As annoying as they can be, pimples are a part of life for most of it—statistically, most people will deal with acne in their lives.¹ It often begins during early adolescence as a result of hormonal shifts in a rapidly changing body. In those assigned female at birth, estrogen levels usually spike during this time. In those assigned male at birth, it’s testosterone that spikes and can trigger an overproduction of the skin’s natural oil (sebum).
Teens and adults of both assigned sexes carry certain amounts of the same hormones, but at varying levels.² So, what exactly is testosterone? And does testosterone cause acne? Read on for a rundown of this hormone, what the body uses it for, and how it can affect your skin.
Testosterone (part of a group of hormones called androgens) is the main male reproductive hormone. It’s responsible for the primary physical and sexual development of males.³ It also regulates secondary masculine characteristics, such as body hair, muscle mass, and bone density. Females also produce testosterone, but usually at lower levels compared to estrogen.⁴
Estrogen (the female counterpart to testosterone) is a hormone responsible for developing female sexual characteristics.⁵ Just as females produce some testosterone, males produce estrogens (but at lower levels).⁶ Both sex hormones are necessary for both male and female bodies to function properly.
Testosterone influences sebum, an oily substance that keeps your skin lubricated.⁷ Sometimes the body’s production of testosterone goes into overdrive—during male puberty, for example—which can cause a spike in sebum production that may clog pores and lead to acne.
A number of different factors—biological and otherwise—can cause testosterone levels to change throughout a person’s life. Understanding these shifts may help you to better prepare for the chance of hormonal acne.
Puberty is probably the most common hormonal shift that everyone goes through! However, males in particular experience almost a 30-fold increase in testosterone production during puberty.⁸
Stress can be psychological, emotional, physical, or even anticipatory (when you get stressed out about something that hasn’t happened yet). There is increasing evidence that stress is a factor when it comes to breakouts.⁹ However, with regard to testosterone, one study noted that prolonged stress can actually lead to lower testosterone concentrations in men.¹⁰
Hormone fluctuations, including testosterone, are common at times during the menstrual cycle.¹¹ The purpose of this cycle is to prepare the uterus for pregnancy, and it resets approximately once every 28 days. Hormones, including testosterone, regulate all of this activity and it has been found that a significant number of adult women have acne during this time.¹²
Certain medical conditions might require hormone therapy. That’s just a fancy way of saying your doctor or healthcare provider has determined that an issue you’ve been experiencing is related to a hormonal imbalance. Testosterone treatment is an increasingly popular option for men as they age and their natural testosterone levels drop.¹³
Another instance where testosterone therapy is often utilized is in the physical transition of a transgender man (transitioning from feminine-presenting to masculine-presenting).¹⁴ Hormone therapy can result in physical changes that help the body align with a person’s gender identity. It has been suggested that testosterone therapy can increase acne, though the severity can vary from person to person.¹⁵
As acne is caused by many factors, topical treatment for hormonally influenced acne is similar to other acne treatments. The best way to tackle any type of acne is, of course, a skincare routine that involves proper washing with gentle cleansers, as well as using skincare and makeup products labeled as “non-comedogenic” (which means they won’t clog your pores).
Overwashing your skin can dry your skin out and potentially cause more problems. It’s also important not to scrub your skin, as this may cause more irritation and make your acne worse.¹⁶ And do NOT try to pop or squeeze acne (as tempting as it may be!). You can push bacteria deeper into your skin and cause further inflammation, infection, or scarring.
Topical treatments containing benzoyl peroxide or salicylic acid can also be helpful in managing hormonal acne. They aren’t just for your face, either. Curology has created a salicylic acid body wash to fight acne on your back, neck, chest, and shoulders.
You can try to reduce sebum production by using the proper skincare mentioned above, but you can also change aspects of your diet or practice de-stressing techniques (to potentially reduce cortisol). That said, too much sebum can cause oily skin and clogged pores, but too little can lead to dry, cracked skin and a host of other problems.
