Even though I know I have hormonal acne, and even though I have done a basically good job of clearing it with supplements, I still feel like I’m a little in the dark. For one thing, my acne seems to reappear if I stop my supplements. For another, my periods (closely related to hormonal acne) are still painful and I still experience significant PMS. Finally, supporting my liver (with Reishi – which I LOVE) has been helping quite a bit, and that has made me curious about the connection between hormones and healthy liver function.
So I’ve spent the last few months researching and reading to see if could become a little clearer on what exactly hormonal acne is. Specifically, I was curious about these things:
- Here are the words I hear bandied about: estrogen, progesterone, bad estrogen, androgens, DHT. I want to find out how these basically relate to each other and what each one is, and does, and where it comes from.
- Is all hormonal acne the same? And if not, what are the different causes and their symptoms of specific hormonal imbalances?
- How exactly does the liver come into play?
- What supplements help with specific hormones?
So I began reading. As you may or may not know, the supplement that is the most helpful for me is called Estroblock, and this is the one that I really notice my acne coming back if I discontinue use. So that’s where I decided to start:
How is Estroblock helping my acne disappear and what underlying problem is it fixing?
Estroblock treats estrogen dominance, which can be caused by a few things.
- fake estrogens from the environment getting into the body
- liver metabolizing estrogen too slowly
- liver metabolizing estrogen into bad estrogen metabolites
- low progesterone or progesterone out of sync with estrogen production
1) Fake estrogens
Sometimes bad estrogens (called estrogen mimics or xenoestrogens, ie alien estrogens) come into our body through the environment. Certain chemicals from pesticides and plastics, soaps, emulsifiers, household cleaning products and even car exhaust look and act enough like natural estrogens that the body mistakenly accepts them as estrogen. They are fat soluble and pass through the skin easily and accumulate over time. Then they latch onto estrogen receptors (located on the body’s cells) both sending false signals to the cell and also preventing the body’s natural estrogen from being able to bind, resulting in more estrogen circulating through the system.
2) Slow estrogen metabolism
Estrogen dominance can also be caused by a slow estrogen metabolism – and this is where the liver enters the picture. Once estrogen has completed its goal with the target cells, it is sent back to the liver, via the bloodstream, to be metabolized. However, if the rate of metabolism is too slow, or if the liver has an excess of toxins to deal with, the estrogen will simply be left in the blood, resulting in an excess of estrogen.
3) Bad estrogen metabolism
When the estrogen is metabolized, it turns out that the liver can metabolize estrogen through 2 different pathways. A healthy liver with efficient estrogen metabolization will mostly convert the estrogen into the beneficial estrogen metabolites, or those produced through the 2 hydroxy pathway: 2-hydroxy and 2-methoxyestrogens. The 2-hydroxy metabolites are intentionally released back into the blood, and account for many of the benefits of estrogen, including the prevention of heart disease and strong, healthy bones. The 2-hydroxy metabolites also have the power to get rid of damaged or cancerous cells throughout the body.
However, the 16-hydroxy pathway, the second metabolic pathway, creates 16-hydroxy estrone and 4-hydroxy estrone, the bad estrogen metabolites that result in estrogen dominance and are linked to many health problems, most notably oxidation, DNA damage, cancer, and as we know, hormonal acne.
So how does Estroblock address the excess of estrogen and bad estrogen metabolites in the blood?
Estroblock is a super concentrated amount of a compound called DIM (Diindolylmethane is formed in the body from plant substances contained in cruciferous vegetables such as cabbage, Brussels sprouts, cauliflower, and broccoli) and appears to help your liver metabolize estrogen more efficiently and promotes the creation of the 2-hydroxy (good) estrogen metabolites.
Is there anything I can do besides take Estroblock to help estrogen dominance?
And at this point, we also have these solutions for high estrogen:
1) Take a DIM supplement
But at the same time try to get your liver up to speed in a more sustainable, natural way. Supplements are good for harsh imbalances, but try to only use them until the body is back in balance and then continue with milder long-term lifestyle and diet therapies that will control our hormonal acne more naturally and sustainably.
2) Support the liver
- Keep the toxin load on the liver low – ie, no chemicals, pesticides, processed foods, alcohol, caffeine, sugar, bad fat – you know the drill
- Take a liver supplement (2 best ones are Reishi and Milk Thistle – personally Reishi has been knocking it out of the park for me)
- Eat a high protein diet (in order to effectively eliminate estrogen from the body, the liver needs several amino acids that come from protein)
3) Lose weight
Only if needed. This is because estrogen production and storage occurs in fat cells. Honestly, this seems like the least effective and most frustrating of all the suggestions, so don’t go too crazy with this one.
