not as boring as it sounds! We’ll explore the best dietary approach for hormonal acne below.
2) Too much dairy
Yes, dairy can play a role in hormonal acne—though not all types of dairy are problematic.
If you think about it, this makes sense. Milk is designed to promote growth—so it’s logical that it should cause your body to release IGF-1, a growth hormone. Milk also causes insulin to shoot up, which means it’s a double-whammy for triggering breakouts .
Whey protein, another form of dairy, appears to be particularly acne-triggering too, with several case reports linking it to breakouts on the chest and back . You can read about this in more detail at Does Whey Protein Cause Acne (12+ Studies): Science-Backed Solutions.
Things are less clear-cut when we look at fermented forms of dairy such as yoghurt and cheese. Some research suggests they contribute to acne, while others have found that they don’t [12,13]. Interestingly, the process of fermentation reduces levels of IGF-1 in dairy—which may be why it’s OK for some people .
We’ll chat about how to approach dairy in your diet in a little bit.
3) Too little sleep
Sleep (or rather, lack of sleep) can play a role in hormonal acne for a couple of reasons:
a) Sleep deprivation raises your stress hormone, cortisol 
b) A single night of sleep deprivation can also raise insulin 
Let’s go back to that flowchart again!
This raised insulin also makes you more likely to reach for those sugary, refined carbohydrates, which spikes your insulin even more—leaving you in a skin-aggravating cycle .
Sometimes great sleep is out of our control (especially if you have small children) but, as you’ll discover below, there’s also a lot you can do to optimise your slumber.
4) Too much stress
Stress worsens hormonal acne, but for a long time scientists weren’t exactly sure why. Now we have some answers.
Let’s look at the mind-bending facts:
– Your skin and your central nervous system have the same embryological origin . Translation: when you were in the womb, your skin and your stress-response system grew out of the same bit. They’re innately connected.
– Your skin cells have their own stress response system . Not only do your skin cells produce stress hormones, but they also have special receptors waiting to be activated by those hormones.
It’s no wonder that skin is reactive to psychological states, and that up to 82% of women report that their acne gets worse during periods of stress .
But it’s not just women: another study found that acne flared in both men and women just a few days after being purposely put in a stressful situation . The mind-skin connection is real—and harnessing it could be the key to clearing your skin.
5) Too many toxins
No, you do not need to go on a ‘detox’—but you do need to be mindful of what your body is exposed to.
A 2021 study found that people with acne have more BPA in their bodies. What’s more, the higher the BPA level, the worse the acne .
BPA is a chemical found in plastics. We ingest it when we drink from plastic water bottles or eat food from plastic containers. Some research suggests even BPA can get into our bodies from just touching plastic materials .
BPA is a known endocrine disruptor, which means it messes with your hormones . But it’s not the only one. Other endocrine disruptors are found in cosmetics, on household goods and in pesticides—and they may all have the potential to contribute to hormonal acne.
This sounds scary, but there’s no need to stress out (especially as stress doesn’t help acne either)! We’ll talk about how you can reduce your toxic exposure below.
Acne is rarely ‘just’ hormonal. Even if you suspect hormones are the driving force of your breakouts, it’s worth considering other factors that may play a role:
Food sensitivities. Inflammation drives acne [28,29], and nothing causes chronic, low-grade inflammation like consistently eating a food that doesn’t agree with you. Keeping a food-skin diary is your secret weapon for spotting patterns.
Poor gut health. Your skin and your gut are linked, which means out-of-balance gut bacteria may be contributing to your skin woes . Head to this article to find out more, or skip to Do Probiotics Help Acne (20+ Studies): Backed By Science to see if a probiotic is the right choice for you.
A damaged skin barrier. When you have hormonal acne, it’s so easy to fall into the trap of using aggressive skincare to make the breakouts disappear. The problem? Harsh skincare can disrupt your natural skin bacteria and damage your skin barrier—making acne even worse . Using a few gentle, pH-balanced products is a much better strategy.
Here’s the bottom line: studies show that the use of the oral contraceptive pill is strongly associated with acne .
But not all birth control pills are the same. Pills that contain the following androgenic hormones may cause or worsen acne :
– desogestrel and 3-cetodesogestrel
If you’re not sure what your oral contraceptive pill contains (and many women aren’t), look at the product information leaflet.
