Hormonal acne isn’t just a teenage thing — and no, it’s not because you forgot to wash your face.
This type of acne is driven by internal imbalances, not bad hygiene or dirty pillowcases. It’s deeply connected to what’s happening with your hormones — specifically estrogen, progesterone, testosterone, and DHEA — and how these hormones rise and fall throughout your cycle. Additionally, hormonal acne is related to how well your systems of elimination are working (or aren’t working) — your skin is your biggest organ of elimination and it works within a system that includes the liver, lymphatic system, and large intestine.
So what does hormonal acne look like?
If you’ve ever noticed that your skin goes haywire right before your period, that’s a clue your hormones are involved. And if the same thing happens after you stop birth control, start a new supplement, or hit a stress wall? Yep — more hormone clues.
In this post, I’m breaking down the hormone imbalances behind acne, the foods that support clear skin, the supplements that can help heal, and the lifestyle shifts that seal the deal.
What’s really going on under the surface? Hormonal acne usually involves one or more of the following:
When we talk about hormonal acne, especially the kind that pops up around the chin, jawline, or neck, we’re often talking about a hormonal imbalance involving the androgen hormones — testosterone, DHEA-S, and androstenedione.
When these androgen hormones get too high, the results is a chain reaction that affects the health of your skin in a big way:
↳ androgens tell your skin to make more sebum (oil)
These hormones stimulate the sebaceous (oil) glands in your skin — especially on your face, chest, and back — to produce more sebum.
↳ excess oil clogs pores
Combine that oil with dead skin cells and a bit of inflammation, and now you’ve got a clogged pore — aka a breeding ground for acne-causing bacteria (Cutibacterium acnes).
↳ bacteria + inflammation = hormonal breakouts
The result? Deep, cystic pimples that are often painful, red, and slow to heal. These tend to show up in hormonal hotspots like the lower face and jawline.
This is where it gets juicy — and so individual. The root cause of elevated androgens can be from a variety of reasons:
PCOS (Polycystic Ovary Syndrome): a major root cause of high androgens, especially when it includes insulin resistance.
Insulin resistance: when your body struggles to manage blood sugar, insulin levels rise — and insulin can stimulate your ovaries to make more androgens.
Chronic stress: your adrenal glands can produce DHEA-S (a precursor to testosterone) in response to long-term stress.
Post-pill rebound: after stopping hormonal birth control, androgens can temporarily spike, especially if the pill was suppressing your natural hormones.
Genetics or family history: some women are just more sensitive to androgens at the level of the skin, even with “normal” hormone levels in labs.
Let’s say your testosterone and DHEA levels are normal, you’re eating clean low inflammatory foods, and your skincare is dialed in — but you still get breakouts, especially before your period.
It’s not just about androgens. Sometimes, the issue is actually an imbalance between estrogen and progesterone.
Even if your estrogen isn’t “high” by lab standards, if progesterone is too low, estrogen takes the lead — and that’s where trouble starts.
Estrogen and progesterone are like hormonal yin and yang — they’re meant to work in tandem. When that balance tips, here’s what can happen:
↳ Estrogen increases histamine and inflammation — setting the stage for sensitive, breakout-prone skin.
↳ Low progesterone means less calming, less anti-inflammatory action — and more room for androgens or cortisol to act out.
↳ Estrogen dominance can negatively affect blood sugar and thyroid function, which are both key players in hormone-related skin issues.
Even though estrogen is often seen as the “pretty skin” hormone, too much of it (relative to progesterone) can have the opposite effect — especially when it’s not being cleared efficiently by the liver and gut.
Estrogen dominance isn’t always about too much estrogen — it’s often about not enough progesterone to keep it in check. Your body is beautifully designed to cycle between these two hormones:
Estrogen rises in the first half of your cycle (follicular phase)
and
Progesterone kicks in after ovulation (luteal phase) to calm, ground, and balance you out
If you don’t ovulate regularly, or your body doesn’t make enough progesterone, estrogen ends up dominating the second half of your cycle — leading to symptoms like:
Some of the most common causes of low progesterone include:
You might not see “low progesterone” listed on your lab results — but your body is always giving you clues. That luteal phase breakout? It’s not just random — it’s your body saying, “Hey, I need a little more support this cycle.”
Here’s something most dermatologists don’t tell you: your skin isn’t just reacting to surface-level stuff — it’s often acting as a pressure valve for deeper internal congestion, especially when your liver and gut are overwhelmed. What you put into your body – the food you eat, the products you use on your skin and hair, the cleaning substances you handle – must be eliminated properly.
If all of your elimination organs are not working optimally, then the leftover toxins will show up on your face as acne. Excess hormones (like estrogen and testosterone) will also be prevented from leaving the body properly and cause you to have all the hormonal symptoms – from acne to PMS.
Your liver is responsible for metabolizing estrogen, especially through what’s called phase I and phase II detoxification. If phase I is overactive (or inflamed), and phase II is sluggish or nutrient-depleted, your estrogen metabolites can become inflammatory — or just get recirculated through your gut.
