The Link Between Hormones and Acne: Part 1

Although acne is the same systemic inflammatory disease in both adolescents and adults, the precipitating events leading to its onset differ greatly between teens and adults.

Changing hormone levels affect the onset of acne. We know that the sebaceous glands can be stimulated by hormones to produce sebum. The male hormones (androgens) stimulate oil production by binding to a special receptor on the oil gland. An enzyme present in the oil gland breaks down these androgen-type hormones, such as testosterone, into a more powerful hormone called dihydrotestosterone (DHT).

Doctors differ in their opinions about the role of estrogen in acne. Some physicians believe that as levels of the hormone progesterone decrease in women as they age, the estrogen comes to predominate, and may cause a problem. Other physicians believe that estrogen is helpful, because the increase of hormones like estrogen that bind up the testosterone also reduces the production of testosterone and other androgens.

But simply measuring the testosterone level in blood does not tell us much because some testosterone is bound to a protein, and only the testosterone that is not bound has an effect on the oil glands. We must also bear in mind that a woman's ovaries can produce androgens (which are male hormones). In addition, androgens can be produced by the adrenal gland (a small gland that sits on top of the kidney), which also produces something called dehydroepiandrosterone (DHEA). The androgens produced by a woman's ovaries and the DHEA produced by her adrenal glands can then affect the oil glands, causing them to convert the androgens into a more potent form, via the enzyme 5-alpha reductase type 1.