When your acne is hormonal, it doesn't mean that one hormone is in overdrive. It means that different hormones together send signals that increase your sebum production and make your skin more susceptible to inflammation. It's their intricate balance that determines whether your skin remains calm or becomes blemished.

Imagine your body is a house

Imagine for a moment that your body is a house. In that house live different residents. These are your hormones. They walk around, talk to each other, send messages, and influence what happens in that house. And your skin? It's in the living room. It hears everything that's said.

Sometimes it's quiet in the house. Sometimes there's a bit more chatter. And sometimes one resident starts shouting very loudly. When that happens, you don't see it as noise. You see it as pimples on your chin or suddenly blemished skin.

Let's see who lives in that house.

What exactly is a hormone?

A hormone is a chemical messenger.

It is produced in a gland and travels through your blood.
It binds to specific receptors on other cells to transmit a message.

Think of it as a WhatsApp message: for example, your ovary sends a message, but only cells with the right "app" can open that message.

Your skin has such an app. So when your ovaries send a message via hormones (estrogen or progesterone), your skin reads that message and adjusts its behavior.

The loudest resident: androgens

In our house live androgens. These are hormones such as testosterone, DHT (dihydrotestosterone, a more potent form of testosterone), and DHEA (dehydroepiandrosterone, a precursor hormone from which other androgens are made).

They are produced in your ovaries, in your adrenal glands, and even in your skin itself.

Yes, your skin, as it were, has a small internal factory that can convert weaker androgens into stronger forms via an enzyme like 5-alpha reductase.

Androgens are steroid hormones, which means they are made from cholesterol and can directly enter your cells to turn genes on or off there. So they give very direct instructions.

When androgens start shouting in the house, they are essentially saying one thing: make more sebum!

Your sebaceous glands listen. They get bigger, produce more oil, and the pore wall thickens faster on the inside. More oil combined with a thicker pore increases the chance of blockages. And that is the basis of hormonal acne, especially the typical pimples on the chin and jawline. (Read more: Hormonal acne: how to adjust your skincare).

Even when your blood values are normal, your skin may be more sensitive to these signals. It's not that there are more androgens, but that your skin listens harder.

The amplifiers from the kitchen: insulin and IGF-1

In the kitchen of the house lives insulin. Insulin is a hormone produced in your pancreas that allows sugar from your blood to enter your cells.

Perhaps you have heard of diabetes. People with diabetes produce too little insulin or their body does not respond well to it.

Every time you eat, insulin rises a little. But especially when you eat fast sugars or many refined carbohydrates, insulin rises faster and higher.

When insulin is often elevated, something interesting happens in the house: It lowers SHBG (sex hormone binding globulin, a protein that "captures" testosterone in your blood). When SHBG decreases, more free testosterone becomes available.

In addition, insulin calls upon its friend IGF-1 (insulin-like growth factor 1, a growth hormone). IGF-1 is like a volume knob in the house.

It amplifies the voice of androgens. It stimulates sebaceous glands, increases sebum production, and promotes cell growth in your pores. When insulin and IGF-1 are chronically elevated – chronic means long-term, for example due to daily high sugar intake – then the androgenic effect becomes stronger. That is why the relationship between diet and acne is so important. (Read more: Diet & acne). Not because sugar "directly" causes a pimple, but because it makes the group chat louder.

The peacemaker: estrogen

In another room lives estrogen. Estrogen is what we often call the female hormone.

There are different forms such as:

• estradiol (the most important in young women)
• estrone
• estriol.

Estradiol is the most potent and most relevant for your cycle and your skin.

Estrogen is primarily produced in your ovaries. In the house, estrogen is the one that says: take it easy. It stimulates collagen, increases hydration, supports your skin barrier, and has anti-inflammatory effects. Additionally, it increases SHBG, which means less free testosterone is available.

When estrogen is relatively more present, you often see more glow, less inflammation, and less blemished skin. Estrogen buffers the effects of androgens. It's not that androgens disappear, but their voice becomes softer.

The mood changer: progesterone

After ovulation, progesterone enters the house. Progesterone is produced in your ovary, in smaller amounts in your adrenal glands, and during pregnancy in the placenta. Progesterone is also a steroid hormone.

Its main task is to prepare your body for a possible pregnancy. But your skin also has receptors for progesterone.

When progesterone rises:

• Sebum production can increase
• It can partially counteract estrogen
• It works together with androgens

What's important is not just that progesterone rises, but what happens simultaneously with estrogen. When progesterone is present and estrogen starts to drop, there's a moment when androgens become relatively stronger. That's often when you feel your skin getting oilier, your chin starting to break out, and your acne returning. (Read more: Why do I get pimples on my chin and jawline?)

The directors upstairs: FSH and LH

Upstairs in the house, in the attic, live FSH (follicle-stimulating hormone) and LH (luteinizing hormone). They are produced in your brain and control your cycle. FSH stimulates your ovaries to produce estrogen. LH triggers your ovulation and progesterone production.

They don't have a major direct influence on acne, but they determine which residents in the house become more active. They essentially regulate the volume.

Stress and cortisol: when the house is under pressure

Cortisol is your stress hormone. Chronically stressed means being under long-term tension, poor sleep, always being busy, or remaining emotionally burdened without real moments of rest.

When cortisol is chronically elevated (= chronic stress), sebaceous glands become more active and inflammatory sensitivity increases. Adrenal androgens can also rise.

It's as if someone else starts shouting in the house. Your skin hears that too.

Which hormones influence hormonal acne the most:

• Androgens → increase sebum production
• IGF-1 → strengthens androgens
• Insulin → increases free testosterone
• Estrogen → protects and buffers
• Progesterone → affects timing of worsening
• Cortisol → increases inflammatory sensitivity

What does hormones in balance mean?

Hormones in balance doesn't mean everyone has to be silent. It means no one dominates. That androgens don't scream. That estrogen is still heard. That insulin and IGF-1 don't constantly turn up the volume. That stress isn't permanently present.

Hormonal acne doesn't mean your body isn't working. It means the group chat has temporarily gotten loud. And if you understand who's talking, you understand why your skin is reacting.

Read more: Acne before your period? How to adjust your skincare.

Frequently asked questions about hormones and hormonal acne

What exactly is hormonal acne?

Hormonal acne is acne that is strongly influenced by fluctuations in androgens, estrogen, progesterone, insulin, and IGF-1.

Why do I primarily get pimples on my chin?

The jawline contains more androgen receptors and is more sensitive to hormonal fluctuations.

Does acne mean my hormones are out of balance?

Not necessarily. Many women with hormonal acne have normal blood values but increased skin sensitivity.

Does diet influence hormonal acne?

Yes. High sugar intake can, via insulin and IGF-1, enhance the effect of androgens.

Should I have my hormones tested?

This is especially useful for irregular cycles, hair loss, or excessive hair growth.

Author: Sofie Dewitte

Sources

• Telkkälä A et al. Etiology of Adult Female Acne – Systematic Review. Health Science Reports. 2025.

• Kanda N, Watanabe S. Regulatory roles of sex hormones in cutaneous biology. Clinics in Dermatology. 2005.

• da Rocha MAD et al. Unveiling the nuances of adult female acne: a comprehensive exploration. Int J Women’s Health. 2024.

• Marie‑Chantal et al. Hormonal imbalance and adult acne severity. Longdom Publishing. 2023 (commentary).