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5 Hormone Imbalances that Cause Acne

woman hiding under sheet who is wondering what hormone imbalance is causing her acne
Wondering what hormone imbalances are causing your acne?


Acne: More than Just a Cosmetic Problem

Acne affects about 85% of young adults between the ages of 12 and 25 years old.  This makes it consistently one of the top three skin conditions that affect the general population.  Pimples aren’t just a problem for teenagers though.  50% of women 30-39 and 35% of women 40-49 still deal with these skin issues.  Acne is more prevalent in women than in men.  Aside from the obvious cosmetic effects, breakouts a clue that there are deeper metabolic problems and hormonal imbalance. 

Did you know that there is more than one hormone imbalance that can cause acne?

It is easy to assume that pimples are the result of too much testosterone, but testosterone isn’t the only game in town when it comes to your skin.  In fact, one study found that 55% of women with acne had at least one high androgen, or male hormone.  That means that 45% of them didn’t have high androgens.  Here are the hormones that cause or contribute to acne:


Acne in women beyond puberty is considered to be caused by too much testosterone.  Testosterone is a male-type hormone, but women do make it too.  In some cases, much more than they should.

Symptoms of testosterone-based acne: Acne on the face on the jawline, chin, neck or cheeks, deep, painful cystic pimples, breakouts on your chest or back, excess facial or body hair, and irregular periods.  Cystic acne is also more prone to scarring.  

What causes high testosterone? In most cases, testosterone levels increase due to excess insulin.  High insulin is the result of carbs and sugar in your diet, lack of exercise and/or high stress.

How to Reduce Testosterone

Because excessive production of testosterone is induced by insulin, the goal is to reduce insulin levels.  Making some dietary changes, reducing stress, and implementing some exercise are all effective ways to lower insulin and therefore testosterone.  In addition, we can use vitamins, minerals and herbs to improve insulin sensitivity and lower testosterone.  


DHEAs is a weaker, male-type hormone, that can act similarly to testosterone, but its effects are milder.  Therefore, the symptoms of high DHEAs-based acne are the same as for testosterone. Although, because DHEAs is a weaker hormone, the symptoms may be relatively mild.

The cause of high DHEAs is the same as the cause of high testosterone.  Carbs and sugar intake, lack of exercise and high stress all contribute.

To fix pimples caused by high DHEAs, the treatment would be similar to that for testosterone-related acne.  

Dihydrotestosterone (DHT)

Dihydrotestosterone or DHT is a potent form of testosterone.  It binds to testosterone receptors more easily and once it does, it stays in the receptor 2-3 times longer.  As a result, it is stronger than regular testosterone.  Regular testosterone gets converted to DHT by an enzyme known as 5 alpha reductase.  Insulin increases the activity of this enzyme, leading to more DHT.   Another hormone, progesterone, helps to block this activity.  

Acne caused by DHT can be severe, cystic and may affect the face, chest and/or back.  Other signs of high DHT include hair loss, excess hair and irregular periods in women, hair loss and prostate problems in men.  

Fixing pimples that are caused by DHT, involves reducing insulin similarly to how we would for testosterone. It also entails ensuring a healthy balance of progesterone.  


Having a balance between estrogen and progesterone before your period helps to prevent premenstrual acne.  An imbalance between these two hormones is what contributes to premenstrual acne.  This occurs either because lower progesterone isn’t balancing estrogen, or because progesterone helps to block the conversion of testosterone to DHT.  

There are a couple of more rare conditions that involve progesterone and acne.  Autoimmune progesterone dermatitis causes pimples that come and go a few days before the menstrual cycle and stops in the first few days of the period.  It is associated with other problems like eczema, hives and swelling.  Congenital Adrenal Hyperplasia (CAH) is a genetic condition where the adrenal glands make high levels of androgens.  CAH can cause severe acne.  Even in a genetic disorder like CAH, eating cleanly and exercising help to moderate androgen levels.  


Excessive levels of estrogen also cause skin problems.  In this type of acne, symptoms are often worse around midcycle or ovulation.  Estrogen-related outbreaks often affect the forehead.  Midcycle is when estrogen reaches its peak.  Other symptoms associated with estrogen excess pimples are very heavy periods and bad cramping or dysmenorrhea

The cause of high estrogen is either increased production due to the effect of insulin on the enzyme that makes estrogen (aromatase) or inefficient liver removal of estrogen.  In either case, I can help through diet and lifestyle interventions, vitamins, minerals and herbs.  

Because these hormone imbalances are an internal problem, I find that topical solutions like acne creams, cleansers and lotions rarely work, at least not for very long.  Makeup and birth control pills mask the problem but don’t address the root of it.  I can help identify the specific source of your skin problems through extensive hormone testing and fix it through natural hormonal optimization.  

By Dr Pamela Frank, BSc(Hons), ND

Picture of Toronto Naturopath Doctor Dr. Pamela Frank, Best Naturopath in Toronto many times over
Dr. Pamela Frank, BSc(Hons), Naturopathic Doctor

Dr. Pamela has practiced as a naturopathic doctor in Toronto since 1999. She has received numerous “Best Naturopath in Toronto” awards. She is registered with the College of Naturopaths of Ontario.

Dr. Pamela Frank uses a natural treatment approach that may include acupuncture, herbal medicine, nutrition, diet, vitamins, supplements, and other natural remedies to restore balance and provide long-term resolution to almost any health problem.


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