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Help With My Acne, I'm So Lost. Androgens ? Stress ? Hypothyroidism ? Many Questions.

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Hello !

First of all, i want to apologize for my really bad english, i'm not a native speaker. I'm glad i've found this site because i'm really, really lost with my hormonal problems, even if i've read like thousands of articles about hormones, acne relations and all this kind of things.

Let me tell you my little story, i hope somebody can help me, because doctors didn't seem to be helpful to my case. Sorry, it's really long and full of details...

First of all, i'm a 20 years old girl.

In my teenage years, i had very mild acne (and a little bit of oily skin) but nothing really awful. I just had once a year the visit of THE big cyst, always near my nose (and it always happened in summer) so strange haha. Except this f*ck*r, my acne wasn't really annoying.

At 16 y-o, i became a little bit more conscious about my physical appearance and wanted to make my little oily skin and little pimples disappear totally. So i went to a dermatologist, and he put me on Accutane, low dose. I wasn't aware of all the side effects of this treatment but fortunately, i only got dryer skin/lips lips. And no more pimples, my skin was perfect, hooray !

May 2010 - June 2012 : I took Accutane during two years, and i stopped it by myself little by little. During the last year i took Accutane, i was really really stressed, anxious, and i discovered many things :

-my upper lips became more hairy

- my eyebrows were growing faster after pulling them etc

- and my doc discovered me an hypothyroidism (Hashimoto's disease in my case).At the moment, i had no symptoms, so i didn't take any Levothyroxine, or something like that. Or i thought i didn't have any symptoms :

- i was more tired than before, but i blamed the finals, and i was also more sensitive to cold, but i blamed the real cold winter of my new town. - - not to mention my hair loss.

I also began to have digestive problems (they calmed down since i quit high school, it was probably stress-related.)

And then... the "nightmare" began, last year.

2 months after stopping Accutane (August 2012), little by little, i noticed :

- that my skin was more oily

- I had more and more little pimples and clogged pores

- 2-3 cyst on my face permanently

- redness on my skin, mostly on the cheeks/nose

The cysts were located most of the time on my forehead, around my nose and more rarely on the side of my jaws.

My nose was very oily and I had most of the little pimples there probably because of the excess sebum which clogged my pores.

I did some research and found something called "hyperandrogenism" with the same symptoms i had. Hair loss, acne, oily skin. But my periods were still regular, so i didn't look into PCOS.

During that period, i was eating crap everyday. My acne was never related to food, so i didn't think of changing anything and ate refined sugar all the time because of stress/anxiety.

I stopped washing it with water, and used (and still using) a soft micellar water and floral water i order to rinse it. My skin was a liiitle bit less dryer, but nothing more.

February 2013 : I decided to begin a more healthy diet and exercised everyday, alternating cardio and light resistance-training. No dairy, no refined sugar. But my skin remained the same. Pimples, redness, still oily. Still losing my hair.

March 2013 : Still following a healthy diet/exercising. I increased the intensity a little bit.

I finally had an appointment with an dermatologist, and he told me he think that i suffer from hyperandrogenism after seeing my hairy belly, my poor thin hair and my beautiful red pimples. I still had regular periods. He gave me an appointment for the next month and asked me to do some hormonal blood tests before giving any final diagnosis. The results are here :

- Ferritin : 18 ng/mL (labo normal values : 10 to 204 ng/mL)

- Testosterone : 0,34 µg/L (labo values : 0,10 to 0,61)

- DHEAS : 3,69 mg/L

(labo values : women before menopause : 0,70 to 3,00 mg/L / women after menopause : 0,20 to 1,00 mg/L)

- Vitamine B12 : 188 pmol/L (labo values : 141 to 488)

- Delta 4 -Androstenedione : 2,20 ng/mL (labo values : 0,70 - 3,50)

7,68 nmol/L (labo values : 2,44 - 12,22)

- 17 Alpha hydroxyprogesterone : 0,60 ng/mL

1,82 nmol/L

Labo values : Follicular phase : 0,15 - 1,10 ng/mL - 0,45 - 3,30 nmol/L

Luteal phase : 0,70 - 3,10 ng/mL - 2,10 - 9,40 nmol/L

Menopause : 0,08 - 1,30 ng/mL - 0,24 - 3,90 nmol/L

April 2013 : I went to the same dermatologist, he checked my blood tests and put me under something called "Androcur" (= cyprosterone acetate) and BCP. Didn't explain anything, said just the words "hyperandrogenism, hirsutism".

