Everything you need to know about hormonal acne

Adult acne skincare and oral contraceptives to limit those breakout cycles—according to dermatologists.

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We’re here to tell you what we know, but don’t take it as medical advice. Talk to your medical provider about your specific health concerns.
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Here’s something many over-the-counter acne products won’t tell you: one of the biggest factors contributing to acne is hormones. Certain hormonal fluctuations cause glands in your skin to release more natural oil (called sebum), which collects in the pores and can contribute to acne. There are several factors that can cause these fluctuations—birth control, diet, hormonal therapy, or even your period (to name a few). 

In this guide, we’ll dig into how hormones can trigger acne and what steps you can take to help prevent a breakout.

What causes hormonal acne?

Acne is a common type of skin inflammation that appears when hair follicles clog with bacteria, oil and dead skin cells. Subtypes of acne include blackheads, whiteheads, fungal acne, cystic acne, and hormonal acne. 

Long story short: when certain hormone levels change, it can lead to pimples (including blackheads, whiteheads, and cysts).  Androgens (e.g. testosterone) and progesterone tend to cause acne flares. Meanwhile, high levels of estrogen can decrease the likeliness of breakouts.¹

Here are a few signs you have hormonal acne: 

  1. Breakouts appear primarily on the chin, cheeks, and jawline. 

  2. Breakouts might flare in response to hormonal cycles like menstruation and menopause. 

  3. Breakouts get better in response to oral hormonal treatments like spironolactone. 

  4. Breakouts might flare when starting hormone replacement therapy. 

  5. Breakouts get better (or, sometimes, worse) when using birth control. 

  6. Breakouts get better (or, sometimes, worse) in response to changes in your diet. 

Fun fact: treatments that don't affect hormones can still help hormonal acne!² That's because, no matter the trigger, acne is always caused by a combination of factors, including bacteria and clogged pores. (We'll explain more about hormonal acne treatments soon!).

Not-so-fun fact: androgens are a common contributing factor to adult acne. According to the Cleveland Clinic, 25% of adults in their 40s who identify as women experience hormonal acne.³ Because androgens aren't specific to any gender, anyone can experience breakouts as a result of hormonal changes. 

Hormonal Acne Face Map Curology Infographic

When oil production ramps up, so can breakouts. Closed comedones (aka whiteheads) and blackheads can result when a mix of excess sebum and dead skin cells get trapped in the pore. You might also experience other types of acne like pimples, pustules, and cysts.

One type of bacteria that normally lives on our skin, Cutibacterium acnes (or C. acnes), can irritate the skin when it feeds off the excess oil in a clogged pore. This inflammatory response is acne.⁴

Even after you stop your breakouts in their tracks, it still takes time to completely heal from acne (especially nodules and cystic acne lesions, which can be especially stubborn). Hormonal acne flare-ups can leave some with acne scars and post-inflammatory hyperpigmentation, too. Your Curology Custom Formula can be adjusted to help address your ever-changing skin's needs! 

Hormonal acne treatments

Topical skincare products can help treat hormonal acne, so long as they have the right ingredients. 

Some treatment options for hormonal acne include:

  • Topical retinoids like tretinoin and adapalene

  • Exfoliating treatments like chemical peels (AHAs and BHA)

  • Oral medications like isotretinoin, spironolactone, and birth control ortho tri-cyclen 

We recommend using a simple routine with a non-comedogenic cleanser, moisturizer, and acne treatment. Basic sun safety and proper sunscreen use is a must, too.

Hormonal imbalances, explained 

Hormonal fluctuations can come from medications, stress, and even the day-to-day of normal life. Increased androgens can stimulate your oil glands to create excess sebum. That means you're more likely to experience oily skin, and, unfortunately, zits.⁵ 

It's normal to experience fluctuating hormones throughout your menstrual cycle and menopause. It can also be triggered when taking certain medications (like birth control). Some hormonal imbalances can be triggered by medical conditions like polycystic ovary syndrome (PCOS), which requires in-person medical attention. 

Androgens may have a more noticeable impact on women right before, during, and after their periods (aka during the perimenstrual period).⁶,⁷ When triggered, sebaceous glands ramp up your skin's oil production. Sebum may then mix with dead skin cells still in the opening of the hair follicle, clogging your pores. 

