Acne is the most common skin condition affecting nearly 80% of the population at some point in time. It is a bothersome condition, with Americans spending $100 million annually on over-the-counter acne products. Acne can have various causes, hormones being one of them. This article will discuss what hormonal acne is, its causes, how to test for it, and how to treat it from a functional medicine perspective.
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What is Hormonal Acne?
Hormonal acne can occur in both men and women; however, it is more commonly seen in women. Pregnant and menopausal women are also more likely to have hormonal acne. Of women in their 20s, 50% will have hormonal acne, while 25% of women in their 40s will experience it.
In women, hormonal acne may be seen at certain times of the menstrual cycle or in certain hormonal conditions, such as Polycystic Ovarian Syndrome (PCOS).
Signs of Hormonal Acne
Hormonal acne can be in the form of whiteheads, blackheads, and cysts. Whiteheads are small white or yellow enclosed bumps. Blackheads are open follicles that contain debris, making them appear black. Cystic acne is described as inflamed pus-filled sacs located deep under the skin.
What Does Hormonal Acne Look Like?
While acne, in general, can affect any part of the face or body, hormonal acne is classically seen on the chin and jawline of the face, distinguishing it from other causes of acne.
What Causes Hormonal Acne?
Hormonal acne is caused by hormones that increase sebum, or oil, production by sebaceous glands in the skin. The overproduction of sebum clogs the skin pore, and thus debris cannot escape, forming a pimple. Inflammation and bacteria also play a role in its etiology.
The hormones DHEA, testosterone, and dihydrotestosterone (DHT) have been implicated in hormonal acne. DHEA can convert into testosterone, and testosterone can convert into DHT. DHEA is primarily made in the adrenal glands and can travel throughout the body. Skin cells can convert DHEA into testosterone and subsequently create DHT. These hormones can then bind to receptors in the skin cells and upregulate sebum production. Stress, medical conditions such as PCOS, puberty, and certain medications have been shown to increase androgen levels.
However, the levels of these hormones do not necessarily have to be elevated in order to induce acne, although sometimes they are. Hormones elicit actions through interaction with their receptors, like keys (hormones) and locks (receptors). Receptor sensitivity can vary, meaning a small amount of hormone on a highly sensitive receptor can cause a greater response than would be expected for that amount of hormone.
We must also remember that hormones are interconnected, and the levels of hormones in both men and women fluctuate. Variations in fluctuations of hormones can induce acne production, explaining why some women are more likely to get breakouts during certain times of their cycles, like ovulation when testosterone rises and estrogen drops or before menstruation begins when estrogen levels are declining.
Testing for Root Cause of Hormonal Acne With These Functional Medicine Labs
Functional medicine tests can help evaluate hormones to understand the root causes of hormonal acne better. Below are some of the most valuable tests that functional medicine practitioners use for this condition:
Hormone Testing, Urine
The DUTCH Complete test, by Precision Analytical, is a dried urine test that assesses hormone metabolism, or how hormones are converted and broken down in the body. This is especially important for DHEA, testosterone, and DHT since they are implicated in the pathogenesis of hormonal acne. Testosterone converts into DHT by the enzyme 5 alpha-reductase. This test can give an insight into how this conversion is occurring. This test also shows estradiol, estrone, progesterone, and other hormones. It's important to assess these hormones since their levels can affect DHEA and testosterone levels. In addition, this test has a section on stress markers, specifically cortisol, which can also influence hormonal acne.
Hormone Testing, Blood
Certain hormones are more accurately tested for in the blood. Access Medical Laboratories offers a follicle-stimulating hormone (FSH) and luteinizing hormone (LH) panel. Both of these hormones are made in the brain and orchestrate the production of other sex hormones, including androgens.
Prolactin is another hormone that can be checked in the blood, such as the test offered by Access Medical Laboratories. This hormone is normally only elevated in lactating women, but other pathologies can cause prolactin to be elevated. Elevated prolactin can cause an increase in androgens.
Sex Hormone Binding Globulin (SHBG) is the carrier for testosterone in the body, acting like a taxi. When testosterone is bound to SHBG, it is unavailable for use. It may be useful to test levels of SHBG, like the BostonHeart Diagnostics sex hormone binding globulin test, to ensure the level is not lower than it should be.
Stool Testing
The final step of estrogen metabolism is in the gastrointestinal tract, where bacteria in the microbiome package up the final estrogen products to be put into the stool. When there is an imbalance in these bacteria, known as the estrobolome, an enzyme called beta-glucuronidase is released in high amounts. Beta glucuronidase can cause estrogen to be recycled and sent back into the blood, leading to higher estrogen levels that can affect androgens. Doctor's Data offers beta-glucuronidase as a single-marker test, although it is also found on many comprehensive stool tests.
Cortisol Testing
Although checking cortisol levels were mentioned when discussing the DUTCH test, it's important to note that cortisol testing can also be done independently. Many lab companies will offer salivary cortisol testing to monitor cortisol levels throughout the day. ZRT Laboratories Diurnal Cortisol test is one example.
Conventional Treatment for Hormonal Acne
Conventional medicine offers various treatments for hormonal acne, including hormonal birth control, which alters the body's natural production of hormones by providing hormones in a pill, and spironolactone, a medication focused on reducing the effects of testosterone.
Natural Treatment for Hormonal Acne with Functional Medicine
Natural treatments may be beneficial for hormonal acne. Below are some examples of evidence-based natural treatments that functional medicine practitioners recommend:
Hormonal Acne Diet
Since hormonal acne has an inflammatory component, a low-inflammatory diet such as the Mediterranean Diet may be beneficial. The Mediterranean diet includes fresh vegetables and fruit, healthy fats, legumes, beans, and minimally processed whole grains. This diet emphasizes eating locally and seasonally for maximum antioxidant content in the foods.
Removing acne triggering foods like cow's milk and sugar are also emphasized by the American Academy of Dermatology.
Supplements and Herbs That Help Hormonal Acne
There are many supplements that can help to balance hormones and reduce the occurrence of hormonal acne. Here are some examples:
Zinc for Hormonal Acne
Zinc is an important mineral required for many body processes, including modulating testosterone levels. A systematic review and meta-analysis assessing zinc it's relationship to acne showed that people who suffer from acne are more likely to have lower zinc levels, and treatments with zinc can improve acne.
Myo-Inositol for Hormonal Acne
Inositols are compounds that our bodies make naturally, and they are also found in fruits, nuts, and grains. Fifty women with PCOS were given myo-inositol for six months. Results showed levels of testosterone and other hormones were significantly reduced after just three months, and acne and other PCOS symptoms improved at the six-month mark. Another study gave 50 women 2 grams of inositol twice per day for six months, and another group of 50 women was given a placebo for six months. Results showed a significant decrease in DHEA levels in the women given inositol, and subsequently, an improvement in acne was seen.
Calcium-D-glucarate for Hormonal Acne
Calcium-D-glucarate can inhibit and thus lower levels of beta-glucuronidase, aiding in phase III of estrogen metabolism.
Adaptogens for Hormonal Acne
Adaptogens are botanicals that can help the body respond properly to stress via their effects on the hormone cortisol, and thus they may aid in the resolution of hormonal acne. Ashwagandha, Astragalus, and Asian Ginseng are all examples of adaptogens that can help modulate cortisol levels.
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Summary
Hormonal acne can affect many men and women, causing disruption and lowering their quality of life. Getting to the root cause of hormonal acne with the help of functional medicine testing creates the potential for a tailored and personalized treatment plan with the hopes of full eradication of symptoms.
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