In some cases, especially with persistent acne that’s resistant to traditional treatments, a dermatology provider might determine that your hormonal acne needs a different approach. One such treatment option is spironolactone, a prescription-only medication available in pill and topical forms.
Hormonal acne can affect anyone at any age. Still, it can be a frustrating experience, especially if it feels like traditional treatments don’t work. It does take some time and patience, but hormonal acne can be effectively treated with direction from a dermatology professional.
Whether you’re dealing with hormone-related acne, rosacea, signs of aging, or hyperpigmentation, Curology’s team of licensed dermatology providers is here to help you improve your skincare game.
Started in 2014 by a board-certified dermatologist, Curology aims to increase access to dermatology care for conditions like acne. If your other treatments aren’t working, one of our dermatology providers can create a personalized prescription formula to help you tackle your skin goals. If you experience hormonal acne, Curology’s licensed dermatology providers may also prescribe you an oral or topical spironolactone treatment (if appropriate for you).
You just need to answer some questions about your skin and snap a few selfies to get started on your skincare journey today.*
Not necessarily. Acne is caused by a number of factors. Hormones do play a part, but so do other factors (i.e., bacteria, clogged pores, etc.).
Acne is multifactorial, so both contributing factors are often involved! It can be difficult to know for sure, but hormonal acne can be seen during times when your body is changing physically, such as puberty or pregnancy.
There’s no exact time frame because everyone’s body is different, but acne from testosterone or other hormonal fluctuations will usually clear up with proper treatment and care. As with all acne treatments, patience is key.
American Academy of Dermatology Association. Skin Conditions by the Numbers. (n.d.).
Endocrine Society. Reproductive Hormones. (2022, January 24).
Nassar, G.N. and Leslie, S.W. Physiology, Testosterone. National Library of Medicine. (2022, January 4).
Davis, S.R. and Wahlin-Jacobsen, S. Testosterone in women – the clinical significance. The Lancet Diabetes & Endocrinology. (2015, September 7).
Delgado, B.J. and Lopez-Ojeda, W. Estrogen. StatPearls. (2022, June 28).
Schulster, M., et al. The role of estradiol in male reproductive function. Asian Journal of Andrology. (May-June 2016).
Makrantonaki, E., et al. An update on the role of the sebaceous gland in the pathogenesis of acne. Dermato-endocrinology. (January-March 2011).
Duke, S.A., et al. Testosterone and Its Effects on Human Male Adolescent Mood and Behavior: A Systematic Review. Journal of Adolescent Health. (2014, n.d.).
Balic, A., et al. The Impact of Psychological Stress on Acne. Acta dermatovenerologica Croatica. (July 2017).
Kyrou, I. and Tsigos, C. Chronic stress, visceral obesity and gonadal dysfunction. Hormones (Athens). (October-December 2008).
Bui, H.N., et al. Dynamics of serum testosterone during the menstrual cycle evaluated by daily measurements with an ID-LC-MS/MS method and a 2nd generation automated immunoassay. Steroids. (January 2013).
Geller, L., et al. Perimenstrual Flare of Adult Acne. J Clin Aesthet Dermatol. (August 2014).
Yabluchanskiy, A. and Tsitouras P.D. Is Testosterone Replacement Therapy in Older Men Effective and Safe? Drugs & Aging. (November 2019).
Park, J.A., et al. Risk factors for acne development in the first 2 years after initiating masculinizing testosterone therapy among transgender men. Journal of the American Academy of Dermatology. (August 2019).
American Academy of Dermatology Association. 10 Skin Care Habits That Can Worsen Acne. (n.d.).
Laura Phelan is a board-certified Family Nurse Practitioner at Curology. She earned her Masters of Science in Nursing at Benedictine University and went on to get her post-master’s certificate as a Family Nurse Practitioner at the University of Cincinnati.
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Laura Phelan, NP-C