Here’s something many over-the-counter acne products won’t tell you: Hormones are one of the most significant factors contributing to acne. Certain hormonal fluctuations cause glands in your skin to release more natural oil (called sebum), which collects in the pores and can contribute to acne. Several factors can cause these fluctuations—birth control, diet, hormonal therapy, or even your period (just to name a few!). 

This guide will dig into how hormones can trigger acne and what steps you can take to help prevent a hormonal acne breakout.

What causes hormonal acne?

Acne is a common inflammatory skin condition that appears when hair follicles clog with bacteria, oil, and dead skin cells. Some subtypes of acne include blackheads, whiteheads, cystic acne, and hormonal acne. 

So what’s the deal with hormonal acne? Long story short: When certain hormone levels change, it can lead to pimples (including blackheads, whiteheads, and cysts). Androgens (like testosterone) and progesterone can trigger acne flares. Meanwhile, high levels of estrogen can decrease the likelihood of breakouts.¹

Here are a few signs you have hormonal acne: 

• Breakouts appear primarily on the chin, cheeks, and jawline. 

• Breakouts might flare in response to hormonal fluctuations like menstruation and menopause.

• Breakouts get better in response to oral hormonal treatments like certain birth control and spironolactone.

• Breakouts might flare when starting hormone replacement therapy. 

• Breakouts get better (or, sometimes, worse) when using birth control. 

• Breakouts get better (or, sometimes, worse) in response to changes in your diet. 

Fun fact: Treatments that don't affect hormones can still help treat hormonal acne! That's because, no matter the trigger, acne is caused by a combination of factors, including bacteria and clogged pores. (We'll explain more about hormonal acne treatments in a bit.)

Not-so-fun fact: Androgens are a common contributing factor to adult acne. According to the Cleveland Clinic, 25% of adults in their 40s who identify as women experience hormonal acne.² Because androgens aren't specific to any gender, anyone can experience breakouts due to hormonal changes regardless of whether they have acne-prone skin.

When oil production ramps up, so can breakouts. Closed comedones (aka whiteheads) and open comedones (aka blackheads) can result when a mix of excess sebum and dead skin cells get trapped in the pore. You might also experience other types of acne like pustules and cysts.

One type of bacteria that normally lives on our skin, Cutibacterium acnes (or C. acnes), can inflame the skin when it feeds off the excess oil in a clogged pore. This inflammatory response results in inflammatory acne.³

Even after you stop your breakouts in their tracks, it still takes time to completely heal from acne (especially nodules and cystic acne lesions, which can be stubborn). Hormonal acne flare-ups can leave some with acne scars and post-inflammatory hyperpigmentation, too. Your custom Curology formula can be adjusted to help address your ever-changing skin's needs.

Hormonal acne vs. fungal acne

Fungal acne, more scientifically known as folliculitis, occurs when excess fungus grow in the hair follicles. Hormonal acne results from hormonal fluctuations triggering the production of sebum—also at the hair follicles.  

• Fungal acne breakouts are often caused by overgrowth of pityrosporum, a naturally occurring fungus that lives on your skin. Breakouts often occur on the forehead and have a relatively uniform appearance. They’re usually pinkish or skin-colored. Fungal acne can be triggered by increased humidity and sweating, and can follow immunosuppression and antibiotic use, which can alter flora in the body.⁴

• Hormonal acne often appears on the lower face third of the face and jaw/upper neck. It often manifests as whiteheads, blackheads, papules, pustules, and cysts and results from hormone triggereing overproduction of sebum leading to clogged pores. 

5 factors that can worsen hormonal acne

Some things can worsen hormonal acne. Some of these we can control—like stress—and some we cannot.  

1. Stress does not directly cause acne, but it has been linked to worsening breakouts.⁵ Find ways to reduce stress, and your skin will thank you. 

2. Menstruation boosts certain hormone levels, which can lead to the overproduction of sebum.

3. Certain types of birth control or contraceptive pills can also affect hormone levels and acne.

4. An increase in testosterone or progesterone due to hormone therapy can trigger sebum production.

5. Pore-clogging (comedogenic) ingredients are something you can control. Look for non-comedogenic ingredients that are oil-free and fragrance-free.

How to help prevent hormonal acne

Just as some things can worsen acne, some can help prevent it. These tips don’t affect the hormonal component of breakouts, specifically, but they can lend a hand in helping prevent  acne from happening in the first place.  

1. Eat a healthy diet. Consider reducing your sugar, dairy, and alcohol intake. You might want to track what you eat to see what triggers your acne. 

2. Get better sleep and reduce stress. This might be easier said than done, but you can take simple steps to promote deeper sleep, like putting away your electronic devices 30 minutes before bed.

