Is Your Acne Hormonal? If So, Here's How To Improve It!

Is Your Acne Hormonal? If So, Here's How To Improve It!

This guest blog post was written by functional medicine dietitian nutritionist, Robyn Johnson, MS, RDN, LD, CLT.

Disclaimer: the information in this article is for educational purposes only and is not designed to replace individualized recommendations from a practitioner. Always check with your doctor before adding supplements or making changes to your treatment plan.

Feel like you’re 30 going on 13 with hormonal acne? You’re not alone.

Adult acne affects 45% of women ages 21-30 and 26% of women ages 31-40. While there are causes beyond hormones, like inflammatory acne and topical irritants, in this article, we’re going to hone in on the hormonal type.

Every year, thousands of dollars are spent on topical creams, medications, facials, and other treatments to address acne but it’s less often that people look inward. Hormonal imbalances are a common culprit for acne.

How do you know if you have hormonal acne or if there’s another cause? Read on to find out!

"Individuals with acne use up the body’s antioxidant stores at a faster rate."

Hormonal Acne 101


Although acne can occur for many reasons, here are some common signs that your acne is hormonal in nature.

      • You get pre-period acne.
      • Acne gets worse when eating more sugar, dairy products, or soy-based foods.
      • Testing confirms androgens or 5-DHT are in the upper range.
      • You have symptoms or testing of low estrogen or poor estrogen metabolism.
      • You have high blood sugar or insulin levels
      • You have PCOS (a condition often linked with high androgens).
      • Acne appears after stopping birth control.


Stick with me here as we get a little science-y to explain how exactly hormones can cause acne.

It really comes down to the ratios of estrogen-to-testosterone and progesterone-to-testosterone.

Androgens (like testosterone) are often defined as male sex hormones, but women have them too, just in much lower quantities. With hormonal acne, DHEA, DHEAS, and androstenedione act as precursors to testosterone and DHT. In women, DHEA is produced from the adrenal glands (think stress).

Our skin contains enzymes for converting these precursors to testosterone and DHT and these both stimulate skin cell growth and sebum production. Testosterone and DHT can cause acne because they increase the size and activity of the sebaceous glands (aka, they boost oil production in the skin).


During the first half of the cycle, estrogen balances the effects of testosterone and keeps sebum production under control. During the second half of the cycle, estrogen levels decrease and progesterone levels increase.

Estrogen reduces sebum production, which is a good thing. Without the balancing effect of estrogen, testosterone stimulates the sebaceous glands to produce more oil. You’ll see information regarding high estrogen causing acne, but in those cases, it’s usually the other root causes impacting estrogen metabolism that factor in— not the estrogen itself. Other symptoms that often present with high estrogen tend to be the real culprits that cause acne.

Examples include:

      • Poor blood sugar control.
      • Inflammation.
      • Gut bacteria imbalance.
      • Poor liver detoxification.
      • High stress levels.

Progesterone helps regulate testosterone metabolism. It blocks 5a-DHT and blocks estrogen activity in the skin. Some research suggests that too much progesterone can trigger acne, so the exact relationship is still somewhat unclear.

The end result of these hormonal fluctuations is that the skin becomes oily and you are more likely to get acne. Therefore, when either of these hormones (estrogen or progesterone) are too low in relation to testosterone or when progesterone is too high (in relation to testosterone), acne can arise.

Recommended Testing

The best test is the DUTCH Complete which will assess DHEA, androgens, estrogen metabolism, progesterone levels, and cortisol.
If that’s not a viable option for you, speak with your doctor and ask for the following:
      • Progesterone, Estrogen, DHEA-S (7 days after ovulation), Free Testosterone, SHBG, FSH and LH, Prolactin
      • hs-CRP
      • Hemoglobin A1c, Fasting Glucose & Fasting Insulin
      • IGF-1
      • Zinc, Serum

Six Tips to Improve Hormonal Acne

Now that you know more about the common signs and causes of hormonal acne, read on to learn about how to improve hormonal acne, naturally.

Ensure You’re Ovulating


Regardless of when acne occurs, the first step is to ensure you’re ovulating, as that is when hormones are produced in the first place.

This can be done with lab testing or temperature tracking, tracking cervical mucus, and cervix changes. Learn more about this here.

Test And Address High Androgens or Poor Metabolism


If androgens or 5a-DHT are confirmed to be high, consider dietary changes and additional nutrient support, which are covered in the following section.

