If you have questions, please PM me, do not respond to this post.
You thought you would "grow out" of your acne and didn't? You're not alone. Many men and women suffer adult acne in their 20s, 30s, 40s, and beyond. Adults with acne often have hormonal imbalances that linger after puberty, and these imbalances create disfiguring acne.
Quick Review on Hormones
The main sex hormones are testosterone, estrogen, and progesterone. Men and women have all three hormones in the body at different proportions. A more general term for testosterones is androgens. When you see "androgens" just remember that it means testosterone hormones in general.
The Culprit: DHT
DHT, or Dihydrotestosterone, is a type of testosterone that is one of most potent androgens in the body. DHT is 2-3x more powerful than "regular" testosterone and 15-30x more powerful than other adrenal androgens. This means that small fluctuations in DHT can have enormous effects on the body.
DHT synthesizes in the skin, hair follicles, testes, prostate, ovaries, and adrenal glands. Excess DHT and/or DHT sensitivity has been linked to:
- acne (men and women)
- balding, hair loss, hair thinning (men and women)
- excessive sex drive (men and women)
- facial hair or excess body hair (women)
- Polycystic Ovary Syndrome PCOS and endometriosis (women)
- prostate problems (men)
- low sperm count (men)
Why am I sensitive to DHT?
There is a lot of evidence to suggest that sensitivity to DHT is largely caused by genetics and the hormonal conditions of the womb while you were still a fetus. Genetics and prenatal hormone conditions work together to mold your adult hormonal state. Both are very powerful influences that a little ProActive is not going to fix.
But the real answer is: I don't know. Neither does your doctor. The fact is that treating a DHT sensitivity often clears acne. So I focus more on what can be done rather than why it happens.
Can I get a test that will tell me if DHT is causing my acne?
No. Medical testing for a sensitivity to DHT does not exist. You can get a test on your testosterone levels. Some people with acne actually have higher levels of androgens. But some have "normal" levels of androgens, yet still manifest symptoms.
Well then why should I treat my acne as if it's hormonal?
- You can completely prevent acne from occurring through hormonal treatment.
- Antibiotics are only a short-term fix.
- Accutane users find their acne coming back a few years later because the sebaceous glands grow back.
- Benzoyl peroxide and retinoids can't prevent deeper cystic acne, and the redness and peeling caused by these products are almost as bad as the acne itself.
How to reduce DHT
Reducing DHT involves avoiding DHT triggers in the food you consume, providing your body with the pre-hormone D3 so it can metabolize hormones efficiently, and using a DHT inhibitor to fight your built-in DHT sensitivity.
1. Eliminate dairy (milk, cheese, yogurt).
Dairy is naturally loaded with hormones (even organic dairy). Remember that cow's milk is made for baby calves to help them grow to maturity. It contains all sorts of growth hormones that only "grow acne" in adult humans. Most commercial dairy manufacturers also add synthetic hormones to keep the cows lactating constantly.
2. Eliminate sugar, refined carbs, and high loads of simple carbohydrates.
Both increase insulin levels which directly stimulate bad hormonal activity that leads to acne. What is a refined carb? Fruit juice. Soda. Candy. Chocolate bars. Crackers. Pretzels. Potato chips. Maple syrup. Sweet tea. Anything made with white flour (most breads and pastas). Anything with sugar added (many frozen or pre-packaged foods). You may be thinking, well what do I eat? Vegetables. Meats. Eggs. Whole grains in moderation. Whole fruits in moderation. Google the "paleo diet" for more ideas.
3. Eliminate coffee, energy drinks, soda, teas, and caffeine in general.
Study upon study has shown that caffeine, even in small amounts, stimulate bad insulin and hormonal activity that exacerbate acne, just like dairy and sugar. Kick the caffeine habit!!!
And what about tea? Many blends have a significant amount of caffeine. Many people on these forums tout green tea but I would stay away from it. Its negative hormonal activities outweigh its good features in my opinion. One recent study shows green tea increasing DHT by 194% and testosterone by 74%.
