Estrogen

A common cause of hormonal acne is estrogen dominance. This is where there is too much estrogen circulating throughout the body. Estrogen is typically highest in the first half of a woman’s menstrual cycle (the follicular phase). The potential causes of how estrogen may get out of balance are below:

1. Xenoestrogen exposure: Xenoestrogens are estrogen mimicking compounds which are not produced by our body. Xenoestrogens bind to estrogen receptors in the body and mimic the effect of estrogen. Xenoestrogens can be found in plastics (ie. plastic water bottles) as well as the common cleaning products under your kitchen sink.
2. Low progesterone: Another cause of a relative estrogen dominance is low progesterone. Progesterone is highest during the second half of a woman’s cycle (the luteal phase). If progesterone is low during this time, it can put estrogen out of balance and create an estrogen dominance picture. This type of acne typically shows up as premenstrual acne among other symptoms that point to an estrogen excess such as low libido, PMS, headaches, and more.
3. Slow estrogen metabolism: The third cause of excess estrogen is slow estrogen metabolism. This could be due to a higher toxic burden on the liver or simply due to the fact that you’re not eating enough fiber to help your body properly bind & detox excess hormones. A great way assess for estrogen metabolism is through comprehensive lab testing, such as the DUTCH test.

Testosterone

For some, hormonal acne may be due to high androgens such as DHT (dihydrotestosterone) at the skin level, thus increasing sebum and inflammation. This is due to the highly active enzyme, 5-alpha-reductase that converts testosterone into this acne-prone form of testosterone.

Cortisol

We must always look at stress and how it is affecting a person’s overall health. When stress is high, cortisol follows suit. High cortisol increases inflammation, sebum, and skin cells – all of which increase acne formation.

Insulin & Nutrition

It is important to always address the root cause, and as a naturopathic doctor, I always consider how a person’s nutrition may be at play alongside a hormonal imbalance. Insulin is the hormone responsible for maintaining and regulating our blood glucose levels. Insulin is linked to IGF-1 (insulin growth factor 1) activity. IGF-1 plays a role in increasing sebum, skin cells, and inflammation – thus increasing acne-prone skin. Increased IGF-1 activity is correlated with spikes in our blood sugar where insulin is working in overdrive, such as from high sugar content foods. Think white rice, breakfast cereals, cakes, cookies, potatoes, and fries to name a few.

• Acne-prone foods: high sugar foods (foods with a high glycemic index), dairy, chocolate (even dark chocolate), and foods high in saturated and trans fats.

Naturopathic Approach

For a comprehensive and holistic approach to address hormonal acne I typically use a combination of functional lab testing to see where the hormonal imbalance may be, as well as botanical medicine, homeopathy, nutrition, and lifestyle changes. Follow these three tips to get you on the right path to find out the root cause of your acne!

1. Track your menstrual cycle & symptoms

When you know when your acne flare-ups are happening during your menstrual cycle it is easier to pinpoint where the hormonal imbalance may be coming from. Also, take note of where your acne lesions are forming – if high DHT you may find more lesions around the mouth and along the jawline.

2. Work on stress management

Stress often cannot be avoided, but adapting to stress more appropriately is crucial. Taking a moment to have 3 deep breaths at times of stress can drastically shift your mind out of the “fight or flight” mode and thus help to lower cortisol. Other great ways to decrease stress are going for a walk, practicing yoga, and reading.

3. Start a Food Diary

This is a great way to increase awareness of how foods may be affecting your day-to-day. Simply journal what foods you eat on a daily basis. And then note if you experience any symptoms, such as acne. You can even try to play around with taking the most common acne-prone foods out of your diet for a month or so, and see if anything changes.

As always consult with your doctor before making any changes, this is not medical advice.

Editor’s Note: The information in this article is intended for your educational use only. Always seek the advice of your physician or other qualified health practitioners with any questions you may have regarding a medical condition and before undertaking any diet, supplement, fitness, or other health program.