Since acne is virtually always a hormonal issue and you have tried many different things, you really are in the dark without hormonal testing. Oral contraceptives can help, however they can have significant long term side effects. In some cases the benefit/cost ratio makes sense. With proper hormone replacement using bioidentical hormones, you have the possibility of all the benefits without the cost when managed by the right doc.

I know you are saying that hormonal testing is not an option. I'm going to mention this hoping you don't know about this alternative or that it might help someone else that reads this.

The life extension foundation offers hormone testing without the requirement to involve your physician.

www.lef.org

They have their testing on sale at least once a year and it's around $200.

What helped me was combining 2% erythromycin gel and benzoyl peroxide. It only deals with symptoms. You could also sanitize the area first with ethyl alcohol. Many here will not like this, however it is very inexpensive, has worked well for me and it sounds like your options are limited.

Are you eating carbs, dairy, sugar?

Good luck!

Eating healthy but had a few chocolates over Christmas.

I wonder what the connection or different mechanism would be for bc vs spiro? Since spiro seems to no longer be working I wonder if bc wouldn't either?

What would be the best bc besides Yasmin or Yaz? If they have the same ingredient as spiro I'm guessing I'd need a different approach?

Anyone have a comment on the vitamin b5 part of my post?

I haven't taken B5, so I can't really comment on that. What keeps my hormonal acne clear is zovia, low fat low gi diet, vitamin C, and a noncomedogenic skin care routine. Zovia and the diet keep my inflammatory acne away; the vitamin C helps with inflammation and oil production; and using noncomedogenic products on my face keeps away most of the comedonal acne.

Eating healthy but had a few chocolates over Christmas.

I wonder what the connection or different mechanism would be for bc vs spiro? Since spiro seems to no longer be working I wonder if bc wouldn't either?

What would be the best bc besides Yasmin or Yaz? If they have the same ingredient as spiro I'm guessing I'd need a different approach?

Anyone have a comment on the vitamin b5 part of my post?

Bc and spiro work via a different mechanism. I can't make any recommendations on bc.

How do you define healthy eating? For you, since you don't have access to hormonal testing, diet is going to be a critical path where you have 100% control. Don't downplay this angle. For some it can much more effective than big pharma. I highly suggest you look at this very carefully.

Paigems, do you think zovia is better than orthocyline or yasmin?

I am a vegetarian, I eat only food I make myself (nothing packaged), I do not eat dairy, do not drink and only have treats once and awhile and they are generally not linked or times by my nodular breakouts.

Paigems, do you think zovia is better than orthocyline or yasmin?

I am a vegetarian, I eat only food I make myself (nothing packaged), I do not eat dairy, do not drink and only have treats once and awhile and they are generally not linked or times by my nodular breakouts.

Hi Bren, what does your vegetarian diet consist of? I'm asking because animal protein does not contribute to acne. Also saturated fat from animal protein is not only healthy, it critical for proper hormone balance. The fat serves as a substrate for the building blocks required to generate hormones.

I know this is annoying, but important. What do you eat besides vegetables?

I'm a vegetarian for environmental reasons, not solely health. I eat complex carbs that can be combined to make complete proteins, like brown rice, quinoa, beans, etcetera..

I understand that food plays a part in acne, however, I ate the same and had clear skin for three years as I am now with skin that has acne.

Paigems, do you think zovia is better than orthocyline or yasmin?

I am a vegetarian, I eat only food I make myself (nothing packaged), I do not eat dairy, do not drink and only have treats once and awhile and they are generally not linked or times by my nodular breakouts.

Sorry, just saw this. I can't comment on how orthocyclen compares to zovia because I have not tried ortho cyclen, but I have heard they have similar effects. Yasmin was much better for my skin than zovia, but it make my hair fall out, makes me super tired, and gives me bad dry mouth. If I didn't mind balding and sleeping all the time I'd definitely go back to taking yasmin lol.

Do you consume a lot of high glycemic carbs? What about fat and soy? Have you ever tried an elimination diet? Also, what kinds of products do you use on your skin on a regular basis?

I'm a vegetarian for environmental reasons, not solely health. I eat complex carbs that can be combined to make complete proteins, like brown rice, quinoa, beans, etcetera..

I understand that food plays a part in acne, however, I ate the same and had clear skin for three years as I am now with skin that has acne.

Like all of us here that have acne, we are experiencing hormonal disturbances. The sebaceous gland is extremely sensitive to changes in androgen levels. Perhaps something increased your free testosterone levels and diet is now exacerbating the problem. My experience is that once the sebaceous glands start over producing, it continues for a while.

The complex carbs will definitely be a problem if your acne is sensitive to spikes in insulin.

I highly suggest you try cutting them out. It has worked for many of us.