If you’re also constipated, those half-detoxed hormones don’t get eliminated — they get reabsorbed. It’s like taking out the trash … and then bringing it back into your kitchen.
Result? Estrogen dominance, inflammation, and hormone-driven breakouts.
When your liver and large intestine are working at a subpar level, your skin steps up and tries to eliminate the toxins – resulting in skin inflammation and acne.
Your skin is never the problem — it’s the messenger.
And when that message says “hey, something’s stuck inside,” it’s time to open up those pathways and let your body flow again.
Your body is detoxing all the time — through your liver, bowels, kidneys, lymph, breath, and skin. But when we say “poor detox pathways” in the context of hormonal acne, we’re usually talking about:
And when those systems are overloaded or undernourished? The skin steps in to help — through oil, inflammation, and breakouts.
Some key signs that your detox pathways might need some support:
You can be using all the right skincare, eating your greens, even taking fancy supplements — but if your blood sugar is on a rollercoaster and your nervous system is always in fight-or-flight, your hormones will keep rebelling. And they’ll often show it on your skin.
Every time you eat, your blood sugar rises. That’s normal. But when it spikes too high, your body pumps out insulin to bring it back down. The problem? Chronically high insulin levels can trigger:
Even “healthy” meals can be problematic if you’re skipping protein or grazing on carbs without fat or fiber.
Your body can’t tell the difference between a work deadline and running from a tiger. Stress (even emotional or hidden stress) activates your brain/adrenal axis, which can:
This chronic stress loop keeps your hormones on high alert — and your skin caught in the crossfire.
What blood sugar dysregulation and stress look like on your skin:
You don’t have to track every macro or meditate for hours. But if you can gently support your blood sugar and find even tiny ways to show your body that it’s safe? Your hormones will soften. Your inflammation will calm. And your skin will start to reflect the peace you’re building inside.
It’s all connected — your skin is like a mirror reflecting what’s going on inside hormonally, metabolically, and emotionally. That’s why a natural, root-cause approach to treating hormonal acne is so powerful: instead of fighting your skin with stronger acids or antibiotics, you’re working with your body to rebalance the deeper issues.
Now let’s get into the good stuff — the best way to heal hormonal acne naturally.
You’ve probably heard the phrase “you are what you eat,” and while it’s a bit of a cliché, when it comes to hormonal acne, it’s so real. What you put on your plate directly affects your hormones — and your skin is often the first place imbalances show up. The best way to prevent hormonal acne is to support the function of your elimination organs with the right foods.
Your liver needs enough micronutrients to work properly to detoxify your body. Foods that are inflammatory cause leaky gut syndrome where microscopic holes develop in the wall of your intestine. These holes let food molecules through which then cause an inflammatory response in the body. This is when the other elimination organ – your skin – tries to take on the workload and tries to eliminate the toxins – resulting in skin inflammation and acne.
The following are the most important diet changes to naturally treat hormonal acne:
Blood sugar spikes = insulin spikes = more testosterone production = more oil production + more inflammation. That’s a major hormonal acne trigger. Here’s what will help:
Ugh, I know — this one’s hard. But for some women, dairy can be a huge trigger for hormonal acne. That’s partly because of hormones naturally present in milk and partly due to how dairy affects insulin and IGF-1 (a growth factor linked to acne). Here’s what will help:
These two nutrients are skin superheroes. Zinc helps with hormone production and immune function, while omega-3s are anti-inflammatory and support cell membranes (aka healthy skin). Here’s what will help:
There’s no one “hormonal acne diet,” but some foods truly nourish your endocrine system and help support efficient detoxification of excess hormones and toxins, which is essential for skin health. Here’s what to include in your daily diet:
This little ritual feels so cozy — and studies suggest spearmint tea may help lower androgens, the hormones most often linked to cystic breakouts.
A quick note on restriction
This is not about being perfect or following some rigid, joyless plan. It’s about being curious and noticing what your body is asking for. Some people do great with occasional dairy. Others can eat chocolate and be fine. The goal here isn’t a diet, it’s a nourishing rhythm that supports your hormones, your skin, and your peace of mind.
The problem with most standard acne treatments is that they do nothing to target the root cause. Poor quality food, excessive exercise, chemicals in your environment, sleep deprivation, the Pill, and stress all strip your body of key micronutrients that keep your hormones healthy and your skin clear.
The supplements I list below include essential micronutrients to act as your “insurance policy” against endocrine disruptive things you’re doing (knowingly or unknowingly) that are throwing you off balance. You might be surprised to learn that zinc deficiency is a very common issue for many women; when we’re deficient in zinc, our pores become easily irritated by bacteria and show redness. A large-scale scientific study actually concluded that zinc supplementation is very effective even when compared to commonly prescribed antibiotics for acne treatment.
When you use targeted supplements to support your hormones and root causes, things will gradually shift — not overnight, but steadily and surely.