4. Reduce or eliminate alcohol.
Just google alcohol and acne. Not only can the chemicals in alcohol create acne, but alcohol is a huge stress on your liver, and when your liver suffers, it purges itself through your skin.
4. Get adequate sun exposure.
Vitamin D3 is not really a vitamin, it is a pre-hormone. Your body cannot regulate hormones without D3.
Many acne sufferers are in a habit of avoiding the sun, slathering on sunscreen, or simply live indoor lifestyles. Important facts about vitamin D3:
- Dairy is fortified with vitamin D2, which is not the vitamin D3 you need for hormone regulation.
- You cannot get D3 when you are blocking UVB light with sunscreen or makeup.
- Glass blocks the UVB rays required to produce D3 (so sitting in the car or by a sunny window don't count)
- The prescription shots are vitamin D2.
I either recommend a lot of outdoor sun exposure, or if you must take a pill:
- 5,000 to 15,000 IU of vitamin D3 a day
- Take it with an omega-3 supplement (fish oil), because D3 is not absorbed from a pill without good fats taken at the same time
5. Stop using "workout" supplements.
Many workout supplements and protein powders (especially whey protein, which is dairy!) are designed to stimulate androgenic activity, which supposedly helps you build muscle faster. Unfortunately too much androgenic activity = acne. If you don't want acne, you may have to accept that professional bodybuilding is not in your future.
6. Women: Pay attention to the type of birth control you are using.
With birth control you are putting hormones directly into your body. This has HUGE effects on acne. All pills/implants contain some type of progestin (a synthetic form of progesterone). If that progestin is highly androgenic, you may as well be throwing gasoline on the acne fire. I have made a separate post on this topic: Good & Bad Birth Control Pills and Implants for Acne.
7. Take anti-androgen drugs or herbal supplements.
This is ESSENTIAL to clearing hormonal acne. Even if you fix everything else, you need to attack the DHT directly.
An anti-androgen mutes some of the DHT activity in your body so that it stops creating acne. If you have a DHT sensitivity problem, your body is freaking out every time your DHT spikes a little bit. SO many things spike DHT on a daily basis. Eating. Exercise. Sex. Stress. Basically LIFE spikes your DHT! This means...you guessed it...you have acne all the time. You have to mute some of this activity so your body stops having "acne freak outs".
The key to this step is PATIENCE and remembering that it is PREVENTION. Anti-androgens prevent new acne. They don't make existing zits disappear any faster.
The most effective anti-androgen is prescription oral spironolactone. Most women succeed on a daily dose of 50mg - 100mg. It is hard to find a doctor that will prescribe spiro for acne. I recommend printing this website out and bringing it into your appointment. It describes how spiro is used for acne and cites medical journals. If your dermatologist still will not prescribe it, I recommend switching to an endocrinologist or ob-gyn, who tend to be more educated in hormonal issues.
Men. Your prescription options are:
- Topical spironolactone. You cannot get oral spiro for acne because it is too strong for males. However, you can get spiro cream for acne with a prescription. (You can also order the over-the-counter hairloss version of the cream, which is perfectly safe to use on your face.)
- Finasteride (also known as Propecia or Proscar) is commonly prescribed to treat balding (which is also caused by DHT). If you already have a balding problem, a nice side effect of this medication is it can clear up acne.
There are several plants that have anti-androgenic effects. You will get better results and less side effects when you combine two or more different plant types. I cannot stress this enough. Taking large doses of saw palmetto will not help nearly as much as taking moderate doses of multiple plants.
You must use standardized extract supplements ("whole herb" supplements are not potent enough).
- Saw palmetto
- Stinging nettle
- Pumpkin seed oil
- Beta sitosterol
Men: Total dosage of all anti-DHT herbs combined should range between 320mg - 1000mg daily.
Women: You should only be taking herbs if you are NOT taking spironolactone. Total dosage of all anti-DHT herbs combined should range between 640mg - 1500mg daily.
I will say this again. You need to combine different plant types and customize your dosages to work with your body. Many people give up on herbal anti-androgens because they do not combine plant types, take too small of a total dose, or take too large of a dose of one plant.
Okay, I'm doing everything. How long do I have to wait?
