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Hormonal Acne: Causes, Types, and Treatment

Hormonal acne refers to acne that occurs due to fluctuations in the levels of your hormones, particularly a rise in androgens or male hormones such as testosterone. Although the acne that results due to hormonal fluctuations occurring during puberty is typically called hormonal acne, it may affect adults at any age. It’s particularly common in females due to a wide variety of factors including hormonal fluctuations at the time of periods and menopause.

What is hormonal acne?

Hormonal acne refers to acne that happens due to hormonal fluctuations, especially an increased level of androgens such as testosterone. Though it is thought to be most commonly present in teenagers who are going through hormonal fluctuations of puberty, hormonal acne may occur at any stage of an adult’s life. Furthermore, hormonal imbalances may lead to acne in adults who have underlying medical conditions. 

Symptoms of hormonal acne

During puberty, the hormonal acne may usually occur on the T-zone, which includes your nose, chin, and forehead. Hormonal acne in the adults may usually occur on the lower area of the face that includes the area around the jaw line and the bottoms of the cheeks. 

Hormonal acne may appear as comedones, which are of two types- whiteheads and blackheads. Blackheads are the type of comedones that are open at the surface of the skin and they appear black due to the effect oxygen produces on them. Whiteheads are the type of comedones that are closed beneath the skin surface. Hormonal acne may also appear as:

Papules: small, raised, red bumps that occur due to inflammation or infection of the hair follicles. 

Pustules: small and red pus-filled pimples.

Cysts: large lumps, which are present under the skin. They contain pus and may be painful and tender to the touch. 

Causes of hormonal acne

Conditions that affect hormone levels can trigger acne, for example:

  • puberty
  • menstruation
  • menopause
  • polycystic ovarian syndrome
  • increased levels of androgens

According to estimates, 50 percent of females between the ages 20 and 29 and 25 percent of females between the ages 40 and 49 suffer from acne. 

The rise in testosterone levels may trigger excessive secretion of sebum from the sebaceous glands in the skin. It may also result in changes in the activity of the skin cells and infection of the hair follicles by acne-causing bacteria known as Cutibacterium acnes. This may lead to the occurrence of hormonal acne. 

Does progesterone cause acne?

Yes, fluctuation in the levels of progesterone during your monthly menstrual cycle may also cause acne before the period. 

The levels of progesterone rise during the middle of the cycle. This may stimulate increased production of sebum from the sebaceous glands in the skin. The increased progesterone may also cause swelling of skin and compression of skin pores. This leads to build up of sebum beneath the surface of the skin. Increased sebum along with dirt, dead skin cells and bacteria result in increased breakouts of acne before and during your periods. 

Testosterone and acne: are they connected?

Yes, testosterone and acne are connected. Hormonal acne usually occurs in response to a rise in the male hormones especially testosterone. During puberty, the production of testosterone increases and it may result in the occurrence of hormonal acne in teenagers. The rise in testosterone may stimulate increased production of sebum from the sebaceous glands in the skin. The excessive sebum clogs the skin pores along with dirt and dead skin cells. The infection of these clogged pores by the acne-causing bacteria may lead to acne. The immune system of your body may react to the bacteria and its metabolites and produce inflammation that accompanies lesions of acne. 

Acne in menopause

Acne in women at the time of menopause may occur due to hormonal fluctuations. The androgen levels in women who suffer from acne around the time of menopause are usually normal but they have reduced levels of estrogen hormone. Due to this imbalance in hormones, the acne may flare in these women. As hormone arrives at a ‘tipping point,’ the sebaceous glands are stimulated by the new hormonal ratios and this may trigger outbreaks of acne. 

On the other hand, in some women, HRT  (hormone replacement therapy)  may actually trigger an acne problem. 

Severity of acne

The severity of acne may be mild, moderate or severe. 