Here are the supplements that can make the biggest difference in your hormonal acne journey:
DIM is a compound naturally found in cruciferous veggies (like broccoli and kale), but in supplement form, it helps the body metabolize estrogen more efficiently — especially important if you’re dealing with estrogen dominance or sluggish detox.
why it helps:
It encourages healthy estrogen pathways and may reduce those painful, cystic breakouts often tied to hormone fluctuations.
what to know:
Spearmint tea has actual research behind it showing that it may help reduce androgen levels — the hormones that tend to spike oil production and lead to hormonal acne, especially on the jawline.
how to use it:
This mighty mineral plays a role in everything from hormone production to immune defense to skin healing — and many women with acne are low in it.
pro tip:
Take it with food to avoid nausea, and avoid long-term use without copper balance.
Inflammation is a huge part of the hormonal acne puzzle, and omega-3s (especially EPA and DHA) help lower inflammation, support healthy cell membranes, and even modulate hormone function.
best sources:
This one’s not directly for acne, but it supports the stress response, promotes better sleep, and helps regulate blood sugar — all key to keeping hormones (and therefore your skin!) happy.
best forms:
If you’re trying to conceive, pregnant, or postpartum, your supplement plan should absolutely be adjusted to match your nutrient needs and safety guidelines. The good news? Many of the acne-friendly nutrients we just covered are also key for hormone health and fertility (hi, zinc, omega-3s, and magnesium!). You can get your hands on my favorite prenatal here.
Gut health is everything when it comes to hormone balance. Your microbiome not only affects how well you digest and absorb nutrients, but it also helps regulate inflammation and clear excess estrogen through something called the estrobolome (a fancy term for gut bacteria that metabolize estrogen).
When your gut is out of whack — from antibiotics, stress, food sensitivities, or even birth control — your skin often pays the price.
why they help:
what to know:
This underrated B-vitamin plays a big role in estrogen and progesterone balance, mood regulation, and skin oil production. If you get irritable, weepy, or breakout-prone before your period, B6 might be part of the fix.
why it helps:
Your liver is your hormone and toxin filtration system — and when it’s undernourished or overworked, it struggles to detoxify used-up estrogens, inflammatory byproducts, and toxins. That burden? It often gets rerouted through the skin. DetoxAntiox supports healthy glutathione production, making it helpful for supporting phase II liver detoxification, while also supporting the body’s antioxidant status and the normal detoxification of chemicals and heavy metals.
why it helps:
Note: Not all supplements are right for everyone. Your cycle, health history, and life stage matter! Always check with your practitioner, or schedule a 1:1 consult with me, before starting something new — especially if you’re trying to conceive or are currently pregnant/postpartum.
While diet and supplements lay the foundation, your daily rhythms and stressors are what hold it all together. No supplement or skincare product can outmatch a lifestyle that’s out of sync with your hormones.
Here are some lifestyle adjustments that will actually make a difference:
Cortisol — your body’s main stress hormone — is super inflammatory. Chronically high cortisol can throw off your estrogen, progesterone, and androgens, leading to breakouts, irregular cycles, and that wired-but-tired feeling.
what to do:
Your skin and hormones repair at night. If you’re skimping on sleep, your body has a harder time regulating insulin, cortisol, and reproductive hormones — all key players in hormonal acne.
sleep upgrades to make:
Your cycle is basically a hormonal symphony. When you learn to track and sync with it, you start to understand why you feel different each week — and how your skin reacts.
cycle syncing looks like:
These sneaky chemicals (like BPA, phthalates, and synthetic fragrances) can mimic or block your natural hormones, throwing off the balance and burdening your liver.
swaps to make:
Rushing through meals, skipping breakfast, or grazing all day? That’s a blood sugar nightmare — and it shows up on your skin.
new rhythms:
If you’ve made it this far, I hope you feel more empowered and less alone on your journey.
Hormonal acne isn’t just about skin. It’s your body’s way of waving a little flag, asking for support, nourishment, and attention. And while it can be incredibly frustrating (and yes, totally confidence-shaking), it’s also a powerful invitation to reconnect with your body in a deeper way.
Whether you’re just starting to explore your hormone health or you’ve tried all the things — know this:
Your skin can heal.
Your hormones want to be in balance.
And it doesn’t have to be perfect to work.
It’s not about finding one magic product. It’s about tuning in, being curious, and making slow, sustainable shifts — through food, supplements, lifestyle, and support — that help your body and skin come back into harmony.
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Sarah Jane Sandy is a certified nutrition therapist, and a fertility and women’s health expert. She has helped hundreds of women increase their fertility naturally and go on to have healthy full-term pregnancies. She has been working with women and couples trying to get pregnant for over 16 years and over 90% of the women who work with her get pregnant and have healthy babies.
She also works with women trying to fix their hormone imbalances, as well as supporting women through pregnancy and the postpartum period. Learn more about her own fertility and hormone journey here. To send Sarah a message, complete her Contact Form.
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