4) Eat foods that balance estrogen and support liver
- obviously cruciferous vegetables, since they are responsible for DIM
- liver supporting foods like beets, grapefruit and greens
- as mentioned before, healthy, organic, grass-fed proteins + complete protein grains like quinoa
5) Get moderate exercise
Exercise + sweating helps with total body detoxification.
6) Progesterone problem solving
BONUS: Find out if there is ANOTHER hormone out of balance that is causing our estrogen to run high (often Progesterone) and treat THAT hormonal imbalance. (You see, this is complicated!)
Why are we talking about Progesterone now?
Well, it turns out your hormones always work in ratios. So if one hormone is too high or too low, it throws off ALL the other hormones. Too much estrogen causes the body to respond by producing more testosterone, specifically the androgen called DHT, which causes acne – we’ll get to this in a second.
But what if estrogen dominance is being caused by insufficient progesterone levels? The plot thickens.
Progesterone is produced in a woman’s body in quantities a thousand-fold greater than estrogens. It is the other “famous” female hormone, although just like estrogen, men have a little bit of it as well.
It is produced in the ovaries and in lesser amounts in the adrenal glands. Progesterone is a pivotal building block for the production of other hormones, including estrogens. Progesterone is responsible for normalizing blood sugar levels, facilitating thyroid hormone, regulating the menstrual cycle, allowing a woman to have a healthy pregnancy, as well as being a natural anti-anxiety and anti-depressant.
Without progesterone there would be no menstrual cycle or reproduction. Progesterone also enhances the positive effects of estrogen, while preventing estrogen dominance.
So how do we know if we have low progesterone and that is the root cause of our hormonal acne? A really easy way is to get a comprehensive hormone test (can be a little spendy, but worth it to know, right?) Symptoms include:
- Mood changes, anxiety, nervousness, irrational fears, irritability
- Headaches, migraines
- Hot flushes (also known as hot flashes or night sweats if they occur at night).
- Low sex drive / libido
- Vaginal dryness
- Menstrual problems such as irregularity or heavy bleeding
- Menopause and peri-menopause problems
- Breast disorders, pain, tenderness
- polycystic ovary syndrome (PCOS)
- Postpartum depression
- Weight gain
- Chronic fatigue, low energy
How to get Progesterone levels up?
1) Natural Progesterone Cream
The best way to get progesterone levels up is with a NATURAL progesterone CREAM. Progesterone is not absorbed well at all when taken orally, and just creates more work for the liver. But applied topically, it is readily absorbed.
To make sure you are using the right dosage, read this article: http://www.growyouthful.com/remedy/progesterone.php#how-to-supplement-natural-progesterone-women
But remember, just like with Estroblock, this solution should be temporary and diet and lifestyle remedies should be employed in the long term, if possible. If you supplement too long with an outside source of Progesterone, the body will simply stop producing its own, and then you’ll have created a permanent instance of the issue you were trying to fix!
2) Increase vitamins B6 and C
The best way to get vitamin C, I think, is to take Camu Camu, the world’s most vit. C rich fruit. It is available in powder or capsule form. (Quality matters! Don’t be afraid to pay a higher price so you get vitamin C that is bioactive and bioavailable.) A study has shown that 750mg of Vitamin C taken every day for six months can considerably increase progesterone production. Plus, vit. C also helps your acne heal faster and helps with Vitex absorption (see below).
B6 is found in walnuts, whole grains, lean red meat, poultry, seafood, bananas, spinach, beans, and potatoes.
3) Increase intake of minerals Zinc and Magnesium
You might be taking Zinc already since there is buzz on the interwebs that it helps heal acne.
Zinc is essential for hormonal health and it is extremely important for the production of adequate levels of progesterone. If you decide to take a supplement, then make sure you get zinc which the body can absorb. Studies have shown that zinc picolinate and zinc methionine have better bioavailability than other forms of zinc.
Good sources of zinc in food are veal liver, lean red meats, shellfish, crabs, dark chocolate, wheat germ, chickpeas, and pumpkin, watermelon and squash seeds.
Magnesium is another key nutrient for increasing progesterone levels, as it plays an important role in maintaining a healthy hormonal balance in the body.
You can either take dietary supplements, or eat more foods that are good sources of magnesium such as black beans, spinach, raw plantain, halibut, whole grain cereals, pumpkin and squash seeds, okra, and nuts.
