Acne


Acne is not just a teenage skin issue—it is often a hormone-driven condition, especially in adult women and men with androgenic imbalances.

Hormonal acne tends to be persistent, inflammatory, and resistant to over-the-counter treatments unless the underlying hormonal triggers are addressed.


 What Causes Hormonal Acne?

Elevated androgens Increase sebum (oil) production, clogging pores

Increased DHT sensitivity

Skin cells are more reactive to normal testosterone levels

Polycystic Ovary Syndrome (PCOS)

Common cause of androgen excess and acne in women

Menstrual cycle fluctuations

Estrogen/progesterone drops trigger breakouts before periods

Stress and cortisol

Can increase androgen production and worsen acne


  Who Is Affected by Hormonal Acne?

 Females:

  • Jawline, chin, and lower cheeks most affected
  • Worsens before periods
  • Often associated with irregular cycles, hirsutism, or PCOS
  • May persist into 30s and 40s

 Males:

  • Often due to high testosterone or anabolic steroid use
  • Can appear on face, chest, shoulders, and back
  • Persistent in those with androgenic alopecia or excess DHT activity


    Oral Contraceptives (for women)

Certain combined estrogen-progestin birth control pills can reduce androgen levels and acne:

  • FDA-approved: Yaz, Ortho Tri-Cyclen, Estrostep
  • Best for women with irregular cycles or PCOS


  Topical Treatments

Retinoids (tretinoin, adapalene) Promote cell turnover, prevent clogged pores

Benzoyl peroxide Kills acne-causing bacteria

Azelaic acidAnti-inflammatory, anti-comedogenic

ClindamycinTopical antibiotic (often combined with BP)


   Oral Antibiotics (short-term use only)

Used for moderate to severe inflammatory acne, usually limited to 3–6 months.


 Isotretinoin (Accutane)

  • Reserved for severe, cystic, or treatment-resistant acne
  • Reduces sebum, shrinks oil glands, and alters follicle lining
  • Requires monthly labs and strict contraception for women of childbearing age


 Vitamins and Supplements for Acne

Zinc (15–30 mg) Reduces inflammation, antibacterial,

DHT blocker

Vitamin A Retinoid precursor, supports skin turnover

Vitamin D Anti-inflammatory and immune modulator

DIM Supports estrogen metabolism, useful in PCOSO

mega-3s Reduces inflammation and androgen effects

Probiotics Gut-skin axis support.


Summary

Hormonal acne—especially in adult women or men with high androgens—requires a root-cause approach. Treatment often involves balancing hormones, short-term antibiotic support, and long-term topical regimens, with diet and nutrient optimization playing a critical role in prevention. Spironolactone, birth control, and retinoids remain key therapies, with alternatives like DIM and lifestyle changes providing natural support.

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