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Green Gables

Member Since 06 Jun 2011
Offline Last Active Jul 15 2014 11:19 AM

#3441495 Adrenal Vs. Ovary Androgens

Posted by Green Gables on 15 July 2014 - 11:13 AM

I was reading some endocrinology research in AMA which specifically talks about acne and elevated androgens / androgen sensitivity in women.


It says you can have an androgen problem initiating from the adrenals or the ovary, or both.


Glucocorticoids are best for adrenal androgen suppression (spironolactone)

"[For adrenal androgen suppression] At this time, spironolactone is the most useful anti-androgen."


Birth controls with anti- or low androgenic progestins are best for ovary androgen suppression (e.g. Yaz, Diane)


Sometimes you need both.


The article also confirms what I've been saying since I started spironolactone: that androgen changes occur very slowly. It recommends a minimum of 2 years of anti-androgen therapy. It says that after 2 years with good results, some people can slowly taper off their dose in 6 month phases (so if you clear on 100mg...imagine cutting down to 75mg after 2.5years, then 50mg after 3 years, then 25mg after 3.5 years...), but recurrence is common, and some will need lifetime anti-androgen therapy. 


More interesting tidbits from the article


  • Ketoconazole (anti-fungal) and cimetidine (a h2 blocker) have anti-androgenic effects. 
  • "Seborrhea occurs soon after androgen levels rise; consequently, acne is usually the first androgenic skin manifestation."
  • "The acne process begins when androgen action increases sebum production by the 
    pilosebaceous unit. Without androgen action on the sebaceous gland, acne does not occur."
  • "Both ovary and adrenal glands secrete androgens, and it is important for diagnosis and treatment selection to determine the relative contribution of each to circulating androgen levels in an individual patient. Both are important as sources of andro- 
    gens, but the proportion of androgens secreted by each varies in individual women. Ovarian pre-dominance is suggested by young age, oligomenorrhea, obesity, and more severe hirsutism. Because there are many exceptions to these generalizations, the relative ovarian and adrenal contributions should be determined by suppression testing. Tes-tosterone and androstenedione can be of either ori-gin, but DHEAS is almost exclusively adrenal. However, when DHEAS is elevated along with other androgens, it cannot be assumed that the ad-renal is the source of the other androgens. "

#3439827 I Miss (A Fraction Of) My Oil. When Will It Come Back?

Posted by Green Gables on 06 July 2014 - 11:43 PM

Part of the problem is that the sebum in acne patients is often not "ideal" sebum. The altered lipid profile is one reason why one person with oily skin gets severe acne and another person with oily skin stays clear. The quality of the sebum is different. Ideal sebum is light and flows freely out of the pores. Sebum in acne sufferers is thick and creates clogs.


So the return of your un-ideal sebum will probably not help you, A little bit of occlusive "moisturizing" capability is not worth the pore clogs, acne, and resulting scars. Just use a good moisturizer. It's a small price to pay for clear skin.

#3439694 It's Only Getting Worse (14 Progress Pictures)

Posted by Green Gables on 06 July 2014 - 12:42 PM

Benzoyl peroxide helps when the primary cause of your acne is bacterial. BP kills bacteria by oxygenating the pores.


It's not going to change anything if your acne is caused by hormones, internal inflammation, or if it's fungal in nature.

#3439691 Androgen Sensitivity. Warning: Possibly Explicit

Posted by Green Gables on 06 July 2014 - 12:32 PM

You have changed your hormones drastically in a short period of time by going off a pill, starting it mid cycle, going off, going on one brand for a month, going on another brand for a month.


It seems so easy for us to do, just take one pill one month and a different one the next month...but our bodies are not designed to respond that quickly to large amounts of artificial hormones being pumped through it. Your body has no idea what the **** is going on. 


I always think, if it took me 8+ months to clear on a regimented diet and spironolactone, without any birth control messing with my body's hormone levels, I imagine someone in your situation could expect to wait a year or more for your hormones to completely balance out. And your skin will only calm down if you pick one hormonal strategy and STICK TO IT. 


Yes, you may find in a year that you picked the wrong hormonal strategy for you and you don't get completely clear. But this is how acne treatment goes. It takes months, years, sometimes for the body to respond even to the right strategy. You will never find the right strategy unless you give each one a lot time and patience to work. 

#3439598 Should A Makeup Remover Be Essential Or Just The Cleanser?

Posted by Green Gables on 05 July 2014 - 09:13 PM

What I've found is that silicones (which are in pretty much every foundation...really...look for any ingredient ending in -cone -conol -oxane or -silane) are not water soluble, meaning that most cleansers will not remove them. Since everyone started freaking out about oils, cosmetic companies went and replaced oils with silicones. Ironically you need to use a cleansing oil to remove silicones from your face :P


Lately I like doing a two-step cleansing system, where I first remove makeup with an oil (right now I'm using Napa Valley Naturals grapeseed oil, you can get a HUGE bottle for $7--just remember it needs to be refrigerated so stick it in your fridge) and then cleanse again with a normal cleanser.