Magnesium is also readily absorbed through the skin, maybe even better than orally, so take those Epsom salt (magnesium sulphate) baths! Swimming in the ocean works too, as do magnesium creams and lotion. If you do take a magnesium supplement, it is best to take it on an empty stomach and without calcium because calcium and magnesium compete for absorption and if both exist, less is absorbed of each.
4) Decrease Stress
Stress can considerably reduce progesterone levels in the body. During chronic stress, adrenal glands aren’t able to produce enough “fight or flight” hormone called cortisol, which they constantly need. In this case, our body converts progesterone into cortisol.
5) Avoid herbs that can increase estrogen
These herbs include blue cohosh, black cohosh, dong quai, hops, lavender, licorice, motherwort leaf, rhodiola rose root, red clover blossom, saw palmetto berry, and tea tree oil. (This is a good reason to not use Tea Tree for acne! There are plenty of other gentler AND more effective EOs to use. And again, out of all these suggestions, this one seems like the least effective, so exhaust your other options before throwing out all your lavender tea or whatever.)
6) Try Vitex and Maca supplements
Vitex supports the pituitary gland, which regulates a large amount of the body’s hormonal production, so it is a good go-to if you’re not exactly sure which hormones are out of whack. Specifically vitex supports the pituitary gland in telling the ovaries to produce the correct amount of progesterone. It can also reduce prolactin, which is another hormone that can lead to low progesterone in the body.
I personally have had improved periods with Vitex, and have only recently begun researching maca. But it seems maca has the same type of stimulatory effect on the pituitary gland as Vitex. It is primarily used for restoring libido and energy, as well as strengthening underactive thyroid and adrenals, but after nosing around the internet a bit, I might give maca a try.
I think with both Vitex and Maca, you MUST be patient and give it 3-4 months for results to appear. With some supplements (Berberine and Estroblock) results can be apparent in as little as 4 weeks, but not so with Vitex and Maca.
7) Eat small meals
Big meals can cause progesterone levels to drop, plus are taxing on the liver.
OK, so I get that we have to identify and fix our estrogen dominance, but how exactly does too much estrogen create hormonal acne?
All roads lead to the mysterious DHT.
I’m reading stuff like this and scratching my head: “Having low progesterone in relation to estrogen increases insulin which can lead to excess androgens, as well as amplify testosterone and DHT conversion in the skin.”
And as we saw with the Estroblock saga above, it works by decreasing estrogen, which in turn decreases the testosterone DHT.
So what is DHT, how is it related to insulin, testosterone, androgens and how does it cause acne?
First, let’s get the relationship between testosterone, DHT and androgen straight.
Straight from wikipedia:
“An androgen is any natural or synthetic compound, usually a steroid hormone, that stimulates or controls the development and maintenance of male characteristics. Androgens are also the original anabolic steroids and the precursor of all estrogens (In a woman’s body, one of the main purposes of androgens is to be converted into estrogens.). The primary and most well-known androgen is testosterone. Dihydrotestosterone (DHT) and androstenedione are less known generally, but are of equal importance in male development. DHT in the embryo life causes differentiation of penis, scrotum and prostate. Later in life DHT contributes to male balding, prostate growth and sebaceous gland activity.”
Aha! So both testosterone and DHT are androgens, and androgens are male hormones!
Excess amounts of androgens result in “virilizing effects” as acne, hirsutism (excess hair growth in “inappropriate” places, like the chin or upper lip) and thinning hair.
How does androgen excess occur?
1) Estrogen dominance
As we’ve seen, one way to get too many androgens in the body is to produce too much estrogen, so the body naturally tries to rebalance by producing too many androgens.
2) Testosterone/androgen imbalance
Another way to get too many androgens is for testosterone to be the primary hormonal imbalance that sets off all the other hormones. (As we’ve seen above, the hormonal imbalance can begin with estrogen, progesterone, and in this case testosterone.) Between 4% and 7% of women produce too much testosterone in their ovaries. These women have a pattern of symptoms called polycystic ovary syndrome. PCOS is not well understood, but genetic factors may be at least partially a cause.
Here is a brief description of PCOS, but if you suspect you might have it, do more research to determine appropriate treatment protocols.
When a woman has a high level of androgen hormones in her body, she can be unable to release eggs from their follicles in the ovaries. Since the fluid-filled follicles don’t open and empty, they stay in the ovary and the ovaries appear to contain many cysts. This is the reason for the term “polycystic” in the name of the disease. Women with this condition may have problems with fertility because egg release (ovulation) stops or happens only once in a while. When no egg is released during a monthly cycle, the woman’s hormones don’t change levels as they normally should.