Other oral contraceptive pills can even improve acne, but only while you’re taking them. The acne often returns once you come off birth control.
So, what can do you? It’s simple: talk to your doctor. You should never stop taking medication because of something you read on the internet—this article included! Your doctor can discuss different birth control options with you. In the meantime, the dietary and lifestyle advice on this page will still support your skin.
The science behind hormonal acne is complicated, but the solutions are simple.
Here’s what you can do to support your skin and clear hormonal acne naturally:
a) Eat a low-GL diet
GL stands for ‘glycaemic load’. A low-GL diet is a fancy term for a way of eating based on complex carbohydrates, lean protein and healthy fats.
One study found that after 10 weeks of eating a low-GL diet, subjects not only had much less acne, but their pores were also smaller . That’s right—your diet can even shrink your pores!
A low-GL diet can be boiled down to two key principles:
i) Choose complex carbohydrates instead of refined carbohydrates
ii) Eat protein and/or healthy fat with every meal or snack
Let’s take a pasta meal as an example:
– A high-GL version would be white pasta with a sugar-laden, ready-made tomato sauce (lots of refined carbohydrate = angry skin)
– A low-GL version would be wholemeal or brown rice pasta, with a homemade tomato sauce, a drizzle of olive oil and a hearty side of cooked vegetables (complex carbohydrates + healthy fat = happy skin)
Or what about a snack?
– A high-GL version would be a store-bought fruit smoothie with added sugar (refined carbohydrate = angry skin)
– A low-GL version would be a fresh apple with a handful of nuts (complex carbohydrate + protein + healthy fat = happy skin)
You get the idea. Once you get into the habit of eating this way, it becomes effortless. And you’ll be amazed to see how your skin responds.
Bonus tip: Drink spearmint tea
Another cool fact: you don’t need to drink much to see an effect. Just two cups of spearmint tea daily are enough! For best effect, use loose leaf tea and make sure it’s covered while it’s brewing (this helps to keep all the goodness in).
Spearmint tea can be particularly helpful if PCOS is behind your hormonal acne.
b) Get selective about dairy
The internet is awash with people saying you need to give up dairy to clear your skin, but that’s not necessarily true for everyone.
Here’s what you need to know:
Cow’s milk seems to contribute to acne, and skimmed milk (or skim milk, for our American friends) is the worst culprit . Try swapping cow’s milk for plant-based milk instead and monitor your skin’s changes.
Ice cream is likely to contribute to acne because it’s a combination of milk and sugar. Sorry.
Cheese may or may not contribute to acne [12,13]. As a rule of thumb, harder, more aged cheeses may be better for your skin than soft cheeses. So, parmesan may be in, but cream cheese may be out. Experiment and see what works for you.
Yoghurt may or may not contribute to acne [12,13]. It may even enhance your skin through supporting your gut health . If you want to eat yoghurt, go for natural, live versions with no added sugar.
Butter is unlikely to be a key driver of acne, especially when eaten in moderation.
To add another layer to this, some people can also eat sheep or goat’s dairy without issue. Using a food-skin diary can be a powerful tool to notice patterns between types of dairy and breakouts. The Happy Skin Roadmap teaches you how to become your own food detective.
c) Prioritise your sleep
A single night of good sleep won’t do much—but consistently sleeping well can have a dramatic effect on your skin.
The secret is to improve your ‘sleep hygiene’. There are many ways to do this, but here are a few examples:
– Go to bed and get up at the same time every day, even if it’s the weekend
– Turn off all screens at least an hour before you go to bed
– Keep your phone out of your bedroom
– Have a wind-down ritual before bed, such as taking a warm bath, reading a good book or meditating
– Optimise your sleeping space with comfortable bedding, dimmed lights and a cool temperature
Which of these resonates most with you? Start there.
Clearing your skin isn’t an overnight job. But stick with it!
Your epidermis (the uppermost layer of your skin) regenerates every 40–56 days . That means it can take a few weeks to notice a shift, and around three months before you see a real difference .
Your expectations are important. If you know it will take a little time, you won’t give up just before things start to change. And they will!
d) Learn to destress
We can’t eliminate stress from our lives, but we can change how we respond to stressors. It all starts with knowing how to relax.