Birth control

While topical treatments can help with breakouts, sometimes we need to directly treat the hormonal aspect of acne, too. Birth control is one option (for women) that can help stop androgens from jump-starting acne vulgaris.⁸ But this isn’t the rule— different hormonal contraceptives may improve or worsen acne, depending on the hormone(s) involved. 

Hand holding purple pill against an orange and peach calendar with other purple pills against a gray neutral background

If birth control pills are your method of contraception, the best ones for acne are generally considered to be combined oral contraceptives that contain estrogen.⁹ These oral contraceptives don't influence sebum production the way birth control pills that tend to trigger acne do. 

Spironolactone

If you’ve struggled with your hormonal acne and other lifestyle changes haven’t made a difference, spironolactone may be an option. Spironolactone is a mild diuretic pill often used for treating high blood pressure. It can also limit how much oil your glands release into the pores, making it a good hormonal acne treatment option. 

It does have some downsides, though. For one, its anti-androgen mechanism also blocks testosterone, so it’s generally not an option for those assigned male at birth. It's also not safe for pregnant women. It has a few other side effects that might not make it a good option for you. 

Spironolactone is a prescription-only oral acne treatment. Ask your in-person medical provider if they think spironolactone can help your hormonal acne. 

Hormonal therapy

Hormone replacement therapy can change your testosterone levels, impacting your skin. According to the Journal of the American Academy of Dermatology, this can either help your breakouts, or potentially make them worse.¹⁰ 

  • Feminizing hormones (i.e., estrogen) tend to improve skin conditions like acne.

  • Masculinizing hormones (i.e., testosterone) tend to worsen breakouts.  

For trans patients undergoing a masculinizing hormone treatment, severe acne can happen. Severe acne can be successfully treated with isotretinoin.¹¹ For less severe acne flares, over-the-counter ingredients like salicylic acid and benzoyl peroxide can help. 

Hormonal acne and diet

Two types of foods are known to be potential acne triggers in some people: 

  1. High glycemic index foods increase insulin levels, a hormone which is linked to androgen release and sebum production.¹² These foods may also lead to blood sugar spikes and inflammation.¹³

  2. Dairy products may increase androgen levels in some peoples, which can increase sebum production.¹⁴   

Full gallon jug of milk with a white and red straw against a gray neutral background

Here’s a surprising tip: relief might come from a cup of tea! There is some evidence that two cups of spearmint tea per day can reduce the levels of androgens that trigger acne.¹⁵ Because spearmint tea can theoretically decrease testosterone, it’s not recommended for men or pregnant women.

Want to try it? Drink your two cups per day, but don’t overdo it—too much can be harmful. If you're more of a coffee drinker, you could consider spearmint supplements instead. You can also try these skin-friendly fruits and veggies:

  1. Kiwis

  2. Peaches

  3. Nectarines

  4. Plums

  5. Cherries

  6. Red pepper

  7. Kale

  8. Mushrooms

  9. Chickpeas

Some other foods that aren’t known to trigger breakouts include lean meats, eggs, tofu, barley, quinoa, and rolled oats. (Is anybody else getting hungry...?)

Life can be chaotic and unpredictable, just like breakouts. Stress is a hormonal response, and it can indirectly lead to both acne.¹⁶,¹⁷ Because we'll all feel stressed at one point or another, mindful self-care is a good idea to help maintain your overall chill. 

The best thing about self-care routines is that they’re unique to you! But, sometimes, it can be hard to heal on our own. Remember that other people are here to help and support you in your mental health journey. 

If you need help right now, these resources are free:

  • Mental Health America

  • National Suicide Prevention Lifeline  (800-273-8255): a 24/7 confidential hotline to support people in emotional distress.

  • SAMHSA (800-662-4357):  a 24/7 confidential hotline to support people in substance abuse recovery. 

  • Crisis Textline (741741): text a crisis counselor to get immediate help, even when you can’t make a call. 

  • Psychology Today: search online to find a therapist or psychiatrist licensed to practice in your state—many have sliding scales and offer telehealth visits!

  • Apps like BetterHelp or Talkspace

FAQs

What triggers hormonal acne?

When certain hormone levels change, it can lead to pimples. Testosterone and progesterone tend to cause acne flares. Meanwhile, high levels of estrogen can decrease the likeliness of breakouts. Hormonal fluctuations can come from medications, stress, and even the day-to-day of normal life. It's normal to experience fluctuating hormones throughout your menstrual cycle and menopause. It can also be triggered when taking certain medications (like birth control). Some hormonal imbalances can be triggered by medical conditions like polycystic ovary syndrome (PCOS), which requires in-person medical attention.