The other piece is that you may be able to survive without a source of animal protein, however your hormones will not be optimized. Saturated fat is critical for the production of hormones. You didn't mention grains, however they can directly drop hormone levels by interfering with the entero-hepatic cycle. When hormone enriched bile is excreted in the digestive system, sex hormones bind to grains and are not reabsorbed.

So, it's been months (and after years of clear skin) I am still struggling with nodular acne . I've tried a bunch of things, including progesterone cream, vitamins and prescription medications. I KNOW everyone recommends I get my hormones tested but that is NOT an option for me at this time, so if that's your comment please don't comment!

My mom insisted I try B5 because of some reviews she's seen online, I've been taking 500mg once daily for a little while now, is it possible that this could be impeding any improvement? My acne was really bad when I started it, so I can't say if it made it worse, but I'm still breaking out, so it hasn't helped.

I™m still on spiro, and no, it's not helping much, but it did before and I worry if I completely cut it out my acne will be ten times worse.

Should I try a bc, I've seen some good things about zovia and orthocycline? Does anyone have good or bad experiences with either of these?

hey brenmc, sorry you are still breaking out. Is it possible your testosterone is now TOO low, and estrogen is dominating? You were taking 2 anti-androgens essentially for some years, maybe now you are estrogen dominant? Just a guess.

Is herpanacine working for you?

Be careful with B5, it can cause hair shedding if the dose is too high. Unfortunately, if the dose is too low, it doesn't help acne. Catch 22.

jlcampi,

I understand and respect your suggestions about diet. However, for me, diet only helps with regular pimples, not nodules. Also, the authors of "The Clear Skin Diet" even say that nodular acne and other types of severe acne may not be addressed with diet. So, diet isn't the 'be all, end all' of acne maintenance. I've tried an elimination diet, I've tried just eating the most healthy organic vegetables and protein, it does not help my nodular acne.

WishClean,

Thanks for the support. It is possible, however, even though I tried the NPC for months (which I thought was supposed to balance estrogen levels) I saw NO improvement in my acne. My nodules always come up a couple days before or during my period. What could that mean as far as what hormones are at play?

jlcampi,

I understand and respect your suggestions about diet. However, for me, diet only helps with regular pimples, not nodules. Also, the authors of "The Clear Skin Diet" even say that nodular acne and other types of severe acne may not be addressed with diet. So, diet isn't the 'be all, end all' of acne maintenance. I've tried an elimination diet, I've tried ust eating the most healthy organic vegetables and protein, it does not help my nodular acne.

WishClean,

Thanks for the support. It is possible, however, even though I tried the NPC for months (which I thought was supposed to balance estrogen levels) I saw NO improvement in my acne. My nodules always come up a couple days before or during my period. What could that mean as far as what hormones are at play?

Hi Bren,

I agree with you that diet isn't the first line option for treating acne. It's the most difficult to implement because it requires significant willpower that is required when we can feel stressed about our skin condition. I was only suggesting it for you because hormonal testing is not an option.

You break out just before your period because estrogen drops at this time and you loose it's neutralizing effects on testosterone.

Progesterone neutralizes estrogen. So, adding progesterone neutralizes estrogen. When estrogen is neutralized you are left with unopposed testosterone. For you, progesterone will probably not help.

The other issue is that progestins (synthetic progesterone) typically have a chemical structure closely related to testosterone. So, progestins can have some testosterone like side effects. They aren't all like this, however. Your goal could be to find the bc with a progestin that has a more anti-androgen like effect. The progestin in Yaz, for example, is related to spiro and has some of it's anti-androgen effects. Many have complained about this bc causing significant side effects. It's known to cause hyperkalemia. This can be very dangerous if you have cardiac issues.

Interesting about estrogen dropping around my period. I wonder if I increased my spiro around that time it might help?

How does Yaz or Yasmin help in ways spiro doesn't alone?

Birth control pills cause your ovaries to stop producing hormones completely, including testosterone. So that can help acne HOWEVER the progestin in birth control is partially androgenic, meaning it attaches to and stimulates the androgen receptor. Spironolactone is completely different in that it binds with the androgens before they get to the receptor preventing them from being stimulated. Spiro should not have much effect on your actual hormone levels. Although Spiro and birth control can work at doing different things, I believe that Spiro cannot block birth control's androgenic effects because it's a progestin attaching to the androgen receptor, not an androgen.

Interesting about estrogen dropping around my period. I wonder if I increased my spiro around that time it might help?

How does Yaz or Yasmin help in ways spiro doesn't alone?

The progestin in Yaz is similiar in structure to spiro. So, taking both could have a potentiating effect. Be carefull as spiro's indication is to lower blood pressure by antagonizing aldosterone.

Michi31 is correct about the effects of BC on the ovaries, however 90% of the testosterone you produce isn't from the ovaries. Rather it's from the adrenals in the form of DHEA that converts to testosterone.

