Acne develops when excess oil and dead skin cells clog the pilosebaceous follicles, creating an environment where inflammation and Cutibacterium acnes can contribute to breakouts. Hormones—particularly androgens such as testosterone—can influence several parts of this process. They stimulate the skin’s sebaceous glands, increasing oil production and making clogged pores and inflammatory lesions more likely.
Hormonal activity is one reason acne commonly begins during puberty, but its effects are not limited to adolescence. Menstrual cycles, pregnancy, menopause, certain medical conditions, medications, and hormone therapy can all affect the skin. However, experiencing acne does not automatically mean that a person has a hormonal imbalance. Normal hormone levels can still stimulate acne in skin that is particularly sensitive to them.
How Androgens Contribute to Acne
Androgens are hormones present in people of all sexes. During puberty, androgen activity increases, causing the sebaceous glands to enlarge and produce more sebum. Although sebum is necessary for protecting and moisturizing the skin, excess amounts can combine with dead skin cells and obstruct the follicle.
Androgens may also affect how skin cells shed inside the follicle and contribute to inflammatory signaling. The result can be a combination of blackheads, whiteheads, papules, pustules, or deeper inflammatory lesions.
A person does not necessarily need to have abnormally high androgen levels to experience hormonally influenced acne. In some cases, the sebaceous glands are simply more responsive to normal hormonal fluctuations.
Why Acne May Flare During the Menstrual Cycle
Hormone levels naturally change throughout the menstrual cycle. In the days leading up to a period, shifts in estrogen, progesterone, and androgen activity may increase oil production or inflammation in acne-prone skin. This can produce breakouts that recur at a similar point each month.
Cycle-related acne is often described as appearing around the chin, jawline, or lower face, although hormonal breakouts can occur elsewhere, including the chest and back. Location alone cannot confirm that acne is hormonal. A recurring monthly pattern and the way the acne responds to treatment provide more useful information.
Hormonal Changes at Different Life Stages
Puberty is one of the most common periods for acne because of the significant increase in androgen activity. Some people improve as hormone levels stabilize, while others continue to experience breakouts into adulthood.
Pregnancy can improve acne in some people and worsen it in others. Changes in estrogen, progesterone, and androgen activity may alter oil production and inflammation, and treatment options may be limited because certain acne medications are not considered safe during pregnancy.
Hormonal changes during perimenopause and menopause may also affect the skin. Even as overall hormone levels change, the relative influence of androgens can contribute to adult breakouts, sometimes occurring alongside increased dryness or sensitivity.
Starting testosterone therapy can also increase sebum production and trigger new or more persistent acne, particularly during the early stages of treatment.
When Acne May Be Connected to an Underlying Condition
Most acne is not caused by an endocrine disorder. However, persistent or severe acne may occasionally occur alongside conditions involving increased androgen activity.
Polycystic ovary syndrome, or PCOS, is one example. In addition to acne, possible signs include irregular or absent periods, excess facial or body hair, thinning scalp hair, or difficulty with ovulation. Acne by itself is not enough to diagnose PCOS, especially during adolescence, when irregular cycles and breakouts may be part of normal development. A medical professional must consider the full pattern of symptoms and, when appropriate, conduct further evaluation.
Sudden, severe acne accompanied by rapid hair growth, menstrual changes, voice changes, or other new symptoms should be evaluated rather than assumed to be a typical hormonal breakout.
How Hormonal Acne Is Treated
Hormonal acne is often treated with many of the same topical medications used for other forms of acne. Retinoids help prevent clogged follicles, benzoyl peroxide reduces acne-causing bacteria, and other topical medications may reduce inflammation or oil production.
When appropriate, a medical professional may also recommend treatments that address androgen activity. Combined oral contraceptives can reduce the hormonal stimulation associated with acne in some patients. Spironolactone blocks certain androgen effects and may help reduce persistent breakouts and oiliness. Topical clascoterone works locally by blocking androgen receptors in the skin.
Combined oral contraceptives and spironolactone are conditionally recommended hormonal options in current American Academy of Dermatology acne guidelines. These medications are not appropriate for everyone and require consideration of medical history, potential side effects, pregnancy risk, and other medications. Improvement is gradual and often takes several weeks or months.
Expectations and Considerations
Hormones are only one part of acne development. Genetics, skin-care products, medications, friction, stress, and other factors can also affect the frequency and severity of breakouts. Treating hormonally influenced acne therefore often requires a combination approach rather than focusing on hormones alone.
Consistent treatment is important because acne medications generally work by preventing future lesions, not simply eliminating an existing breakout overnight. Picking or squeezing lesions can increase inflammation and raise the risk of discoloration and permanent scarring.
Persistent, painful, or scarring acne should be assessed by a qualified medical professional. With an individualized treatment plan, hormonally influenced acne can often be controlled, although continued maintenance may be needed to prevent it from returning.