Why you're still breaking out in your 20s - the hormonal acne guide
Why you're still breaking out in your 20s - the hormonal acne guide
One of the most common things I hear with my acne clients is "I'm in my mid 20s, why do I still have acne!?".
Acne isn't just an unavoidable rite of passage for teens. It can stick around into your 20s and 30s, or even present for the first time then too. There are many different drivers for acne, including bacterial, hormonal, inflammation, thyroid and gastrointestinal. What I see present the most in my clinic is the hormonal link with your sex and adrenal hormones.
Hormonal acne has a very characteristic pattern, often showing on the jawline, chin and lower cheeks. It can worsen in the week leading up to your menstrual bleed, or even during ovulation. Generally referred to as being a beard-like placement of spots on the face.
The most common driver I see is elevated androgens. Androgens are what's commonly referred to as male sex hormones, but all women produce them to some level. It's when these levels get too high that they can trigger excess oil production, blocked pores and inflammation.
More often than not, high circulating androgens are linked to polycystic ovarian syndrome (PCOS). PCOS is a hormonal condition that sees the ovaries producing higher levels of androgens and can dampen natural ovarian function. There may or may not be cysts on the ovaries as well.
This is where your naturopath comes in. Identifying the cause of the high circulating androgens and rectifying the problem will be the only long term solution.
And the pill isn't the answer you think it is
The oral contraceptive pill works by suppressing your entire natural hormone cycle, both the healthy parts and the less healthy parts. So your acne can improve if it's being driven by high androgens, but your natural menstrual cycle has gone too.
When you're ready to come off the pill, the acne can come back — because we never identified and fixed the problem. It can return sometimes worse, and sometimes with other symptoms of hormonal dysregulation like a lost period. If your acne was initially driven by PCOS, diagnosed or not, coming off the pill can cause genuine fear and anxiety around acne returning, periods having gone missing and fertility in the long run.
If this is you, your naturopath can help before you come off the pill to help reduce the effects of suddenly taking this blanket hormone dampener away.
What I actually look for
When anyone steps into my clinic, I'm looking at their entire picture, not just their skin. Together we do a deep dive into you. I want to know everything.
When it started. Have you just come off medication or hormonal contraceptives that may have been masking the symptoms? Have you just travelled or been unwell, which may have introduced a bacterial component into your acne presentation.
What makes it better or worse? Have you noticed a change when you're on top of changing your pillowcase? Did it improve briefly when you were on antibiotics? Does it get worse in the week before your bleed?
How is your menstrual cycle? Regular or irregular, painful or not, when the pain occurs and where. This tells me a lot about the oestrogen and progesterone balance, and whether sex hormone testing would be useful.
What are you eating? High glycaemic foods spike insulin, which in turn elevates androgens. Fibre matters too. And nutritional deficiencies including zinc, iron and vitamin D can have a significant part to play in acne that often goes unaddressed.
How is your sleep? Melatonin is a potent antioxidant, and while you sleep your body has an opportunity to repair and regenerate. Poor sleep doesn't just leave you tired — it reduces your skin's ability to heal overnight and leaves the inflammatory drivers of acne unchecked.
How is your digestion? Your liver is constantly working to process stress hormones, used neurotransmitters, excess histamine, metabolic waste and sex hormones. If the liver isn't clearing circulating sex hormones efficiently, they remain in the body and throw off the delicate ratios they should be in. A lot of hormonal acne has a liver and gut component that never gets addressed.
Naturopathic treatment options
Herbal medicine: If high androgens are the driver, herbs like spearmint, peony and licorice can be highly effective. Adrenal driven presentations respond well to rehmannia, saffron and rhodiola. For liver support, St Mary's thistle is a cornerstone herb. Herbal medicine is highly individual — the right herb for one person can be contraindicated for another. Please work with a qualified herbalist or naturopath rather than self prescribing.
Nutritional medicine: Zinc, iron, selenium and vitamin A are commonly indicated in hormonal acne. The specific combination depends on your case — please work with a practitioner rather than self prescribing, as supplementing without understanding your picture can cause its own imbalances.
Diet: Supporting blood glucose levels is crucial for everyone, especially for PCOS clients who have an insulin resistance picture — around 70% of cases. Ensuring adequate amino acid intake for wound healing and including cruciferous vegetables, think broccoli, cabbage, kale, cauliflower, brussels sprouts, rocket. Cruciferous vegetables contain fibre for blood glucose stabilisation, as well as compounds like glucosinolates and sulforaphane which actively support liver detoxification.
Lifestyle: Every time your stress response fires, cortisol rises — and cortisol directly stimulates androgen production. This is why acne so often flares during exam periods, relationship stress and big work deadlines. You may have noticed this pattern before. Furthermore, if you're not sleeping due to stress- melatonin, commonly referred to as the sleep hormone, is also a potent antioxidant that helps the skin to heal. So if you're stressed and not sleeping, your skin isn't being given the opportunity to heal. The way we respond to stress and your bodies natural ability to handle stress can all be supported by your naturopath.
Your skin is trying to tell you something. I'd love to help you listen.
Seeing clients in Cranbourne South and via telehealth across Australia. Book here. 🌿