I know if's tempting however, please do not attempt to interfere with the adrenal system without a competent physician supervising and blood work.

jlcampi,

I understand and respect your suggestions about diet. However, for me, diet only helps with regular pimples, not nodules. Also, the authors of "The Clear Skin Diet" even say that nodular acne and other types of severe acne may not be addressed with diet. So, diet isn't the 'be all, end all' of acne maintenance. I've tried an elimination diet, I've tried ust eating the most healthy organic vegetables and protein, it does not help my nodular acne.

THANK YOU. I've had to repeat that same thing over and over to every single person who always suggested that all i need to do to fix my obviously hormonal acne is, and I quote, 'eat more bananas'. That one's my favorite. Came from my obgyn.

jlcampi,

I understand and respect your suggestions about diet. However, for me, diet only helps with regular pimples, not nodules. Also, the authors of "The Clear Skin Diet" even say that nodular acne and other types of severe acne may not be addressed with diet. So, diet isn't the 'be all, end all' of acne maintenance. I've tried an elimination diet, I've tried ust eating the most healthy organic vegetables and protein, it does not help my nodular acne.

THANK YOU. I've had to repeat that same thing over and over to every single person who always suggested that all i need to do to fix my obviously hormonal acne is, and I quote, 'eat more bananas'. That one's my favorite. Came from my obgyn.

But hormones are affected by diet.

Brenmc, I can't remember if I've asked you this before, but when your nodular acne started, did you start using anything new on your skin (skincare products or makeup)? Did you start using any new detergents or something similar? Or start eating something new? When I hear someone has nodular acne I lean toward thinking it's a reaction to something (maybe an allergy?). My hormones have been crazy out of whack before (very high testosterone and DHEA) and I never got nodular acne.

Nothing external changed. I've suffered from nodular acne on and off since I was 16. I am 100% sure it's hormonal as it always comes during my period.

I do agree diet can impact normal acne, when I cut out peanut butter the pimples on my cheeks went away but, as the authors of The Clear Skin Diet note, nodular acne may not be addressed by diet alone. I wish it could.

From what I've read high progesterone (that comes during one's period) can contribute to acne, but there's little information on how to reduce this. Anyone know? I'm thinking this may be an issue for me due to the moderate increase in acne I had while using NPC, the progesterone-increasing effects of spiro, and the timing of the breakouts.

brenmc, this is a very simplified quiz about hormonal imbalances. I seem to have symptoms of various ones, including cortisol. You may want to try this and see what the results say about you. It's definitely not 100% accurate, and some symptoms overlap (e.g. high/low estrogen). John Lee has done pioneering research into bioidentical hormones, so maybe taking the test will help a bit (or, confuse you even more - if so, I'm sorry!) http://www.johnleemd.com/store/resource_hormonetest.html

Can you find a photo online of what you mean by nodular acne, esp. the size of nodules? Nodular acne can mean different things depending on who you ask, so I want to see what kind of acne you get, maybe that could help. If it looks a bit like boils or hives, perhaps it has to do with blood sugar/glucose, histamines, and/or the thyroid more than other hormones.

Thyroid disorders and cortisol deficiency/excess can also cause acne indirectly. And so can poor digestion. Many factors to consider unfortunately.

I do agree diet can impact normal acne, when I cut out peanut butter the pimples on my cheeks went away but, as the authors of The Clear Skin Diet note, nodular acne may not be addressed by diet alone. I wish it could.

 

From what I've read high progesterone (that comes during one's period) can contribute to acne, but there's little information on how to reduce this. Anyone know? I'm thinking this may be an issue for me due to the moderate increase in acne I had while using NPC, the progesterone-increasing effects of spiro, and the timing of the breakouts.

Hi WishClean,

I will definitely look into this test, thank you. My derm and family doctor diagnosed my acne as nodular and it fits with everything I've ever read about that type of acne. Large, swollen and painful lumps under the skin that don't come to a head. They can range in size from a pea to a penny. I'll take this test tomorrow and report back.

Do you know anything besides inositol and metformin that's effective on insulin, what about chromium?

Do you know of anyway to reduce progesterone?

Hi WishClean,

I will definitely look into this test, thank you. My derm and family doctor diagnosed my acne as nodular and it fits with everything I've ever read about that type of acne. Large, swollen and painful lumps under the skin that don't come to a head. They can range in size from a pea to a penny. I'll take this test tomorrow and report back.

Do you know anything besides inositol and metformin that's effective on insulin, what about chromium?

Do you know of anyway to reduce progesterone?

Oh I see. My acne was mostly nodular last year but after inositol I don't often get those type of nodules anymore unless I eat too much sugar/ carbs. Maybe it has to do with insulin resistance?