#3439412 Hopeless And Unsure What To Do

Posted by Green Gables on 04 July 2014 - 12:51 PM

So I'm on my 4th month of yaz and now it hasn't even been a week since my last breakout and I already got another 3 huge nodules, 2 on my face and 1 on my body. This is still worse than I was off the pill, 4th month in. I got scars and ugly red marks all over my face, i can't look at myself up close without crying, this pill used to do wonders for my skin and now its doing the opposite. and i don't even know what to do anymore, i really thought i'd be working by now, i can't take this anymore. im paranoid to try anything else now because i dont want to make it even worse. at the same time the way it is now is unbearable. im depressed and borderline suicidal every day now, all it takes is for me to remember the condition my skin is in, which i do every 30 seconds of every day of my life. Im scared to do anything or change anything at this point. scared to stop BC, scared to try spiro, scared to not stop BC because what if it never gets better and im just causing this to my skin for no reason at all. its been a year and i have nothing to show for it, no progress whatsoever.


Solving acne is a lot of trial and error. You will need to get over your fear and just be willing to try things. And everytime you try something you will have to have faith that it works, and even if it doesn't and you have to switch, then you'll have to have faith in the new thing. Just because every good treatment takes time and patience. 


Spiro worked great for me, but I tried so many things that were "miracles" for other people before I found spiro.

#3439388 Spironolactone

Posted by Green Gables on 04 July 2014 - 12:18 PM

I started taking spironolactone a little over a month ago. I've seen some subtle improvements so far but nothing drastic, though I've heard it's supposed to drastically improve skin. When should I start seeing results? I also heard about weight gain as a side effect...how often does this occur? I'm also on birth control, will this alter anything or interact with the spironolactone?


Since spiro blocks some testosterone (which can help burn fat) and increases estrogen (which is the primary reason why women naturally have more fat than men), yes it can cause weight gain.


Initially when I was on 100mg I gained 5-10 pounds. I freaked out and halved my dose to 50mg. The weight came off but the acne worsened. I went back to 100mg and this time the weight did not come back. I think what made the difference for me was that I made sure I took my first pill at breakfast and my second pill at lunch. When I gained the weight I was taking one pill at breakfast and one pill at dinner. Spiro increases cortisol and if you take it too late in the day it can mess up your body's rhythm.

#3401684 Do I Have Acne Or Is This Redness, How Do I Clear This Up Please!

Posted by Green Gables on 17 December 2013 - 08:01 PM

  • Are you eating more dairy, sugar, soy, or caffeine than you did at home?
  • Is your sleep schedule more irregular?
  • Do you have more stress?
  • Are you more sexually active and/or physically active?


Most college students do...all are triggers for acne. 

#3401610 "estrogen Dominance" May Be A Histamine Problem

Posted by Green Gables on 17 December 2013 - 12:31 PM

My "permanent redness" is the classic rosacea butterfly pattern on the face. My flushes make my whole face go red as well as the whole neck/chest and even shoulders.


I haven't used SLS/fluoride/peppermint/wintergreen/anything irritating in my toothpaste/mouthwash for ages, and it's not concentrated around my mouth anyway.


I don't get any spots anywhere on my body since using spiro, though I only got acne outside my face very very rarely anyway. I don't recall ever getting hives, if that's what you mean. 


If the redness isn't really rosacea, and if it turns out not to be from the MTHFR, really all I have left is lupus, but frankly if I have lupus maybe I don't want to know. eusa_hand.gif


You can improve methylation pathways through some various lifestyle changes and also specific forms of some B vitamins. Apparently if you can't methylate you can't process B vitamins because they're not in the most active form. So for example you can test for B vitamins and show a really high serum level, but your cellular level will be really low because you're not utilizing it properly. Like how some people need D3 because they can't properly convert D2. 


You can get some of the B vitamins in the "active" form over the counter. There are also a few prescriptions, such as Deplin, which offer that as well for MTHFR folks. 


All this stuff also effects stuff like Sam-e and serotonin, so you get the fun of depression/anxiety tendencies thrown in the mix. 


You can read Dr. Lynch's Basic MTHFR Protocol

#3401304 How Else Can I Improve My Diet? Running Out Of Ideas

Posted by Green Gables on 16 December 2013 - 05:27 PM

One recent study shows green tea increasing DHT by 194% and testosterone by 74%.


This applies to not only green tea, but most traditional teas with caffeine content, or other caffeinated beverages such as coffee. 


If you've read anything about the relationship between DHT/testosterone and acne, this is a pretty big deal.

