Hormonal acne: understanding and managing breakouts linked to hormones

Breakouts can feel especially frustrating when they seem to appear out of nowhere, despite a consistent skincare routine. But acne is not always just about what happens on the surface of your skin. For many adults, hormonal changes can increase oil production, clog pores, and trigger acne that keeps coming back. Understanding what hormonal acne is, what causes it, and how it can be managed can help you feel more confident in your skin and take more informed steps toward clearer, healthier skin.

Table of Contents

• What is hormonal acne?
• What causes hormonal acne?
• How to get rid of hormonal acne: practical tips and solutions
• Frequently asked questions about hormonal acne
  

What is hormonal acne?

There are several types of acne, including cystic, fungal, hormonal, and nodular acne. Hormonal acne is adult acne linked to hormone changes or hormone sensitivity, especially involving androgens like testosterone and DHT, as well as fluctuations in estrogen, progesterone, and stress-related cortisol. These hormones can increase sebum production in the oil glands. This excess oil can mix with dead skin cells and bacteria in the hair follicles, clogging pores and leading to acne breakouts.

It affects adults ages 20 to 50 and can occur in both men and women, but it is most common in women, especially during pregnancy or menopause.

Source: Cleveland Clinic, 2021; Cleveland Clinic 2023; Schweiger Dermatology Group, n.d. 

Symptoms of hormonal acne may include:

• Location: Often appears on the cheeks, but can also affect the face, neck, back, shoulders, and chest.

• Appearance: May show up as whiteheads, blackheads, papules, pustules, or cysts.

• Texture: Can feel raised, or like fluid-filled pockets under the skin.

• Discomfort: Lesions may become inflamed, red, painful or sore.

Source: Cleveland Clinic, 2021

What causes hormonal acne?

Hormonal acne is caused by hormonal changes and imbalances, in different life stages, due to health conditions, lifestyle factors, genetics, or certain medications. These can increase sebum production, clog pores, and trigger breakouts.

1. Life stages and health conditions
   Common triggers include puberty, menstruation, pregnancy, menopause, stopping birth control, testosterone treatment, polycystic ovary syndrome (PCOS), and other conditions such as thyroid disorders.

2. Lifestyle factors
   Stress, lack of sleep, pore-clogging skincare products, and diets high in refined sugars, processed foods, or high-glycaemic carbohydrates may worsen hormonal acne.

3. Genetics
   A family history of acne can increase your risk by affecting how your oil glands respond to hormones and how your skin heals.

4. Medications
   Steroids and other medications that affect hormone levels may trigger or worsen acne.

Source: The Endocrine Clinic, n.d.

How to get rid of hormonal acne: practical tips and solutions

Treatment for hormonal acne depends on how severe it is and the type of breakouts you have. The goal is to reduce excess oil, prevent clogged pores, limit new pimples, and calm inflammation.

1. Topical or oral treatments
   Mild acne may be treated with topical creams like tretinoin, while inflammatory acne may need a retinoid, antibiotic, benzoyl peroxide, or a combination. Moderate to severe acne may require oral antibiotics or isotretinoin.

2. Hormonal treatments
   Birth control pills may help manage hormonal acne by regulating hormone levels.

3. Cystic acne treatments
   Painful cystic acne may be treated with steroid injections, such as intralesional triamcinolone.

4. Skin care and lifestyle changes
   Daily gentle cleansing, avoiding pore-clogging products, and making lifestyle changes may help reduce breakouts. Reduce stress, get better sleep, and a healthy diet can support skin health.

5. In-office treatments
   Laser or light therapy may also be used to help manage acne, especially when other treatments are not enough.

Be patient with results. Acne treatments often need a few days, weeks or up to several months to show improvement. 

Source: Cleveland Clinic, 2021

Taking control of your skin health

Dealing with hormonal acne can feel discouraging, but it is manageable. The first step is understanding that your breakouts may be connected to what is happening inside your body, not just what you put on your skin.

Hormonal Acne Tracking Checklist

• Track when breakouts appear and track possible triggers (e.g. before period, in stressful times, new skincare products, diet changes)
• Note where acne shows up on your face or body
• Record the type of breakout (e.g. whiteheads, cysts, or painful bumps)
• Rate how severe the breakout feels
• Watch for related symptoms (e.g. hair thinning, or weight changes)

If you think your acne may be linked to a hormonal imbalance, a hormone test can offer useful insights to discuss with a healthcare professional. Homed-IQ provides accessible home hormone testing to help you better understand your health from home, while not replacing medical advice.

Frequently asked questions about hormonal acne

Risks and Complications

Besides affecting how comfortable you feel in your own skin, acne can also lead to scarring. This may happen when inflamed spots, especially nodules or cysts, burst and damage nearby skin. Picking or squeezing acne can also increase the risk. The three main types of acne scars are ice pick scars, which are small and deep; rolling scars, which create uneven skin texture; and boxcar scars, which are round or oval depressions in the skin (NHS, 2023).

When to Get Professional Help

If your hormonal acne is not improving, keeps coming back, or is getting worse, it may be time to see a dermatologist. They can assess your skin and recommend stronger or more targeted treatments to help manage breakouts (Cleveland Clinic, 2021).