Dairy is known to increase IGF-1, which then increases testosterone.

For additional DHT metabolism support, ask your doctor about:
    • Saw Palmetto
    • DIM
    • Nettles
    • Reishi Mushroom
Trial A Sugar, Cows Dairy, and Soy Elimination Diet


These are foods that can impact the various mechanisms discussed in the Hormonal Acne 101 section above.

Trial an elimination diet for 6-12 weeks to see if improvements occur.

Include Healthy Fats In Your Diet


Fat is essential to hormone production and is necessary in order to form the skin’s protective barrier, retain moisture, and aid in cellular repair.

FOCUS ON anti-inflammatory fats:
      • Extra Virgin Olive Oil
      • Avocados
      • Nuts/Seeds
      • Coconut Oil
      • Butter or Ghee
AVOID inflammatory fats:
      • No Canola Oil
      • No Peanut Oil
      • No Sunflower Oil
      • No Vegetable Oil
      • No Soybean Oil
      • No Margarine
      • No Corn Oil
Boost Your Antioxidant Intake

Studies comparing blood antioxidant levels between people with and without acne found individuals with acne had significantly less antioxidant loads. When compared, people with acne had lower levels of these four antioxidants:

      1. Beta-carotene: 65% lower
      2. Vitamin E: 45% lower
      3. Vitamin C: 40% lower
      4. Vitamin A: 33% lower

To compensate for the higher demand of antioxidants in the skin, individuals with acne use up the body’s antioxidant stores at a faster rate.

Be sure to include a variety of fruits and vegetables to ensure you’re replenishing your antioxidant load.

Address Nutritional Insufficiencies

The next section covers the key nutritional insufficiencies that must be addressed to improve hormonal acne.

Nutritional Insufficiencies to Address

1. Zinc

How it Helps: This trace mineral helps to reduce inflammation and boost immune function which can help prevent the likelihood of acne from bacteria and decrease the redness/irritation associated with it. Zinc is also key for adequate hormone production and helps block 5a-DHT production.

Nutritional Sources: Oysters, animal proteins, pumpkin seeds, sesame seeds, lentils/beans.

To Supplement: Take 15-30mg per day.

2. Magnesium

How it Helps: This mineral helps regulate inflammation, and it supports the nervous system, thyroid and sex hormones. It also helps to keep blood sugar stable.

Nutritional Sources: Dark leafy greens (spinach, chard, kale, beet greens), dark chocolate, seeds (sesame, pumpkin, sunflower), black beans.

To Supplement: Take 200-800 mg/day.

3. Vitamin E

How it Helps: Vitamin E is a major antioxidant in the skin. It’s transported to the skin via oil. Studies have shown vitamin E flows more to areas of the skin that produce more oil (like the cheeks).

Nutritional Sources: Sunflower seeds, almonds, spinach, swiss chard, avocado, turnip greens, beet greens, asparagus, tocos powder.

To Supplement: Take 400-600 IU/day of mixed tocopherols (not just alpha).

4. Vitamin C

How it Helps: The role of vitamin C in skin health has been under discussion since the 1930s as the remedy for scurvy. This antioxidant protects the skin from oxidative stress. Some research suggests the bioavailability of vitamin C in the skin is inadequate when it is administered orally. The use of topical vitamin C is therefore preferred in some practices of dermatology.

Nutritional Sources: Camu Camu, papaya, bell peppers, broccoli, brussels sprouts, strawberries, pineapple, oranges, kiwi, cantaloupe, cauliflower.

To Supplement:

    • Oral vitamin C: 750 - 1000 mg per day (based on bowel tolerance).
    • Topical Brand: Eva Naturals Topical Vitamin C.

Seeking Help

In need of some professional help to address your acne?

Here are two resources for finding functional medicine practitioners who will help you address the root cause of acne:

Robyn Johnson (MS, RDN, LD, CLT) is a Functional Medicine Dietitian Nutritionist. Her passion for using food and lifestyle as medicine found her after a personal battle, and triumph, with psoriasis. She specializes in helping women optimize their health & hormones by finding the root cause of their symptoms. Robyn runs a virtual private practice and is the co-creator of Her Hormones Academy, an online program for women who want to improve their health and hormones with food and lifestyle. Robyn believes healthcare should be individualized, and that starts with each person understanding how their body works and what their body needs to truly thrive!

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