Today we’re going to talk about one major part of the acne forming chain: hormones.
Hormones are a really complex thing, so hold on to your hats for this blog, it gets a bit sciency.
First a bit of background - acne forms through a series of domino like events. This chain of events starts with genetics but lifestyle, diet and your environment can also play a part in setting the dominoes falling. Once they topple, there is a cascade of events driven by inflammation and hormones which leads to blocked pores, bacterial imbalance and inflammation. We call this cascade the acne forming chain (see this earlier post).
Like genetics, there isn’t just one ‘acne hormone’ that is responsible for breakouts (although DHT often gets the blame but more on that later).
Hormones work in our bodies in an absolutely mind boggling way, there are literally hundreds of them and to top it off the way they interact with each other (and the relative amounts of each of those interacting of hormones) can cause even more effects than a single hormone working alone. Mind. Blown. This confusing set of affairs is why people can have two different sets of acne symptoms from the same 'baseline' set of hormonal levels.
So with this complexity in mind lets jump into the hormone part of the chain…
In the world of acne there are many different hormones which can affect and influence hormonal changes in our skin, but the principal ones that work directly on the acne forming chain are androgens – a gang of Testosterone, Dehydroepiandrosterone sulfate (DHEAS), Androstenedione, Dihydrotestosterone (DHT) and Dehydroepiandrosterone (DHEA). It’s fair to say these androgens are required to get acne and studies have shown people with an androgen deficiency or dysfunctional androgen receptors don’t produce sebum (and if you follow the chain) won’t develop acne.
Out of this gang, DHEA, DHEAS, and androstenedione are a warmup act. Our skin converts these hormones to testosterone and DHT using enzymes. Testosterone is a headliner, but it’s no acne supervillain – that role is saved for the nefarious DHT – and our skin uses an enzyme called 5α-Reductase to convert Testosterone to DHT.
We did say hormones were complex.
A good way to think about it is the hormone ‘chain link’ is a minichain all in itself.
DHEA, DHEAS, androstenedione -> testosterone -> DHT
It’s this conversion of Testosterone to DHT by 5α-Reductase that is a key contributor to acne. You could have high Testosterone, but you might not be suffering from acne if a lot of that testosterone is not being converted into DHT. Isotretinoin (Accutane) treatment works by reducing blood levels of DHT, it has no effect on the levels of the precursor hormones.
DHT causes acne by increasing the size and activity of the sebaceous glands and in doing so boosts the amount of sebum (skin oil) the skin produces – this has an effect further down the acne forming chain by facilitating the blocking of a pore and providing an easy snack for the bacteria found within which results in inflammation.
To add further injury when the skin produces more sebum, the concentration of linoleic acid in sebum goes down and this has been shown to irritate the skin cells and also cause inflammation.
Androgens of course aren’t bad – they are needed by men and women for optimal health – for example they help our bodies grow muscle mass and strength and increase bone density, growth and strength. Without them we wouldn’t be very healthy at all. The problem arises when our androgens are out of balance (i.e. we have too high a level of androgens) or if we become sensitive to them.
A sensitivity to androgens means even the tiniest increase beyond normal levels can cause our bodies to go into overdrive – our sebaceous glands produce way too much sebum and we end up (further down the acne forming chain) with oily skin and acne. In fact, other symptoms will likely be present to - excess facial hair, weight gain and hair thinning.
So, what causes androgen's to increase in the first place?
The answer lies at the very start of the acne forming chain and the fact that hormones interact with each other. To explain, let’s look at some a simple example. The hormone Insulin.
We all probably eat too much sugar and refined carbs in our diets. These foods cause our blood sugar level to spike and to combat this our bodies increase our insulin hormone levels.
In the short term, sugar plays havoc with our hormones, particularly insulin and the insulin like hormone IGF-1. When we increase these hormones we suffer higher levels of inflammation, increased skin oil production and a greater build-up of skin cells.
Over time this causes (in women) ovaries to produce an excess of androgens (specifically Testosterone). An excess of testosterone results in the body being unable to ovulate efficiency and inefficient ovulation causes low progesterone levels.
Progestero..what? Progesterone is the skin calming hormone which helps inhibits the 5α-Reductase and in doing so stops Testosterone being converted into that more potent androgen DHT.
So that’s all very interesting, but what does it all mean for me?
Well, all acne is caused by some form of hormone imbalance and by understanding your hormones, and seeing if they are out of balance, you can make a plan to tackle the hormones which may be driving your acne.
How? First look for any other symptoms you might have and these might indicate a hormonal imbalance - weight gain, anxiety, bloating, mood swings, hair thinning, menstrual headaches, tender breasts, reduced sex drive. If you’re noticing these signs as well as poorly skin, it may well be worth exploring how to balance your hormones. This is not face mapping - just because you don't have jaw acne doesn't mean your hormones are not to blame. Don't get me started on face mapping.
It also means you should stick to a routine for a lot longer than you might have thought necessary – 12 weeks. Skin and hormones work in cycles of 12 weeks. To see best results with any changes to diet, new supplements and/or different skin care it will take at least this long. After all your acne didn’t happen overnight, and it won't go away overnight.
Look for improvement over the 12 weeks (see our blog on progress not perfection here) and if you’re plan is right for you you'll notice lots of other things before your skin gets visibly better - better sleep, more energy, less sugar cravings, a reduction in PMS all have been reported around the two month mark.
If your plan is working you’ll also start to notice less spots, less redness, less inflamed breakouts and spots which heal quicker around month three. Three months is aggggeessss so it’s a great idea to keep a skin diary to plot these changes so you know you’re heading in the right direction and not lose your drive to clear skin.