How do I get rid of hormonal acne?

Topical skincare products can help treat hormonal acne, so long as they have the right ingredients. Some treatment options for hormonal acne include:

  • Topical retinoids like tretinoin and adapalene

  • Exfoliating treatments like chemical peels (AHAs and BHA)

  • Oral medications like isotretinoin, spironolactone, and birth control ortho tri-cyclen  

We recommend using a simple routine with a non-comedogenic cleanser, moisturizer, and acne treatment. Basic sun safety and proper sunscreen use is a must, too.

How do you know if acne is hormonal?

Here are a few signs you have hormonal acne: 

  1. Breakouts appear primarily on the chin, cheeks, and jawline. 

  2. Breakouts might flare in response to hormonal cycles like menstruation and menopause. 

  3. Breakouts get better in response to oral hormonal treatments like spironolactone. 

  4. Breakouts might flare when starting hormone replacement therapy. 

  5. Breakouts get better (or, sometimes, worse) when using birth control. 

  6. Breakouts get better (or, sometimes, worse) in response to changes in your diet.

Does Curology work on hormonal acne?

Even if your breakouts are in a hormonal pattern, topical treatments such as Curology are still helpful to ensure you are treating the multiple factors that play a role in causing your breakouts. However, if topical treatment just doesn’t seem to be enough, you may want to try another option such as dietary changes or an oral medication like birth control.

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Curology was founded in 2013 by Dr. David Lorschter, MD, a board-certified dermatologist. You tell us about your skin and one of our dermatology providers will consult with you about your skincare routine. If Curology is right for you, we’ll prescribe you a Custom Formula with a mix of ingredients chosen for your unique needs. 

Get your personalized skincare routine with Curology

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PS. We did the research so you don't have to.

  1. Elsaie M. L. Hormonal treatment of acne vulgaris: an update. Clinical, cosmetic and investigational dermatology. (2016).

  2. Elsaie M. L. Hormonal treatment of acne vulgaris: an update. Ibid.

  3. Cleveland Clinic. Hormonal Acne. (n.d.).

  4. Toyoda, M., & Morohashi, M. Pathogenesis of acne. Medical electron microscopy : official journal of the Clinical Electron Microscopy Society of Japan. (2001).

  5. Elsaie M. L. Hormonal treatment of acne vulgaris: an update. Ibid.

  6. Geller, L., Rosen, et al. Perimenstrual flare of adult acne. The Journal of clinical and aesthetic dermatology. (2014).

  7. Raghunath, R. S., et al. The menstrual cycle and the skin. Clinical and experimental dermatology. (2015).

  8. Geller, L., Rosen, et al. Perimenstrual flare of adult acne. Ibid.

  9. Zaenglein, A. L., et al. Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology. (2016).

  10. Dhingra, N., et al. Medical and aesthetic procedural dermatology recommendations for transgender patients undergoing transition. Journal of the American Academy of Dermatology. (2019).

  11. Turrion-Merino, L., et al. Severe Acne in Female-to-Male Transgender Patients. JAMA dermatology. (2015).

  12. Elsaie M. L. Hormonal treatment of acne vulgaris: an update. Ibid.

  13. American Academy of Dermatology. Can the righ diet get rid of acne? (n.d.).

  14. Adebamowo, C. A., et al. High school dietary dairy intake and teenage acne. Journal of the American Academy of Dermatology. (2005)

  15. Grant, P., & Ramasamy, S. An update on plant derived anti-androgens. International journal of endocrinology and metabolism. (2012).

  16. Chiu, A., et al. The response of skin disease to stress: changes in the severity of acne vulgaris as affected by examination stress. Archives of dermatology. (2003).

  17. Yosipovitch, G., et al. Study of psychological stress, sebum production and acne vulgaris in adolescents. Acta dermato-venereologica. (2007).

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• • •
Our medical review process:We’re here to tell you what we know. That’s why our information is evidence-based and fact-checked by medical experts. Still, everyone’s skin is unique—the best way to get advice is to talk to your healthcare provider.
Nicole Hangsterfer Avatar

Nicole Hangsterfer, PA-C

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