I never took them. Why ? The month before i saw the dermatologist again, my skin has totally cleared, smoothed, i had no more weird redness (or just a little bit). My dermatisis (nose, eyebrows) disappeared. I don't know how this magic occurred, but i know that at the same time i began to eat even more healty (I never cut the carbs, i think i was at 200-220 gr of carbs/day, mostly fruits, sometimes flavored soya yogurt, not always low IG (eating bananas), but NEVER refined sh*t).

Still eating some gluten (oatmeal at breakfast), but no dairy as usual.

I think sport has something to do with that because I increased the intensity of my workouts + I lost some weight.

But weirdly 1-2 month or so after, my skin became more oily again, i had little pimples all over my nose (i think they were clogged inflamed pores because of their tiny size), my hair was falling again. I think that it has something to do with adrenal fatigue, because I restricted my diet even more (dairy, soy, gluten-free) and was still working out a lot. Stress, stress, stress = bam adrenals ! I was feeling really tired but still working out... huge mistake.

During summer 2013 : I ate like crap once a week because I couldn't impose to my family my eating habits, stressed less about my food, worked out a little bit less and tada... My acne calmed down a litlle bit, and was less oily.

September 2013 : New town, new school, new boyfriend, new everything : I was a little bit stressed, ate not very well, but my skin was ok with just few liiiittle pimples not noticeable. I had a huge breakout after a stressful event, I didn't worried much about, and it calmed down after a week.

October 2013 : I went to my endocrinologist and he put me on Levothyroxine 50mg because of my extreme fatigue and my hair loss. He told saw some pimples on my cheek and told me that acne can be related to hypothyroidism, but nothing more.

November 2013 : I began to take a very low-dosed birth control pill. Did nothing to my body, skin and hair the same. spotting all the time. Still eating like crap, 0 hour of exercise. Still feeling more and more tired, losing my hair. Litlle bit more anxious and stressed.

February 2014 : I alternated between mild depression and little moment of happiness during those 4 months, but the end of the month i was mostly depressed and anxious. I began to eat healthy again since mid-February. I was still feeling tired as hell, still losing hair.

March 2014 : Still eating healthy.

- I took some spirulin during 4 days : breakout. Stopped it and my skin was ok again.

- Started jojoba to moisturize, and my skin was never that beautiful since April 2013, but I breakout one week after the first application.

- I noticed bigger pimples on my back, chest, and pimples on my chin (i never had pimples there)... They've disappeared since April. Why are they coming back again ?

Also stopped birth control pill this month, lowering the doses gradually in order to avoid a brutal drop in hormonal levels. I don't think it had any impact on my skin, since it never improved something... or am i wong ?

I also upped my Levothyroxine intake to 100/125 mg instead of 75mg. And had my first breakout one week after...

Now I have more time for myself, I'm also working on managing my stress, i don't think that much on my diet but eat really really healthy, it became a habit, trying to not think about my skin too, but... It didn't improved that much.

Soooo... (if somebody was brave enough to read that all !) i have some hypothesis, and i wanna have if possible your opinion :

- Is there a relation between stress/acne ? I know that in my family they all have clear skin, and my mom had only one huge breakout in her 20's after one big stressful event. My dad has some colopathic issue because of stress, (but clear skin even in his teenage years) so probably we are more sensible to the stress factor more than androgens/diet/etc... Because I'm really fed up to eat that healthy (my eating habits are close to an elimination diet, now for 2 months...) and not seeing results.

- I saw that my DHEAS levels where elevated and my testosterone levels normal... Can it be the cause of my hirsutism/acne/hair loss even if they are not that elevated ? I've read some articles talking about that too. Or probably it's more a problem in the adrenals area + my hypothyroidism ?

I think I'm gonna see my endocrinologist to talk with him about that and ask him a new hormonal blood test, with cortisol levels, estrogen etc etc. I'll have an abdominal ultrasound this week to check if i'm PCOS or not, i'll tell you if i have something new !

I'm also trying spearmint tea in order to lower my androgen levels... I don't know, i try.

Thanks for reading ! (and sorry for my really bad english again...)

Edited by Nailana

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Your english is actually really good! Remeber to capitalize your I's.

Maybe in April 2013, you lost weight becuase your skin was better and you felt better going outside to excerise. I know that when my skin is nasty, I fall off the wagin a bit and stay inside, no excerise... etc.

Maybe your skin got bad again becuase you changed your diet?

Stress has a lot to do with body condition, your skin, your stomach, everything. When a person gets stressed, nerves become hyperative, causing the brain to have bit of a meltdown, which makes you feel awful. Skin oil productions go way up, and pores get clogged.

I don't really understand why you stopped Accutane, it seemed to be working really well for you?

