The Role of Estrogen in Acne

In Both Males and Females, Estrogens Improve Acne by Decreasing the Production of Sebum (Skin Oil)

The Role of Estrogen in Acne

Article Summary

Both males and females produce female hormones, called estrogens. Estrogens counteract the effects of male hormones in the body, thereby decreasing the production of skin oil and reducing acne.

Birth control pills containing estrogens can be used to treat acne in females but come with potentially serious side effects.

   

Estrogens are female sex hormones. Although they are primarily female hormones, they are also produced in males in smaller amounts. There is actually no single hormone called “estrogen.” Instead, estrogens are a class of closely related hormones with similar names.


Role of Estrogens in the Body

In females, estrogens are responsible for the development and activity of the female sex organs, as well as for the development of secondary sex characteristics—like the growth of breasts and widening of the hips. Estrogens also regulate menstrual cycles.

In both males and females, estrogens increase bone density, help with blood clotting, and increase fat stores.

Estrogen Production in the Body


Where in the Body Are Estrogens Produced?

In females, estrogens are produced in the:

  • Ovaries*
  • Placenta during pregnancy*
  • Adrenal glands
  • Liver
  • Breasts
  • Skin
  • Fat tissue

*Most of a woman’s estrogens are produced in the ovaries—or in the placenta when she is pregnant—with much smaller amounts being produced by the other five organs.

In males, estrogens are produced in the:

  • Testes
  • Fat tissue

The production of estrogens is controlled by the pituitary gland, which is located at the base of the brain. The pituitary gland is the master hormonal gland of the human body, which means that it acts like a central computer—controlling other organs in the body. The pituitary gland does this by producing hormones that then stimulate the production of other hormones by different organs.1

To stimulate the production of estrogens, the pituitary gland sends out two hormonal signals: follicle-stimulating hormone (FSH) and luteinizing hormone (LH). FSH and LH work as follows:

  • In females, FSH and LH stimulate the ovaries to produce large amounts of estrogens** and small amounts of androgens (male hormones like testosterone)
  • In males, FSH and LH stimulate the testes to produce large amounts of androgens and small amounts of estrogens**1

**Estrogens are actually produced from androgens, which means while females ultimately hold small amounts of androgens, the ovaries make a large amount of androgens at first and then convert most of it into estrogens.2

Types of Estrogen


Types of Estrogens

The four main estrogens include:

  • Estradiol (the primary estrogen)
  • Estriol
  • Estrone
  • Estetrol (produced only in women during pregnancy)

These estrogens are present in both males and females, with the exception of estetrol.

Scientists do not fully understand how the body controls the balance between androgens and estrogens. However, this balance is critical for overall health as well as specifically for skin health.3

Chemical Structure of Estradiol (Estrogen)


Estrogens Improve Acne

Researchers and doctors have long recognized that estrogens appear to improve acne. For example, in females, acne tends to occur when the levels of estrogens in the blood are low.

Clinical Biochemistry

An overview article on the role of hormones in acne, published in 2011 in the journal Clinical Biochemistry, noted that in many cases, females with acne possess low estrogen levels:

  • Acne in females often occurs at puberty, when menstrual cycles are just beginning to be established and estrogen levels are low
  • Acne in females may worsen just before the beginning of a menstrual cycle, when estrogen levels drop
  • Females with acne tend to have less estrogen in their blood than females without acne4

Estrogenic Medications Tend to Decrease Acne

Since high estrogen levels tend to decrease acne, medications that contain estrogen can be used as an acne treatment. In fact, many doctors prescribe these types of medications to females with acne. For males, estrogen therapy is not an option because of unwanted side effects, such as gynecomastia (enlarged breasts) and sexual dysfunction. Estrogen therapy usually comes in the form of oral contraceptives (birth control pills), which contain estrogen.

Oral Contraceptives as a Treatment for Acne

Research has demonstrated that oral contraceptives containing estrogen are beneficial for acne. They contain synthetic (made in a laboratory) versions of hormones that work in the same way as natural hormones but are convenient since they are easy to manufacture. Today, most oral contraceptives are combined oral contraceptives (COCs), meaning that they combine two components.