Mild acne usually consists of whiteheads and blackheads. You may not require any help from a dermatologist to treat it. In mild acne, there are less than 15 inflammatory lesions or 20 comedones or a total of 30 acne lesions. 

Moderate acne consists of both non-inflamed and inflamed lesions. There are 15 to 50 inflammatory lesions, 20 to 100 comedones or a total of 30 to 125 lesions.

Severe acne consists of widespread inflammatory lesions. It may impact your appearance as well as self-esteem. The lesions may also lead to scarring. 

Acne of any severity may cause distress. Even mild hormonal acne may affect your self-esteem. This happens not only due to the fact that it affects your physical appearance and beauty but also due to the fact that it may affect you at the time when you are young and starting to develop relationships. 

Hormonal acne treatment

What is hormonal acne treatment? Unless you have mild hormonal acne, over-the-counter treatments aren’t usually successful. Oral medicines may work by balancing your hormones and clearing the skin. Common options are anti-androgen drugs and oral contraceptives. 

Oral contraceptives

Oral contraceptives used in the treatment of hormonal acne contain ethinylestradiol along with one of the following ingredients:

  • drospirenone
  • norethindrone
  • norgestimate

These ingredients in combination target the hormones, which cause acne. This may be particularly helpful during times of hormonal peaks such as at the time of ovulation. You shouldn’t take oral contraceptives if you have a history of high blood pressure, breast cancer or blood clots. You should also avoid them if you are a smoker. 

Anti-androgen drugs

These drugs work by reducing the androgen hormone. Natural levels of androgen are present in both women and men. Excessive androgen may cause acne by increasing the production of sebum. 

Although Spironolactone is used primarily to treat hypertension (high blood pressure), it also has anti-androgen effects. This implies that it may prevent the body from producing excessive androgen and stabilizes the levels of the hormone. 

Spironolactone is not appropriate for all women; be sure to discuss its risks and benefits with your doctor.


What is hormonal acne treatment? You may use topical retinoids to treat mild hormonal acne. They are derivatives of vitamin A. Many retinoid gels, lotions and creams are available as over-the-counter products. But you may get a prescription-strength product from your dermatologist as it is most effective to keep your acne at bay. 

While using topical retinoids, it is imperative to use sunscreen daily as they may make you more prone to sunburn. 

Natural treatment for hormonal acne

What is hormonal acne natural treatment? You may use plant-based treatments to treat mild hormonal acne. But they may be not as effective as conventional methods. Furthermore, research to prove the efficacy of these treatments is lacking. One of these natural treatments is tea tree oil. Talk to your doctor about potential risks and to ensure the treatment won’t interact with any medications you’re taking.

Tips for people with acne

Self-care tips may help to clear acne or even prevent it from getting worse. 

  • Wash your face gently not more than two times a day and after heavy sweating.
  • Use mild cleansers or soaps and lukewarm water. Don’t use hot water.
  • Don’t use exfoliating or harsh scrubs.
  • Don’t scrub, pick or scrape your pimples as doing so may worsen them and cause inflammation.
  • You should avoid makeup or use noncomedogenic makeup.
  • Avoid very humid environments, which cause too much sweating. 

Excessive washing and scrubbing aren’t good for you if you have acne as it may remove oil from your skin and cause more irritation. The skin may respond by secreting more oil and this may worsen the acne. 

Hormonal acne is the acne that occurs due to the fluctuations in hormones particularly a rise in androgens such as testosterone. The rise in testosterone may stimulate excessive secretion of sebum from the sebaceous glands. This results in clogging of the skin pores along with the dirt, dead skin cells and bacteria that cause acne (P. acnes). Hormonal acne at puberty may occur on the T-zone, including the nose, forehead, and chin. Acne may also occur at the time of menopause due to fluctuation in hormones. According to severity, hormonal acne may be categorized as mild, moderate and severe. You may treat hormonal acne by taking oral contraceptives or anti-androgen drugs as well as topical treatment.


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