3. Choose non-comedogenic products. Make sure your products won’t clog pores and look for over-the-counter products that treat acne. Better yet, try Curology’s custom cream designed for your skin type.

4. Stick to a simple skincare routine. We recommend following a straightforward skincare routine twice daily, in the morning and the evening: wash your face, apply treatment, moisturize, and wear sunscreen (unless you’re off to bed). 

Hormonal acne treatments

Topical skincare products can help treat hormonal acne, so long as they have the right ingredients. 

Some treatment options for hormonal acne include:

• Topical retinoids like tretinoin and adapalene

• Exfoliating treatments like chemical peels (AHAs and BHA)

• Oral medications like isotretinoin, spironolactone, and birth control 

We recommend using a simple routine with a non-comedogenic cleanser, moisturizer, and acne treatment. Basic sun safety and proper sunscreen use are musts, too.

Hormonal imbalances, explained 

Hormonal fluctuations can come from medications, stress, and even day-to-day ordinary life. Increased androgens can stimulate your oil glands to create excess sebum. That means you're more likely to experience oily skin and, potentially, acne.⁶

It's normal to experience fluctuating hormones throughout your menstrual cycle and menopause. It can also be triggered by certain medications (like some birth controls). Some hormonal imbalances can be triggered by medical conditions like polycystic ovary syndrome (PCOS), which may require in-person medical attention. 

Androgens may have a more noticeable impact on women right before, during, or after their periods (aka during the perimenstrual period).⁷, ⁸ When triggered, sebaceous glands ramp up your skin's oil production. Sebum may then mix with dead skin cells still in the opening of the hair follicle, clogging your pores. 

Birth control

While topical treatments can help with breakouts, sometimes we need to directly treat the hormonal aspect of acne, too. Hormonal birth control is one option that can help stop androgens from jump-starting acne vulgaris.⁹ But this isn’t set in stone— different hormonal contraceptives may improve or worsen acne, depending on the hormone(s) involved (for example, contraceptives containing drospirenone may help improve acne).

If birth control pills are your method of contraception, the best ones for acne are generally considered to be combined contraceptive pills that contain estrogen.¹⁰ These oral contraceptives don't influence sebum production the way birth control pills that tend to trigger acne do. 

Spironolactone

If you’ve struggled with hormonal acne and other lifestyle changes haven’t produced your desired skin goals, spironolactone may be an option. Spironolactone is a diuretic pill often used for treating high blood pressure. It can also limit how much oil your glands release into the pores by decreasing testosterone production, making it a good hormonal acne treatment option. 

It does have some downsides, though. For one, its anti-androgen mechanism also blocks testosterone, so it’s generally not an option for those assigned male at birth. It's also not safe for pregnant people. It has a few other side effects that might not make it a good option for you. 

Spironolactone is a prescription-only oral acne treatment. Ask your medical provider if they think spironolactone can help your hormonal acne. 

Hormonal therapy

Hormone replacement therapy can change your testosterone levels, impacting your skin. According to the Journal of the American Academy of Dermatology, this can either help your breakouts or potentially make them worse.¹¹

• Feminizing hormones (i.e., estrogen) tend to improve skin conditions like acne.

• Masculinizing hormones (i.e., male hormones like testosterone) tend to worsen breakouts.  

For trans patients undergoing masculinizing hormone treatment, severe acne can happen. Severe acne can be successfully treated with isotretinoin.¹² For less severe acne flares, prescription topicals such as tretinoin and over-the-counter ingredients like salicylic acid and benzoyl peroxide can help. 

Hormonal acne and diet

Two types of foods have shown to be potential acne triggers in some people: 

1. Foods with a high glycemic index increase insulin levels, a hormone linked to androgen release and sebum production.¹³ These foods may also lead to blood sugar spikes and inflammation.¹⁴

2. Dairy products may increase androgen levels in some people, which can increase sebum production.¹⁵

Here’s a surprising tip: Relief might come from a cup of tea! There is some evidence that two cups of spearmint tea per day can reduce the levels of androgens that trigger acne.¹⁶ Want to try it? Drink your two cups daily, but don’t overdo it—too much may be harmful. If you're more of a coffee drinker, you could consider spearmint supplements instead. You can also try these skin-friendly fruits and veggies:

• Kiwis

• Peaches

• Nectarines

• Plums

• Cherries

• Red pepper

• Kale

• Mushrooms

Other foods that aren’t known to trigger breakouts include lean meats, eggs, tofu, barley, quinoa, and rolled oats. 