An easy way to relax is to practise deep, diaphragmatic breathing. Breathe in for a count of four, and then breathe out for a count of eight. Repeat this for 2–3 minutes.
This technique is simple yet surprisingly powerful. It works because it rapidly activates your parasympathetic nervous system via stimulation of your vagus nerve . Put more simply: deep breathing sends a signal to your body that it’s OK to relax. And as you know:
A relaxed body = lower stress hormones = calmer skin.
You can use this breathing technique during any moment you’re feeling stressed (notice how it immediately calms you down) or periodically throughout the day.
5) Reduce your toxic exposure
Just like you can’t eliminate stress, you can’t avoid all toxic substances. What you can do is make more skin-friendly choices. Here’s where to start:
Stop drinking and eating out of plastic containers. If necessary, invest in a stainless steel water bottle and glass Tupperware.
Go fragrance-free. The fragrances used in cosmetic and household products can disrupt your hormones . So, if you wear perfume every day, burn scented candles or use air fresheners in your home, now could be a good time to stop.
Filter your tap water. You can install a filter in your home or use a freestanding filter jug.
Choose organic food as much as you can, within the realms of your budget. Prioritise buying organic food in this order: meat, eggs and dairy, fruits and vegetables. Organic or not, wash all fruits and vegetables before eating.
Cook from scratch as much as possible. This will naturally reduce your intake of food additives.
The other side of the coin is learning how to optimise your body’s natural detoxification function. And I repeat: that does NOT mean going on a detox! You can learn more about that here.
Bonus tip: Use smart skincare
Certain skincare ingredients are especially helpful at soothing hormonal acne from the outside in. These include:
Zinc: this helps to control androgen activity in the skin and reduces sebum production . Look for zinc PCA in formulations.
Niacinamide: a form of vitamin B3, this has sebum-reducing and anti-inflammatory effects . Look for niacinamide, vitamin B3 or nicotinamide in formulations.
The dietary and lifestyle tips listed here are enough to see significant changes in your hormonal acne, and you should focus on these first. But if your skin needs a little extra support, these supplements can help:
Please note, if you’re pregnant or breastfeeding, or taking any medication, please check with your doctor before taking any new supplements.
a) Zinc: supplemental zinc can also help to reduce androgen activity in the skin , with several studies in humans proving its effectiveness at treating acne . Don’t take zinc on an empty stomach, as it can make you nauseous.
b) Berberine: this supplement helps to improve your sensitivity to insulin, stopping the acne-driving pathway at its source . One clinical trial found that berberine could reduce breakouts by almost a half in just four weeks . But berberine can also affect your gut bacteria, so don’t take it for longer than 6–8 weeks at a time.
c) DIM: this is a natural compound found in broccoli and other cruciferous vegetables. It too can reduce androgen activity , but it’s not suitable for everyone because it can also affect your oestrogen (estrogen) metabolism . It’s best to work with a practitioner if you’d like to take DIM.
d) Reshi: preliminary studies have shown that reishi mushroom can reduce androgen activity too . It’s not my first choice for hormonal acne, simply because more research in humans is needed.
You don’t need to take all these supplements. Choose one to start with and give it at least three months before judging its effect.
– Hormones don’t cause acne all by themselves. Diet and lifestyle factors trigger hormonal imbalance, which in turn aggravates your skin.
– The key hormones involved include insulin, IGF-1, androgens, and stress hormones.
– You can tell your acne is partly hormonal if it’s clustered around your mouth and chin, it flares with your period, and if your close family members have also suffered from acne.
– Root causes of hormonal acne include too much sugar, too much dairy, too little sleep, too much stress and too many toxins.
– Other factors to consider include food sensitivities, poor gut health and a damaged skin barrier.
– Solutions for hormonal acne include eating a low-GL diet, being selective about dairy, prioritising sleep, learning to destress, and reducing your toxic exposure. Drinking spearmint tea may also help.
– Supplements for hormonal acne include zinc, berberine, DIM and reishi, though you should focus on the dietary and lifestyle changes first.
– Skincare ingredients such as zinc, EGCG and niacinamide can help hormonal acne from the outside too.
Fiona Lawson is a former national magazine editor turned registered nutritionist and acne specialist. She holds a BANT-registered qualification in Nutritional Therapy, and she is currently working towards her MSc in Nutritional Medicine.