Try and relax a bit every day to keep your stress levels down, and maybe it will work out a bit better for your skin.

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Get yourself checked for adrenal disorders like non classic adrenal hyperplasia or anything involving your adrenals. Accutane can induce adrenal hyperplasia in rats according to this: http://www.roche-australia.com/content/dam/internet/corporate/roche/en_AU/files/retinoids/roaccutane-pi.pdf

Of course I'm aware the study says those rates are "prone" to multiple endocrine neoplasia but somehow I just don't trust Roche's words ( for the record I have not taken Accutane, I'm merely studying it and weighing my options.) Take a test called OH-17 Pregnenolone. It measures steroid conversion. If your steroid conversion is off, your adrenals may be suffering from hyperplasia. It may be for that matter Accutane induces adrenal issues in people already PRONE to these disorders, just like those rats. Just a thought. Get tested if you can..

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Thank you !

I'll tell my doctor about this and update if i have some blood test results to show :) I think it has something to do with my increased DHEAS levels too ?

Edit : sorry I didn't see your answer yellowturtle ! Hmm i don't think my weight loss has a relation witch my acne, but I know that since the moment i started less focusing on it (and focusing more on exercising in order to manage my stress) my acne disappeared. And I followed a really good diet since February of this year but finally my acne worsened even with a good diet) So I don't think diet and acne are that much related in my case since I was also eating like crap those last 6 months and my skin remained the same...)

I'm gonna try to relax and think less about it, because you're right, stress is a major cause of my acne, I hope my skin will improve a little bit.

I stopped Accutane because I was afraid of all the bad side effects, and taking it for more than 2 years was not approved by my doc... I had many friends who stopped taking it and remained clear, I thought it would be the same for me since i had only mild acne. Unfortunatly, no...

Edited by Nailana

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Focusing on your diet more than excersise could cause you more stress anyway, because then you'll worry about what you ate, how much you weigh, and have to keep track of your calories and sugar intake.

A lot of stress could also make your hair fall out?

Hmm. I know Accutane is supposed be the nuclear version for war on your face, which is probably why it works so well!

Have a stress-free day

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Hello ! Little update :)

- I have an appointment with my endocrinologist in 10 days. Hope that he'll give me at least an answer at some of my questions.

- I've done an abdominal ultrasound last week and I have no ovarian cysts. I know that you can have PCOS even while having normal ovaries, but since I've just stop to take the pill I'm still waiting for my periods, they should arrive soon haha... I hope that it´s gonna be ok. Waiting for blood tests too.

- I've read many things on adrenal fatigue and it seems to be more related to my case than adrenal hyperplasia : fatigue, no energy when waking up on the morning even after sleeping for 10 hours, but feeling ok in the evening/difficulty to sleep, headaches, anxiety, stress... Poor adrenal health can cause an excess of androgen production (in my case I have high DHEAS) and my skin improved totally when I was feeling better (less stress, good mood = healthier adrenals = balanced hormone production ?) Any idea on that ? Because my fatigue worsened those last 2 weeks, I don't sleep well, wake up in the middle of the night... I can't even do 5 minutes of exercise without feeling exhausted. I was used to do one hour and feeling good after, not totally dead.

Important thing I've also read : Levothyroxine should not be taken if the adrenals are not ok. And guess what ? My breakouts began 1 week after I increased my Levothyroxine dosage (went to 50mg to 100/125mg alternated).

Insulin resistance. Look it up.

Edited by Nailana

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Sounds like Levothyroxine might have something to do with it. Some people can't tolerate a higher dose.

For insulin resistance, I recommend you try -- in addition to a low GI diet -- inositol to regulate your blood sugar levels and keep them stable all day long.

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Sounds like Levothyroxine might have something to do with it. Some people can't tolerate a higher dose.

For insulin resistance, I recommend you try -- in addition to a low GI diet -- inositol to regulate your blood sugar levels and keep them stable all day long.

Hmm yes, that's why I'm trying to see if lowering the Levothyroxine's dose is gonna do something. I took 75mg today instead of 100, so, wait and see...

I've heard about inositol too and want to give it a try, how much should I take ? (and I've see that buckwheat is a great source of d-chiro-inositol and that's what i eat every morning, I'm on the good way haha !)

Btw, thanks for your help :)

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I too just recently found out that I have excess DHEA, it is twice the normal lab range and my testosterone is normal but slightly on the high end of normal. From my research, I came across PCOS, adrenal hyperplasia, and adrenal tumors although I've also read some posts where women had none of the above. As for symptoms, I have pretty severe adult acne (only on my face) and I am tired a lot/have anxiety. I eat SUPER healthy which I think helps keep my acne to a manageable level but it would be nice to not have to eat so strict.