Self-care and you

Life can be chaotic and unpredictable, just like breakouts. Stress can lead to a hormonal response, which can indirectly lead to acne.¹⁷, ¹⁸ We've all felt stressed at one point or another, and mindful self-care is a good idea to help maintain your overall peace of mind. 

The best thing about self-care routines is that they’re unique to you! But, sometimes, it can be hard to heal on our own. Remember that other people are here to help and support you in your journey to better mental health. 

If you need help right now, these resources are free:

• Mental Health America

• National Suicide Prevention Lifeline (988): a 24/7 confidential hotline to support people in emotional distress.

• SAMHSA (800-662-4357):  a 24/7 confidential hotline to support people in substance abuse recovery. 

• Crisis Textline (741741): text a crisis counselor to get immediate help, even when you can’t make a call. 

• Psychology Today: Search online to find a therapist or psychiatrist licensed to practice in your state—many have sliding scales and offer telehealth visits!

• Apps like BetterHelp or Talkspace

Does Curology work on hormonal acne?

Even if your breakouts are in a hormonal pattern, topical treatments such as Curology are still helpful in treating the multiple factors that play a role in your breakouts. However, if topical treatment just doesn’t seem to be enough, you may want to try additional options such as dietary changes and oral medication like birth control.

Curology was founded in 2014 by Dr. David Lorschter, MD, a board-certified dermatologist. You tell us about your skin, and one of our licensed dermatology providers will consult with you about your skincare routine. If Curology is right for you, we’ll prescribe you a personalized prescription formula with a mix of ingredients chosen for your unique needs. 

Get your personalized skincare routine with Curology

Get your personalized skincare routine with Curology

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Curology is free to start—you’ll get a custom prescription formula, plus any of our recommended skincare products, for just $4.95 (plus tax)* to cover shipping and handling. Go ahead and start your Curology free trial now.

P.S. We did the homework so you don’t have to:

1. Elsaie M. L. Hormonal treatment of acne vulgaris: an update. Clinical, cosmetic and investigational dermatology. (2016)

2. Cleveland Clinic. Hormonal Acne. (n.d.).

3. Toyoda, M., & Morohashi, M. Pathogenesis of acne. Medical electron microscopy : official journal of the Clinical Electron Microscopy Society of Japan. (2001).

4. Rubenstein, R.M., et al. Malassezia (Pityrosporum) Folliculitis. (2014, March).

5. Graubard, R., et al. Stress and Skin: An Overview of Mind Body Therapies as a Treatment Strategy in Dermatology.Dermatology Practical and Conceptual. (2022, October 1).

6. Elsaie M. L. Hormonal treatment of acne vulgaris: an update. Ibid.

7. Geller, L., Rosen, et al. Perimenstrual flare of adult acne. The Journal of clinical and aesthetic dermatology. (2014).

8. Raghunath, R. S., et al. The menstrual cycle and the skin. Clinical and experimental dermatology. (2015).

9. Geller, L., Rosen, et al. Perimenstrual flare of adult acne. Ibid.

10. Zaenglein, A. L., et al.Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology. (2016).

11. Dhingra, N., et al.Medical and aesthetic procedural dermatology recommendations for transgender patients undergoing transition. Journal of the American Academy of Dermatology. (2019).

12. Turrion-Merino, L., et al. Severe Acne in Female-to-Male Transgender Patients. JAMA dermatology. (2015).

13. Elsaie M. L. Hormonal treatment of acne vulgaris: an update. Ibid.

14. American Academy of Dermatology. Can the right diet get rid of acne? (n.d.).

15. Adebamowo, C. A., et al. High school dietary dairy intake and teenage acne. Jo

    urnal of the American Academy of Dermatology. (2005).

16. Grant, P., & Ramasamy, S. An update on plant derived anti-androgens. International journal of endocrinology and metabolism. (2012).

17. Chiu, A., et al. The response of skin disease to stress: changes in the severity of acne vulgaris as affected by examination stress. Archives of dermatology. (2003).

18. Yosipovitch, G., et al. Study of psychological stress, sebum production and acne vulgaris in adolescents. Acta dermato-venereologica. (2007).

19. American Academy of Dermatology. Stubborn Acne? Hormonal Therapy May Help. (n.d.).

20. Hammer, K.A. Treatment of Acne with Tea Tree Oil (Melaleuca) Products: A Review of Efficacy, Tolerability, and Potential Modes of Action. International journal of antimicrobial agents. (2015, February). 

This article was originally published on November 2, 2020, and updated on August 10, 2022.

* Subject to consultation. Subscription is required. Results may vary. 

Written by

Curology Team

Medically reviewed by

Nicole Hangsterfer, PA-C