  1. A synthetic version of estrogen
  2. A synthetic version of progesterone, which is another type of female hormone
Most Common Synthetic Versions of Estrogen and Progesterone Found in Oral Contraceptives

Ortho Tri-Cyclen Oral Contraceptive
 
Yasmin Oral Contraceptive



The synthetic estrogen component in oral contraceptives works similarly to natural estrogen and can thus reduce acne, which numerous studies have shown.

One large study published in 2012 combined and analyzed the results of many earlier studies with a total of over 12,000 participants. The researchers concluded that the findings of all the studies agree that oral contraceptives can reduce acne.5

Expand to read details of study 

Cochrane Library

A large study was published in 2012 in the Cochrane Database of Systematic Reviews. The authors performed a meta-analysis, which means that they combined the results from many different clinical studies and analyzed them in order to draw some general conclusions. For this meta-analysis, the scientists examined 31 separate studies on oral contraceptives and acne, with a total of 12,579 participants. The researchers found that in the studies which compared a combined oral contraceptive to a placebo (in this case, an identical-looking pill without any hormones), the oral contraceptive significantly reduced acne. They wrote, “All [studies] showed [combined oral contraceptives] reduced acne lesion counts, severity grades and self-assessed acne compared to placebo.”5


The scientists found that all the combined oral contraceptives were effective in reducing acne, regardless of the particular synthetic estrogen each contained.5 However, it is important to keep in mind that oral contraceptives cause moderate to potentially serious side effects, such as increased risk of blood clots, stroke, and heart attack, especially in women over 30 years old who smoke. Some people may also be at increased risk of developing venous thromboembolism (a blood clot in a vein). It is a good idea to speak with your doctor about any family history of blood clots before beginning hormonal therapy for acne. Because of the potential side effects, oral contraceptives are usually only prescribed for acne when other treatments, like benzoyl peroxide and/or retinoids, fail.

Safety Concerns of Combined Oral Contraceptives


How Do Estrogens Improve Acne?

Estrogens improve acne in both males and females by counteracting the effects of androgens, which tend to worsen acne.6 To understand how estrogens relieve acne, we first need to understand the effects of androgens on acne. Androgens, such as testosterone, signal skin oil-producing glands, called sebaceous glands, to produce more skin oil, called sebum. Androgens from the blood do this by binding to the cells of the sebaceous glands, called sebocytes. Inside these cells, the androgens then head for the nucleus, which is the so-called “control center” of each cell. The nucleus contains the cell’s genetic material, which is the biological instructions telling the cell what to do and how to grow. When androgens penetrate the nucleus of a sebocyte, they “turn on” specific genes that “tell” the cell to start synthesizing more sebum. In other words, increased androgen levels in the blood results in more androgens interacting with sebaceous glands, causing an increase in sebum.

On the other hand, estrogens have the opposite effect, meaning that they decrease sebum production in both males and females.

How Do Estrogens Decrease Acne?
Scientists speculate that estrogens achieve a decrease in sebum this by one of three mechanisms.

  1. Estrogens may stop the production of androgens in the body via a so-called “negative feedback loop.” As we have seen, in both males and females, the sex organs begin producing both androgens and estrogens when the pituitary gland sends a signal to the sex organs. The pituitary gland constantly monitors the amount of sex hormone in the blood to see if there is already an abundance of estrogen or androgen in the body. If it senses much estrogen in the blood, it stops sending a signal to the sex organs, which stop producing androgens that the body can convert into more estrogens. In other words, having a lot of estrogen in your blood can temporarily stop your body from making more androgens. Less androgen production entails less sebum production, which potentially means less acne.
  2. Estrogens may decrease the amount of so-called “free” testosterone in the blood. Free testosterone is testosterone which floats around in the blood by itself and can bind to sebaceous glands to stimulate sebum production. Most testosterone in the body is not free but is bound to proteins. Estrogens may cause the liver to synthesize more of these proteins, so that more testosterone is bound and less is free.
  3. Estrogens may also indirectly help with acne by entering the cells of the sebaceous glands and “turning on” genes that tell the cells to produce less, not more, sebum.8

Besides reducing the amount of sebum, estrogens also reduce inflammation—in other words, they reduce the redness, swelling, and soreness that come with acne breakouts.4 Thus, estrogen not only helps to prevent the first step in acne development, but helps to relieve the symptoms of acne as well.