#3401302 How To Take Spironolactone

Posted by Green Gables on 16 December 2013 - 05:25 PM

A quick question about the initial breakout (IB) some people have been experiencing with Spiro...


Is the IB a reaction to the change or do you think it is just your body purging (as a result of the change) what was already on the verge of coming out anyway? Just wondering if anyone have heard anything from their derm about this or if they happen to know.


I've been on it for about a week and a half. I wouldn't call it an IB but there has been no change for better or worse. Just old ones VERY SLOWLY healing and new ones popping up here and there.




For some, any hormonal change (even a good one) can both speed up the release of old zits and also cause a few new ones until the hormones stabilize. 

#3401135 Good & Bad Birth Control Pills And Implants For Acne

Posted by Green Gables on 15 December 2013 - 10:54 PM

I will make certain people on this board upset by saying this, but there is not a lot of evidence that shows that estrogen causes acne. Too much estrogen can cause weight gain and some other side effects. But in general, estrogen does wonderful things for the skin, such as counteracting androgens, increasing the skin's ability to stay hydrated and supple, and decreasing sebum viscosity. The baby soft, poreless skin we associate with women is because of the estrogen. The grizzled, coarse skin we associate with men is because of their higher androgen levels. 


You really need to give a good anti-androgen protocol (such as using Ortho Cyclen) a chance before worrying about "estrogen dominance." For most women, countering the androgens is what ultimately solves the acne. 


I know you're in a difficult place right now, but you're only going to halt your progress by trying to research every possible avenue. Get the Ortho Cyclen. Give it a few months. Don't focus on the acne for a bit. In a few months, come back and re-assess where you're at. 


When I started spironolactone, I tried to just ignore the acne, take my pill, and live my life. I didn't even visit these boards much. I think if I had obsessed about my "progress" or "is this really the right course of action", I would have given up on spiro and not be enjoying clear skin right now. 

#3400590 Identifying Male Hormonal Acne

Posted by Green Gables on 12 December 2013 - 08:19 PM

From just reading around, it seems female hormonal acne comes around their periods. But what about for guys? How do we identify if it's hormones causing acne or something else?


Sorry if it sounds like a stupid question.


Most acne is "hormonal" in nature, and it doesn't always fluctuate with periods. For some people, just lifestyles that spark androgenic activity (for example, intense athletic activity) is enough. 


It's not a stupid question, but I do think there is this misconception that there is "acne" and then "hormonal acne". For most people, men and women, hormones play a key role in the development of acne. We don't talk about the hormonal component in men very often, and most doctors just shunt men onto Accutane, which is unfortunate. 

#3400412 Help Me Find A High-End Foundation!

Posted by Green Gables on 11 December 2013 - 11:12 PM

Dermablend was designed to be "corrective" and cover up facial issues. 

#3400080 "estrogen Dominance" May Be A Histamine Problem

Posted by Green Gables on 10 December 2013 - 04:18 PM

Histamine and Hormones

Histamine-intolerant women often suffer from the symptoms listed above, especially headaches and menstrual pain, during certain phases of their menstrual cycle. Histamine levels tend to fluctuate with the level of hormones, especially oestrogen, at ovulation and just prior to the onset of menstruation. In contrast, many women with both allergies and histamine intolerance find significant relief of their symptoms during pregnancy; this is because the placenta makes a great deal of DAO, the enzyme that breaks down histamine. The result is that the level of histamine no longer exceeds the woman’s tolerance threshold, and she remains blissfully free from her symptoms throughout her pregnancy. Unfortunately, the symptoms tend to recur once the DAO from the placenta is no longer available after the birth of her child.


Pain and Inflammation. A low progesterone to estrogen ratio is associated with increased levels of molecules that cause inflammation. These molecules are called kinins. Estrogen increases kinin levels, and giving progesterone can decrease them. Kinins occur naturally in the body but promote the release of histamines. In conditions of allergic inflammation, kinins are elevated. High levels of kinins are linked to asthma, rheumatoid arthritis, psoriatic arthritis, and a number of bowel diseases.


Histamine stimulated a dose-related increase in estradiol secretion with a maximal stimulatory effect at 10(-3) mol/l.


To summarize:

- Progesterone promotes myelination, which is one of the pathways the body uses to break down histamine (primary pathways are DAO in the gut and HMT on the cellular level).

- Unopposed estrogen increases histamine overall, which is why some women feel better on progesterone, even if their progesterone is not actually low. 

- Histamine stimulated estrogen secretion. Catch-22? Estrogen increases histamine, increased histamine also increases estrogen...

- Estrogen increases kinins and progesterone decreases them. Kinins promote inflammation. If you have a histamine issue, progesterone may help by decreasing the kinins. 



I'm not making any blanket statements here. So no one get their panties in a twist if progesterone was your miracle cure. But it's an interesting discussion to get going.


Read the full article here. 


Other reading:


Histamine and histamine intolerance