I highly doubt you have high progesterone to the point where it would cause acne, unless it's converting to testosterone. But, again, high progesterone is not usually an issue with women on this forum, it's more likely the opposite for most of us here. Perhaps your progesterone: estrogen ratio is off. EIther too high estrogen or too low compared to progesterone. I bet you if you took a blood test all your hormones would be within normal levels, but the ratio of some compared to others might be off. That's the issue with my hormones, since they are all within the "normal" range, but some on the very low end and some on the high.

The issue might be more with progesterone spikes and drops...I think it's the sudden increase/decrease of hormones (not just prog.) that can cause skin problems. Sudden drops/surges in estrogen can do that too, that's why PMS can affect our mood so much if we are sensitive to hormonal fluctuations.

Hmmm chromium does have side effects from what I read, but those are rare and if you take too much of it for too long. It's not meant to be a long term supplement like inositol or metformin (although if you read met's side effects, jeez...you can get the same results with more inositol imo). I think before you try chromium you should give inositol a try on its own (not glucosmart) or DCI (check the chiral balance website...it's pricey though).

Low sugar diet and eating small frequent meals does wonders for me in terms of keeping insulin stable....I used to nearly pass out if I didn't have anything sweet every few hours, but now that I cleaned up my diet I don't get those dizzy spells anymore.

Thanks for the quick reply! I do see that androgens are the most common issue associated with acne; however, from what I've read, progesterone spikes during your period, it can be converted to testosterone and it contributes to the production of sebum. I can't recall where, but I think I also read that progesterone can be inflammatory.

I know insulin is key in my acne, since metformin and spiro gave me the clearest skin I had since I was a baby (harhar). This whole time I've been saying that the spiro stopped working, but perhaps it was the glucosmart? I had previously weaned off met onto glucosmart (because of met's side effects) and that kept things clear for a couple years, but perhaps the glucosmart lost effectiveness or I became resistant to it and had a rebound effect.

 

Hi WishClean,

I will definitely look into this test, thank you. My derm and family doctor diagnosed my acne as nodular and it fits with everything I've ever read about that type of acne. Large, swollen and painful lumps under the skin that don't come to a head. They can range in size from a pea to a penny. I'll take this test tomorrow and report back.

Do you know anything besides inositol and metformin that's effective on insulin, what about chromium?

Do you know of anyway to reduce progesterone?

Oh I see. My acne was mostly nodular last year but after inositol I don't often get those type of nodules anymore unless I eat too much sugar/ carbs. Maybe it has to do with insulin resistance?

I highly doubt you have high progesterone to the point where it would cause acne, unless it's converting to testosterone. But, again, high progesterone is not usually an issue with women on this forum, it's more likely the opposite for most of us here. Perhaps your progesterone: estrogen ratio is off. EIther too high estrogen or too low compared to progesterone. I bet you if you took a blood test all your hormones would be within normal levels, but the ratio of some compared to others might be off. That's the issue with my hormones, since they are all within the "normal" range, but some on the very low end and some on the high.

The issue might be more with progesterone spikes and drops...I think it's the sudden increase/decrease of hormones (not just prog.) that can cause skin problems. Sudden drops/surges in estrogen can do that too, that's why PMS can affect our mood so much if we are sensitive to hormonal fluctuations.

Hmmm chromium does have side effects from what I read, but those are rare and if you take too much of it for too long. It's not meant to be a long term supplement like inositol or metformin (although if you read met's side effects, jeez...you can get the same results with more inositol imo). I think before you try chromium you should give inositol a try on its own (not glucosmart) or DCI (check the chiral balance website...it's pricey though).

Low sugar diet and eating small frequent meals does wonders for me in terms of keeping insulin stable....I used to nearly pass out if I didn't have anything sweet every few hours, but now that I cleaned up my diet I don't get those dizzy spells anymore.

Hmm I don't know. A lot of women clear on estrogen modulators (either more or less estrogen) and progesterone...most birth control doesn't contain androgen/ DHT blockers, just synthetic estrogen and progestin, and many women clear on that combination. Of course, others gets worse. It's a gamble for you at this point. Glucosmart lowers androgens more than metformin from what I understand. Maybe you have low testosterone, or maybe you are estrogen dominant?

Hi WishClean,

I will definitely look into this test, thank you. My derm and family doctor diagnosed my acne as nodular and it fits with everything I've ever read about that type of acne. Large, swollen and painful lumps under the skin that don't come to a head. They can range in size from a pea to a penny. I'll take this test tomorrow and report back.

Do you know anything besides inositol and metformin that's effective on insulin, what about chromium?

Do you know of anyway to reduce progesterone?

Brenmc,

I feel I must ask this question as you are very persistent about finding the solution to your problem. You are seeing seeing your family doc and a specialist, trying various therapies but can't test your hormone levels. Without this information you are flying with your eyes closed. I know of some ways you can have it done that aren't that expensive. Why not get the proper testing?