Acne is often dismissed as a teenage problem — but hormonal acne affects adults of all ages, and it is one of the most visible and distressing manifestations of hormonal imbalance. If your breakouts are cyclical, concentrated around the jaw, chin, and lower face, or resistant to topical treatments, hormones are almost certainly involved. Treating the skin without addressing the underlying hormonal driver is treating the symptom, not the cause.
What Is Hormonal Acne?
Hormonal acne is driven by fluctuations or imbalances in hormones that stimulate the sebaceous (oil) glands to overproduce sebum. Excess sebum, combined with dead skin cells and bacteria, creates the conditions for blocked pores, inflammation, and breakouts. Unlike teenage acne, which tends to be widespread, hormonal acne in adults typically presents as deep, cystic lesions around the lower face, jaw, and neck.
Key Hormones Involved in Acne
Androgens (Testosterone & DHEA)
Androgens are the primary hormonal drivers of acne. They stimulate sebum production and increase skin cell turnover. Even mildly elevated androgens — or heightened skin sensitivity to normal androgen levels — can trigger significant breakouts. In women, elevated testosterone or DHEA is often associated with PCOS.
Oestrogen & Progesterone
Oestrogen generally has a protective effect on skin, reducing sebum production and promoting collagen synthesis. When oestrogen drops relative to progesterone (or androgens) — as occurs in the luteal phase of the menstrual cycle, perimenopause, or with certain contraceptives — acne flares are common. Low progesterone can also contribute to skin inflammation.
Cortisol
Stress-driven cortisol elevation stimulates androgen production and promotes inflammation — a double hit for acne-prone skin. This explains why breakouts often worsen during periods of high stress, poor sleep, or intense exercise.
Insulin & IGF-1
High insulin levels — driven by a high-glycaemic diet or insulin resistance — stimulate androgen production and increase IGF-1, a growth factor that directly promotes sebum production and skin cell proliferation. Dietary interventions that reduce insulin spikes are among the most evidence-based approaches to managing hormonal acne.
Symptoms and Patterns of Hormonal Acne
- Breakouts that worsen in the week before menstruation
- Deep, cystic lesions on the jaw, chin, and lower cheeks
- Acne that persists or worsens into the 20s, 30s, and beyond
- Breakouts accompanied by other hormonal symptoms (irregular periods, excess hair growth, fatigue, mood changes)
- Skin that doesn't respond to standard topical treatments
Testing Your Hormones for Acne
Our dedicated Acne Test (LCMS) is specifically designed to identify the hormonal imbalances most commonly associated with acne — including testosterone, DHEA, oestrogen, progesterone, cortisol, and insulin. Using LCMS saliva analysis for unparalleled accuracy, this test provides the data needed to understand exactly which hormones are driving your skin issues.
For women whose acne is accompanied by other symptoms such as irregular cycles, hair loss, or weight gain, our Comprehensive Female Saliva Hormone Profile (LCMS) provides a broader hormonal assessment. For men experiencing acne alongside low energy, reduced libido, or mood changes, our Comprehensive Male Saliva Hormone Profile (LCMS) offers equivalent depth of assessment.
Treatment Approaches for Hormonal Acne
- Address insulin resistance: Reduce refined carbohydrates and sugar; prioritise protein and fibre.
- Manage cortisol: Prioritise sleep, stress management, and recovery from exercise.
- Support oestrogen-progesterone balance: Particularly important for women with cyclical acne.
- Consider targeted supplementation: Zinc, spearmint, inositol, and DIM have evidence for hormonal acne — but should be guided by test results.
- Work with a practitioner: Hormonal acne often requires a multi-pronged approach. Test results give your practitioner the data to personalise treatment.
Clear skin starts with understanding your hormones. Test first, treat with precision.