It is important to note that estrogen therapy is not the only hormonal therapy that can improve acne by counteracting the effects of androgens. Another option is a class of drugs called androgen receptor blockers or “antiandrogens.”


Females Only: Androgen Receptor Blockers (Antiandrogens) as a Treatment for Acne

Androgen receptor blockers, or antiandrogens, are hormone-containing drugs that can be used for treating acne in females. They are not used for treating acne in males due to undesirable side effects, such as gynecomastia and sexual dysfunction. Androgen receptor blockers work to treat acne by preventing the activity of androgens.

Three antiandrogens have been approved for treating patients: cyproterone acetate (CPA), spironolactone, and flutamide. Cyproterone acetate is usually a part of oral contraceptives, and spironolactone and flutamide are usually standalone medications. However, each of these drugs presents potentially serious side effects.9

Androgen Receptor Blockers as a Treatment for Acne


The Bottom Line

Estrogens can improve acne by reducing the production of sebum and relieving the symptoms of breakouts. Oral contraceptives containing estrogen have been shown to be effective in treating acne in females, but they come with potentially serious risks. Estrogen therapy for acne is not available for males because of undesirable side effects.

The Experts at Acne.org

Our team of medical doctors, biology & chemistry PhDs, and acne experts work hand-in-hand with Dan (Acne.org founder) to provide the most complete information on all things acne. If you find any errors in this article, kindly use this Feedback Form and let us know.

References:

  1. Silverthorn, D. Human Physiology: An Integrated Approach (Pearson, 2010).
  2. Thiboutot, D. Regulation of Human Sebaceous Glands. J. Invest. Dermatol. 123, 1–12 (2004).
  3. Estradiol. <https://en.wikipedia.org/wiki/Estradiol>
  4. Arora, M. K., Yadav, A. & Saini, V. Role of hormones in acne vulgaris. Clin. Biochem. 44, 1035–1040 (2011).
  5. Arowojolu, A. O., Gallo, M. F., Lopez, L. M. & Grimes, D. A. Combined oral contraceptive pills for treatment of acne. Cochrane Database Syst. Rev. 7–9 (2012).
  6. Toyoda, M. & Morohashi, M. Pathogenesis of acne. Med. Electron. Microsc. 34, 29–40 (2001).
  7. Degitz, K., Placzek, M., Borelli, C. & Plewig, G. Pathophysiology of acne. J. Dtsch Dermatol. Ges. 5, 316–323 (2007).
  8. Thiboutot, D. Acne: Hormonal Concepts and Therapy. Clin. Dermatol. 22, 419–428 (2004).
  9. Thiboutot, D. & Chen, W. C. Update and Future of Hormonal Therapy in Acne. Dermatology 206, 57–67. (2003).
  10. Couzinet, B., Le Strat, N., Brailly, S. & Schaison, G. Comparative effects of cyproterone acetate or a long-lasting gonadotrophin-releasing hormone agonist in polycystic ovarian disease. J. Clin. Endocrinol. Metab. 63, 1031–1035 (1986).
  11. Conway, G. et al. The polycystic ovary syndrome: a position statement from the European Society of Endocrinology. Eur. J. Endocrinol. 171, P1–19 (2014).
  12. McCartney, C. R. & Marshall, J. C. Polycystic ovary syndrome. N. Engl. J. Med. 375, 54–64 (2016).
  13. Spritzer, P. M. & Motta, A. B. Adolescence and polycystic ovary syndrome: current concepts on diagnosis and treatment. Int. J. Clin. Pract. 69, 1236–1246 (2015).
See More References

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