Hormonal acne is acne that moves with your cycle and often appears along the jawline, chin and neck. The cause usually lies with androgens, male hormones that make the sebaceous glands more active. Three values often give the most insight here: total testosterone, DHEA-S and SHBG.
I notice that women with hormonal acne often go from one cream to the next without result. That makes sense, because if the cause comes from within, a product on the skin only helps to a limited degree.
Below you read how to recognise hormonal acne, which hormones are involved, which values give insight and when testing is useful.
How do you recognise hormonal acne?
Hormonal acne stands out by its location and timing: often deep, tender spots along the lower jaw, chin and neck, which appear around your period. Unlike teenage acne, this form often responds poorly to usual acne products.
Features that point to a hormonal cause:
- Spots mainly along the jawline, chin and neck
- Flaring up around your period or in the second half of your cycle
- Deep, tender bumps rather than surface blackheads
- Acne that returns despite a good skincare routine
Does the acne come together with excess hair growth or an irregular cycle? Then it is useful to look further, because that combination can point to too many androgens.
Which hormones play a role in acne?
With hormonal acne it mainly comes down to androgens. A higher testosterone or a low SHBG, which makes more testosterone freely available, can stimulate the sebaceous glands. DHEA-S shows whether the adrenal glands have a share in the androgens.
The three values that usually say the most about this:
- Total testosterone, the general degree of androgens
- SHBG, because a low SHBG makes more testosterone freely available
- DHEA-S, which points to a share from the adrenal glands
No single value proves on its own that your acne is hormonal. It is about the pattern, together with your complaints and the location of the acne.
Hormonal acne and PCOS
Acne along the jawline is one of the best-known signs of too many androgens, and that often fits PCOS. If the acne comes together with an irregular cycle and excess hair growth, that can point to the PCOS picture.
In PCOS you often see a raised testosterone with a low SHBG, sometimes with excess hair on face or body. See also our PCOS pillar on symptoms, causes and diagnosis if you recognise both.
Are you unsure where your complaints come from? Then read our pillar on irregular periods and which hormones to test.
When is testing useful?
A hormone test is mainly useful when your acne moves with your cycle and goes together with other complaints such as hair growth, hair loss or an erratic period. With mild acne without other signals, the cause more often lies with the skin itself.
Consider a check if you recognise this:
- Stubborn acne along the jawline that does not respond to usual products
- Acne together with excess hair growth or hair loss
- An irregular cycle alongside your skin complaints
The Hormones Women panel measures testosterone and SHBG among others in one draw. Do you mainly have thinning hair alongside acne? Then read which hormones to test for hair loss.
What can you do yourself?
Alongside a good skincare routine, attention to your whole lifestyle can help, though the effect differs per person. Stable blood sugar, enough sleep and stress management seem to make a difference in some women. As for the skin, patience matters, because you often only see an effect after weeks.
Steps that can help:
- A mild, steady skincare routine without too many different products
- Attention to stress and enough sleep
- Food that keeps your blood sugar steadier
If the complaints persist or are severe, discuss them with your GP or a dermatologist. You always discuss an abnormal blood value with a doctor, because they can place the whole picture.
Frequently asked questions
Does hormonal acne mean I have PCOS?
Not automatically. Acne can be a sign of too many androgens, but only combined with an irregular cycle or excess hair does it point towards PCOS. A doctor assesses the whole picture.
Which hormone causes acne in women?
Androgens, especially testosterone, often play a role. A low SHBG makes more testosterone freely available, and DHEA-S shows a contribution from the adrenal glands. It is about the pattern, not one value.
When in my cycle do I have my hormones tested?
For androgens such as testosterone, SHBG and DHEA-S, the timing is less strict than for cycle hormones. If you have no fixed cycle, blood can be drawn at any time. Discuss with the doctor what suits your situation.
References
- NHG. NHG-Standaard Acne. Dutch College of General Practitioners. Available via richtlijnen.nhg.org.
- Thuisarts.nl. I have acne. Dutch College of General Practitioners. Available via thuisarts.nl.
- Bozdag G, Mumusoglu S, Zengin D, Karabulut E, Yildiz BO. The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod. 2016;31(12):2841-2855. PMID: 27664216.
Every blood test result through Lunara includes a professional assessment by a BIG-registered doctor. For treatment decisions, discuss your results with your GP.
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