HORMONE SERIES | Androgens 101
With all this talk about progesterone and estrogen, you might be thinking, “Wait! Then what’s the deal with androgens and acne?” Great question. Reducing excess androgens is one of the keys to clearing up your skin. Perhaps the most important. But I’m jumping ahead. Let’s back up and start at the beginning.
What exactly are androgens? Androgens are primarily thought of as “male hormones,” and include testosterone, androstenedione, dihydrotestosterone (DHT), dehydroepiandrosterone (DHEA), and DHEA sulfate (DHEA-S). These hormones are present in smaller amounts in women and are necessary for the production of estrogen. They also play a role in female mood, libido, and bone health. Low androgen levels can lead to painful sex and low libido, while high androgen levels can mean irregular cycles, infrequent ovulation, and ACNE. Yep, the “Goldilocks Rule” applies again and you want your androgen levels to be just right.
How do androgens relate to acne? Remember that sebaceous glands and sebum production play a central role in the development of acne. Androgens, particularly testosterone and DHT, are responsible for enlarging sebaceous glands and increasing sebum production. Androgen receptors are located in the basal layer of the sebaceous gland. When free testosterone enters the cell, it is quickly reduced to 5-dihydrotestosterone (5-DHT) by the 5α-reductase enzyme. DHT is ~5-10 times more potent than testosterone in its interaction with androgen receptors. Tl;dr, nipping excess androgens in the bud equates to stopping acne before it starts.
What causes excess androgens? There are a number of conditions that can lead to increased androgen production, including:
- PCOS. Polycystic Ovarian Syndrome affects approximately 1 in 15 women in the U.S. and is the leading cause of infertility. PCOS causes the ovaries to produce androgens, which typically results in acne, hair loss on the head, and hair growth in unwanted places like the chin, cheeks, and belly (aka hirsutism).
- Congenital Adrenal Hyperplasia. This is a surprisingly common genetic condition that causes the adrenals to produce too many androgens.
- High Prolactin Levels. Known as hyperprolactinemia, an estimated 40% of amenorrhea cases are related to high prolactin levels. Elevated prolactin causes more activation of testosterone to DHT.
- Hypothyroidism. A 2012 study found that women with acne had a statistically significant increased relative risk of having high levels of anti-TG (anti-thyroglobulin) in comparison with healthy controls.
- Birth Control with High Androgen Index. Technically not a condition, but I’m putting it here because it’s a trigger with an easy fix. Do a little research and if you find that your birth control is one of many that contains synthetic progestins that produce a “testosterone-like” effect, then ditch it and find a new one.
Anything a little subtler? The conditions above result in chronically elevated androgen levels, but there are a number of other factors that can boost androgen levels unrelated to any formal diagnosis. These include:
- A Sugar-Laden Diet. Insulin increases androgen production, which explains why studies have linked a high glycemic diet to acne.
- Quitting The Pill. Many birth control pills prevent acne by lowering androgen levels so when you stop taking the pill, you may experience a surge of androgens. Additionally, low estrogen levels are typically a consequence of taking the pill and amongst many other great things, estrogen directly opposes androgens within the sebaceous gland. (Before diving into treatment, it’s important to note that often times post-pill hormone levels will balance out on their own.)
- Hypersensitivity to Androgens. Yep, you might just be extra sensitive to androgens. In fact, only 15 to 40% of women with acne have higher than normal androgen levels. So don’t lose hope if your blood work reveals normal testosterone and DHT levels. You can still benefit from an anti-androgen game plan.
- Stress. Our old friend, stress. We know all too well that stress increases acne. This is because high cortisol levels stoke the androgen flame.
What can be done to control androgen activity? I know you want to dive into topical treatments, but let’s start by chatting about some of the internal work that can be done. Some internal treatments, include:
- Balance That Blood Sugar. A diet packed with sugar and refined carbohydrates is no one’s friend, especially not someone worried about high levels of androgens and acne. Focus on wild protein, healthy fats, plenty of fiber and veggies, and a small portion of carbohydrates. Balanced blood sugar supports gut health and healthy estrogen and progesterone production as well!
- Reduce Stress.
- Consider Introducing an Androgen-Blocking Supplement. Great choices include reishi mushroom, a licorice and peony blend (do not take if you have high blood pressure), spearmint tea, and Vitex (especially where prolactin levels are high). That being said, don’t think that you can sip spearmint tea and pop some Vitex while enjoying a crappy diet. Diet first, supplements and skincare second!
What about topical treatments? Balancing hormones from the inside out is the key to long-term success, but that is not to say that we can’t speed things up with a little strategic skincare:
- Keep Pores Clear. Androgens increase sebum production, which results in clogged pores, which leads to an inflammatory response… and you know the story from there. So let’s prevent all of this madness in the first place. Exfoliating acids (like this and this) and retinols are your friends. Start slowly with both to prevent irritation. Once a week, swap out your everyday acid for a stronger treatment mask.
- Focus on Fatty Acids. Acne prone skin tends to be deficient in free fatty acids, particularly linoleic acid, so reach for oil cleansers and facial oils to moisturize.
- Avoid Sensitizing Ingredients. Rather than piling on anti-inflammatory ingredients, it’s more important to remove ingredients that are causing chronic irritation. Things like silicones, colorants, perfumes, drying alcohols, sodium lauryl sulfate, chemical sunscreens, and essential oils can be highly sensitizing and irritating. Remember that your skin is an intelligent organ with its own capacity for healing. So let it.
Hormone balance is within your reach! But if you are feeling completely overwhelmed and unsure of where to start, book a session. I’m here to help!!