Too much testosterone can also be produced via genetic disorders or adrenal or ovarian abnormalities.
3) Excess insulin/ insulin resistance
Studies show excess insulin can cause ovaries to make extra androgen hormones, so insulin resistance is also a possible cause of high androgens, as is the consumption of high sugar and high carbohydrate foods, which cause lots of insulin to rush into the bloodstream.
What?? Now we’re talking about insulin?
Yes, yes we are. Stay with me. So insulin in ANOTHER hormone, produced by the pancreas which helps cells absorb glucose (sugar) from the blood to use as energy.
Insulin, which is released when you eat, helps the body maintain a healthy (low) level of circulating glucose by allowing glucose from the blood to go into the cells.
With insulin resistance, your pancreas produces insulin, but your cells aren’t using it as well as they should. When insulin is not working the way it should, your cells don’t absorb glucose properly, which leads to a buildup of sugar in your blood. This triggers your body to release more insulin.
Alternatively, maybe you are eating sugar and carbs all the time OR your constitution happens to be sensitive to sugar/carbs, and there is naturally a lot of glucose in the blood. This can create a chronic condition of continually elevated insulin, which will stimulate more androgen production. It is important to note, that insulin levels are heavily dependent on diet.
(This begs the question: WHY does insulin produce androgens? There is not too much information out there, so for now, let’s table our curiosity and suffice it to say that lots of insulin raises androgen levels, which is bad, because, well, hormonal acne!)
Insulin activity is also accompanied by insulin like growth factor 1 (IGF-1). Just as the name suggests, IGF-1 stimulates the growth of sebocytes (the body’s sebum producing cells) and thus increases sebum production. Insulin and IGF-1 also make skin cells grow faster (leading to more pore clogging via more dead skin cells not being cleared properly) as well as make the skin more sensitive to DHT – we’ll get to DHT in a second, the suspense is building….
OK, so how are androgens bad exactly, and what is the DHT connection?
Androgens enlarge the sebaceous glands in the skin and causes these glands to increase sebum production (similar to what IGF-1 does). The increased sebum production exacerbates plug formation and serves as more “food” for acne bacteria. (Incidentally, I wonder if the sebum composition (ie more oleic vs linoleic acid) has anything to do with facilitating this OR if androgens change sebum COMPOSITION as well as quantity?)
As if this weren’t enough, androgens also stimulate new cell growth (seemingly good right?) BUT simultaneously hinder the separation of dead skin cells, so pores are more likely to get clogged.
Finally, androgens increases inflammation in the skin and weaken skin barrier function. Healthy skin barrier retains moisture and prevents entry for bacteria and other pathogens. Weaker skin barrier function makes the skin just that much more prone to acne.
OK, finally – here’s the DHT connection: Androgens get converted into DHT in the skin via an enzyme called 5-alpha reductase. DHT is a super powerful androgen, and is up to 10 times more potent than your typical, already very annoying androgens. Uh-oh, right? Powerful androgen means powerful acne…
Well, it may come as no surprise, but many people who have hormonal acne have much more 5-alpha reductase activity than those with healthy skin, and therefore a higher percentage of the especially bad androgen, DHT. And coming back to insulin once more, IGF-1 further stimulates this conversion and makes a bad situation even worse. Aha!
So to restate again, perhaps more explicitly – androgens, especially DHT, are responsible for multiple things that exacerbate and create acne – more sebum, a higher chance of that sebum creating a plug by combining with dead skin cells, increased inflammation and weakened skin barrier function.
OK, so we discussed how to fix estrogen dominance, how to increase progesterone, how to support the liver, and now, we have some other things to fix holistically: too much insulin, excess androgens and too much 5-alpha reductase activity.
Some solutions to consider re: insulin and IGF-1:
1) Cut down on sugar and processed, simple carbs
2) Cut down on dairy (dairy contains IGF-1 and other growth hormones)
3) Take a Berberine supplement – it helps stabilize insulin levels so much so that it is used with diabetics
If you do take Berberine, be sure to research how to properly take it – it is one of those herbs you need to cycle on and off and you must take a probiotic concurrently. There are other supplements that can help balance blood sugar including cinnamon, but in this arena especially, your best bet, for the most drastic results, is to create a plan that works for you to decrease/eliminate sugar/carbs. Incidentally, I am a pro at creating plans that are DOABLE by all, even those with funky diets or tastes or predelictions. My plans are very custom and creative, with an incredible success rate.
