Testosterone and Acne: Is There a Link?

Testosterone is one of the male sex hormones or androgens responsible for developing sexual characteristics in them. It is responsible for developing masculine features in men, including an increased muscle mass and a deeper voice. Although it is primarily known as a male sex hormone, it is also produced in females. In females, adrenal glands and ovaries produce a small quantity of testosterone.

The amount of this hormone tends to fluctuate, which is expected as long as these fluctuations happen within the normal ranges. A problem arises when these levels exceed the normal ranges.

Testosterone and Acne

Before we get into the details of how testosterone levels are responsible for acne breakouts, let's first see the pathophysiology or mechanism of acne breakout.

Research has shown that the sebaceous glands play a significant role in acne breakouts (Makrantonaki, 2011).

Our skin produces oil called sebum to keep it hydrated and protect it against dryness. While normal sebum levels are essential for skin health, increased oil production can be problematic. Excess sebum can clog or block the skin's pores or be trapped in the hair follicle. These clogged pores can become inflamed and result in tiny bumps on the skin, known as acne (Elsaie, 2016).

You can experience acne in different forms, including:

• Whiteheads
• Blackheads
• Pustules
• Cysts
• Nodules
• Papules

Testosterone can contribute to acne breakouts as it is directly linked to increased sebum production (Saturia, 2021). Testosterone levels and other androgens change drastically during puberty in males and females as they are responsible for developing secondary sexual characteristics. This is why teenagers are prone to acne breakouts that can persist through adulthood.

Several types of research have been conducted in this field. The researchers have concluded that the severity of acne flare-ups in both men and women is directly related to androgen levels, especially testosterone levels (Iftikhar, 2019).

Testosterone and Acne Breakouts in Women

You might have known testosterone as a male sex hormone which is accurate as it plays a significant role in developing primary and secondary male sexual characteristics. But this hormone is not confined to the male population; a small amount of testosterone and other androgens are also present in females. The role of testosterone is different in females than in males. But in terms of skin problems, high testosterone production produces similar negative consequences (Uysal, 2017; Leon, 2021).

Causes of Testosterone Fluctuations

Hormonal fluctuations are a normal process that happens throughout life in both men and women, especially when they hit puberty. Testosterone levels are highest in men during their teenage years. They decline as they age, and a significant reduction in these levels occurs after they reach thirty (Zirkin, 2012).

In women, testosterone levels are thought to be raised during ovulation. But research shows these fluctuations are only minor compared to regular day-to-day changes. A woman experiencing acne during the mid-cycle is most likely due to estrogen and progesterone (Bui, 2013).

Other conditions that can cause testosterone fluctuations include PCOS in females, testicular tumours in men, and ingestion of anabolic steroids in both.

Available Treatments for Hormonal Acne

For mild cases of hormonal acne, topical therapy is the treatment of choice. Topical medication in gels, medication-soaked pads, washes, and solutions is suitable for oily skin as they tend to cause skin dryness. On the other hand, topical lotions, creams, and ointments are hydrating and are preferred if you have a dry skin type. You can choose from one of the following topical treatment options (Kraft, 2011; Elsaie, 2016):

• Topical retinoids commonly available as tretinoin, tazarotene, and adapalene
• Topical antimicrobials like benzoyl peroxide, erythromycin, and clindamycin combination therapy
• Over-the-counter medication like Proactiv system and salicylic acid 2% wash

These topical treatments can be applied to acne and help prevent new lesions. Some of these treatments can cause side effects, the most common of which is local irritation. It is essential to know that topical treatments do not provide a quick solution for acne. Some of these treatments might take 6 to 8 months to cause any improvements.

Over-the-counter medications are very popular, and most people try these before visiting a dermatologist. But the research to establish the efficacy of these products is not comprehensive (Kraft, 2011).

Suppose you face a moderate to severe form of acne. In that case, your healthcare provider will choose systemic therapy to treat your condition. Systemic therapy is the treatment of choice in this case, and it consists of oral antibiotics, hormonal therapy, and isotretinoin. The available treatments for moderate to severe forms of acne include (Kraft, 2011; Boen, 2017):

• Antibiotics such as tetracycline, doxycycline, minocycline, erythromycin, etc.
• Hormonal therapies like antiandrogen therapy, estrogen-containing oral contraceptives, and oral antiandrogen spironolactone
• Alternative or herbal therapies like tea tree oil and oral ayurvedic compounds have been effective. Still, the research is limited regarding their efficacy.
• Oral isotretinoin (Accutane). It's highly effective but contraindicated in pregnancy.
• Physical treatments like comedone extraction, chemical peels, microdermabrasion, phototherapy, etc.
• Laser treatment

Helpful Tips for Acne-Prone Skin

Following are some valuable tips for acne-prone skin (AAD, 2021):

• Sweating can make your acne worse, so wash your face when there is sweating
• Only use your hands to cleanse your face, and avoid using washcloths or other abrasive objects
• Use gentle, alcohol-free skin products
• Do not use products like toners and exfoliants that can irritate your skin
• Do not scrub your face harshly
• Use lukewarm water to wash your face
• If you have oily skin, then shampoo daily
• Picking, squeezing, or popping your acne can delay the healing
• Avoid touching your face unnecessarily
• Please do not go near tanning as it is damaging to your skin
• Avoid UV light

If your acne is not controlled using these tips, you should consult your dermatologist to find a suitable treatment option.

Conclusion

Hormonal acne can be unpleasant and sometimes depressing as it mainly occurs on the face and affect your appearance. If you think hormonal imbalances are responsible for your acne breakout, it is advised to see your doctor. They can make a definitive diagnosis after assessment and determine an appropriate course of action.