It depends on how severe your acne is, how messed up your hormones are, and how strictly you follow all of the recommendations. I had severe nodular/cystic acne that took 8 months on 100mg of spironolactone to resolve. For the first 4-5 months, my skin looked EXACTLY THE SAME as when I started. If that's not discouraging, I don't know what is.
Hormones are SLOW. Do not expect that you can be "tweaking" your regimen every week. Basically start from a good place, and slog through. If you don't see any improvements at about 4 months, then consider making changes.
Can I speed this along?
There really is not a quick fix for hormonal issues. For various reasons that I will not go into here because it would take far too much time, I DO NOT recommend combining hormonal treatment with antibiotics, retinoids, or benzoyl peroxide products.
How should I wash my face?
Less is more. The short version is that your skin needs an ideal pH level of 5.5 to fight off infection and heal itself. Get above or below that and your skin suffers.
Most of you wash your face with alkaline city or well water, then you use an alkaline cleanser, then you slather on some acne product that is too alkaline or too acidic. Some of you do this 2-3 times a day. What you are really doing is leaving your skin in a disrupted state...all the time.
(By the way, the marketing term "pH balanced" is crap. It's not regulated. It doesn't mean anything. Companies can slap this on whatever they want.)
When I was going through hormonal treatment, this is the exact regimen I followed:
- Cleanse skin once a day with distilled water (this has a neutral pH) and CeraVe cleanser
- Moisturize once a day with CeraVe Hydrating Lotion
- Wear makeup/sunscreen as little as possible
- 30 minutes of sun exposure daily
- No caffeine, alcohol, dairy, or sugar. Diet low in refined carbs.
How did it work for you?
How long did it take you to have clear skin?
I went from severe acne to zero zits after 8 months of following all of the steps above. It can be a very discouraging process. At month 4, my skin looked about the same as at month 1. But between month 4 and month 8, I saw zits slowly disappear. Expect this. The changes are slow. It is worth it in the end.
How bad was your acne?
My acne was graded by several dermatologists as severe. On the Leeds scale I was an 8 (out of 10), on the Cooks scale a 7 (out of 8), and on the Pillsbury scale a 4 (out or 4). After 8 months following the steps above, my skin was completely clear of active lesions. My exact regimen is as follows:
- 100mg of spironolactone daily
- Washing face once a day with distilled water and CeraVe Hydrating Cleanser
- Moisturizing with CeraVe Moisturizing Lotion
- NO caffeine, dairy, and sugar. Diet generally low in refined carbs.
- 30 minutes sun exposure daily (no sunscreen)
What treatments failed you?
- Oral and topical antibiotics: Cephalexin, Amoxicillin, Tetracycline, Doxycycline, Clindamyacin, Minocycyline, Azithromycin
- Topical retinoids: Differin, Retin-A Micro, Retin-A
- Benzoyl peroxide
- Acids: salicylic acid (BHA), glycolic acid (AHA), mandelic acid, lactic acid
- Light therapy: blue light, red light, infrared light
- Exfoliation regimens: Clarisonic, dry brushing, scrubs
- Washing regimens: Oil Cleansing Method, water-only method
- Vitamin regimens: zinc, vitamin A, vitamin B5, MSM, probiotics, digestive enzymes, fish oils, omega fats, iodine
Will I have to take an anti-androgen long-term?
I have to. I experimented with not taking mine on vacations and have broken out again.
How is everything going now?
My skin remains clear. I currently follow the same simple cleansing regimen, take my anti-androgen daily, and get adequate sun exposure. I never drink caffeine, however I now allow myself some dairy products and occasional desserts. I only wish I had known about the hormonal causes of acne sooner.
Do Milk and Sugar Cause Acne? By Dr. Mark Hyman in the Huffington Post
Female Acne and Hormones By Dr. Geoffrey Redmond and the Hormone Help Center of New York
Progesterone: The Almost Forgotten Hormone By Energetic Nutrition and citing Dr. John Lee
If you have questions, please PM me, do not respond to this post.
Edited by Green Gables, 16 November 2013 - 10:36 AM.