Some solutions to consider re: high androgens and 5-alpha reductase:
1) Naturally decrease androgens by decreasing insulin and estrogen (see above)
2) Topical Exfoliants
Topically, use products that help clear your skin pores of dead skin cells. moss products contain pumpkin bioferment and moth bean – very special ingredients that excite cellular turnover and dead cell release but are mild enough even for sensitive, aggravated (ie acnegenic) skin. (This is also why salicylic acid and retinoids (much harsher) are so popular.)
3) Green Tea Extract
Green tea extract applied topically and in sufficient levels has been shown to inhibit 5-alpha reductase activity. (A word to the wise, it is not enough just to swab green tea all over your face.)
4) Green tea and spearmint tea
Compounds in these teas taken internally have been shown to reduce androgen activity.
5) Supplements such as Saw Palmetto and Nettle Root
Saw Palmetto and Nettle Root both inhibit DHT activity as well as balance hormones generally.
Well, I think that mostly covers it. Is it possible that we have come to the end of this incredibly long post? Almost – last thoughts below on creating a treatment plan that works!
How do I fix my hormonal acne then??
I found it really helpful to make a little chart that illustrated all the possible causes of hormonal acne and I’ve included it below. The causes go from bottom to top, and as you’ll see if you count all the boxes, there are certainly a lot of things that could be causing our hormonal acne.
When you think about treating your hormonal acne, I want you to think about it in this way: if you are treating a cause closer to the TOP of the chart, your chances of success are GREATER at stopping the symptoms, but you are probably not addressing the ROOT CAUSE. (Think about it – all the prescription topical solutions are concerned with mitigating the direct observable consequences of too much DHT, but the minute you stop using them, your acne returns!)
If you find the cause/causes at the BOTTOM of the chart causing your hormonal acne, and treat them, your acne will go away naturally, even though that might be a harder, more long term effort.
Here’s what I suggest – DO BOTH.
Treat the DHT symptoms AND the suspected underlying hormonal imbalance causing the excess DHT AT THE SAME TIME. Once you’ve gotten your hormones balanced, you can phase out the stuff you’ve been doing to control DHT – ie, stop using so much crap on your face, start eating ice cream again, and so on. 🙂
Here is the infographic that traces all the different causes and causes of causes of hormonal acne back to DHT.
Well, I feel like now I have more answers and feel a little clearer about how hormonal acne occurs. I am also – quite frankly – exhausted. That is a lot to take in, and it can be stressful being confronted with so many potential problems and potential solutions all at once!
Bonus Round: I Randomly discuss my supplements!
I think I finally have a little more clarity on my supplements too – lately, for me, supplements have gotten a little out of control – basically, anything I read about that sounds feasible, I try.
I have been trying out supplements after supplements and I take a lot! I would like to get my supplements down to a more manageable amount.
Moving forward I think I will take:
(these are all powders which can be mixed. The camu camu is very tart and makes a good addition to a smoothie, and the maca does too – I personally mix Reishi, Maca and Dandy Blend (a dandelion root coffee replacement) into a diluted cup of coffee every morning – it tastes enough like regular coffee to keep me happy – I do NOT like giving up coffee! – as well as provides these amazing herbs – and bonus – my coffee is very diluted so I can drink more of it!
Estroblock – same – tried and true
Nettle Root – I was going to take Saw Palmetto till I saw that it can increase estrogen, Nettle Root seems like a better all-around bet
Milk Thistle – for liver support
Zinc – for hormone support
I’m also really into Goji Berries and green tea (esp. matcha!)
Currently, I am taking:
Papaya Digestive Enzyme
Vit C via a multi-vitamin
But for me, I think I have ruled out insulin sensitivity so no need for the Berberine, and I have ruled out food allergies and digestive issues so no need for the digestive enzyme and probiotic.
Burdock and red clover were attempts at blood and liver detox, but the reishi is awesome so I will stick with that and drop the other two (how do I know which is working? Honestly, largely intuition, which took a long time to access. But now I have pretty clear insight about my body.)
The Cranberry was for UTIs which the Nettle also supports, so feel ok dropping that.
The marine collagen is *supposed* to help with replacing collagen in your skin, but there is no conclusive evidence and it is a bitch to take b/c it has to be on an empty stomach. Not worth it.
Finally, I am subbing out vitex for maca, knowing that I can always go back to the vitex, and curious about how maca will work – a lot of controversy out there surrounding it.
So, going from 11 supplements to 7 – that seems less crazy.
This article took me all day to write, and it’s kind of a rough draft brain dump, but I hope you find it insightful!