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  • Writer's pictureDr. Randi Brown, ND

Hormonal Acne Woes and Why's

Updated: Nov 25, 2023

Hormonal Acne: What is it? And why does it happen?

Sex hormones (such as testosterone and other androgens) play a role in the development of acne by stimulating sebaceous glands to produce sebum creating whiteheads and pimples. Premenstrual Acne is acne that gets worse before your period and is very common among women. It is usually a flare of acne within 7-10 days of your expected period.

Why do Women Get Premenstrual Acne?

In the last half of the cycle, right before you get your period, your sex hormones progesterone, and estrogen plummet rapidly. With this decrease, another important protein in your blood, called sex-hormone-binding globulin (SHBG for short), also declines rapidly. SHBG is important because it binds excessive testosterone in the blood, making testosterone less available to stimulate sebaceous glands on the skin. Simply put, premenstrually, when estrogen falls, SHBG falls, meaning free testosterone goes up. Increased free testosterone = more acne.


Women with the lowest levels of SHBG and highest levels of free testosterone tend to have more severe and persistent forms of acne, as we commonly see in women with PCOS.

Women with PCOS experience acne, male facial hair growth, weight gain, and irregular periods.

Causes of Sex-Hormone Imbalances

Other factors such as genetics, prenatal exposures, metabolic disturbances (diabetes, or insulin resistance), inflammation, endocrine-disrupting chemical exposure, diet, and endotoxemia (gut-derived foreign molecules that get into the bloodstream) can all influence the level and activity of these sex hormones and thus acne.

This is ultimately where treating acne requires an individualized, holistic approach to treatment for clearer skin. Taking a deeper dive into the underlying causes such as diet, inflammation, and hormones through comprehensive testing can help uncover the underlying causes of your acne.

For more information on my approach to treating acne, you can check out my blog posts here, or book your meet and greet to discuss your personal skin concerns.


Dr. Randi Brown, ND


Demirbaş, A., & Elmas, Ö. F. (2020). The relationship between acne vulgaris and irritable bowel syndrome: A preliminary study. Journal of Cosmetic Dermatology.

Maguire, M., & Maguire, G. (2020). Gut Microbiome Production and Modulation of Hormones That Influence Host Skin Health.

Kim, H., Moon, S. Y., Sohn, M. Y., & Lee, W. J. (2017). Insulin-like growth factor-1 increases the expression of inflammatory biomarkers and sebum production in cultured sebocytes. Annals of dermatology29(1), 20-25.

Geller, L., Rosen, J., Frankel, A., & Goldenberg, G. (2014). Perimenstrual flare of adult acne. The Journal of clinical and Aesthetic dermatology7(8), 30.

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