My insulin, glucose, and thyroid levels are all normal.

I will be working with a doctor over the next few months to figure out what is happening. I was tested for PCOS before and didn't have it so I'm not sure what's going on. I will keep you updated on my results!

Good luck!

Edited by RacingheartZ

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YEs, hyperthyroidism can have something to do with it. My DHEAs were higher than my testosterone too, but blood tests are very inconclusive. I posted studies on inositol a while ago, and basically it helps reduce hirsutism, acne, and other PCOS symptoms over the course of 6 months. It doesn't hurt to try it. I recommend taking it in powder form with no added ingredients. 1/8 of a teaspoon is good to start with, then you can increase it to 1/8 twice a day if you are doing well on it.

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RacingheartZ : Thank you, I'll be glad to be informed since we have quite the same hormonal problem ! Wish you luck too ! I'm still waiting for my glucose tests etc, and my TSH was about 9,6 but my T4 and T3 were in the lab range...

And yeah, it's sometimes hard to follow such a strict diet - and not seeing any improvement in my case :/

WishClear : Thanks ! I finally bought the inositol's powder from Source Naturals (I think it's the same you used ?).

This morning I woke up with at least 4 new small red pimples on my cheeks - and I never get pimples there. They are a little bit itchy too... My skin is more oily than last week too, I have to remove excess sebum every hour ! I don't know what´s going on because I still ate right (the only thing I ate too much yesterday was almonds... and bananas. Ok, the GI index is not the lowest but I don't think one or two bananas are going to make someone breakout haha...

I resume what I took this week (supplements etc) :

- Vitamin C, about 500mg max.

- B-complex vitamine last Tuesday, but I stopped after reading that it can cause breakouts because of the amount of B6 and B12 in it (even if I have the Solgar one which is pretty well-balanced...

- Milk thistle tincture : it was written to take 10 drops twice or 3 times a day. I didn't take more than 8 drops the first time, and upped little by little to 10 drops (my skin was still okay) but yesterday I took something like 16 drops...

- Spearmint tea : I was drinking 2 cups a day, my skin didn't improve but didn't get worse. 2 week, my skin become more oily with more and more clogged pores on the nose and whiteheads on the forehead...

- Vitamine D3 (fat soluble) : I took 2400 UI the first three days, and upped to 4000 UI this week. I don't think it has something to do with my breakout even if my skin became more oily 2 days after taking it for the first time. I broke out from spiruline and jojoba, everything is possible with me !

I think I'm gonna keep only the vitamin C and add inositol too. If my skin get better I'll add little by little one supplement at a time to see how my skin reacts.

I've also heard about B5 for supporting the adrenal glands (and good for skin too)... But one thing at a time :)

Edited by Nailana

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Hello !

- So after a week of moderate low-carbing (70-80 gr of carbs), my skin was less oily and I had less pimples, in fact my skin was pretty clear ! I added Inositol at the same time, so probably it's the combinaison of both ? But one big thing I've noticed before all : I'm less tired and sleep better than before ! One good point :)

- I went to my endocrinologist but the only thing he did was putting me on a lower dose of Levothyroxine.

But today I had new pimples bigger than the other I had this week too :( I know I ate too much nuts and had salmon and shrimp. I also cooked with coconut oil more than before.

Two weeks ago, I broke out after eating shrimps and salmon and nuts... I have small itchy pimples not really reddish in my jawline. Is it possible to have a reaction to fatty fish and shrimps ? Or coconut ? Or nuts ? It's so hard to understand to what food exactly I'm reacting and I'm not ready yet to go on I elimination diet, I eat very strictly all the time :(

Another thing, I tested my fasting blood sugar and it's about 55-68 mg/dL, so very low... And one-two hours after a normal meal (fats + protein + carbs) it's about 92-98 mg/dL. What does it mean ? Because even with such low results, I feel less tired than before

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Tough to say about the glucose! The doctor that I work for said her blood sugar is always around 75-80 and she feels fine. In school, we learn that for hypoglycemic people it's best to eat smaller more frequent meals. Skin cells take about 3 weeks to turn over in the body so it might take some time for you to really see results from your dietary changes.

Do you track your menstrual cycle? It might be good to know exactly when you are breaking out (ie. only at ovulation, only at menstruation, during the whole luteal phase of your cycle). I break out pretty much during the whole luteal phase of my cycle. As you know, for some reason the vitamin D is helping me soooo much! We shall see how it goes during this luteal phase. There are great apps for tracking your cycle if you have a smart phone. I use iPeriod app.

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