The Role of Testosterone in Acne

In Both Males and Females, Testosterone and Other Male Hormones Increase Acne by Stimulating the Skin to Produce More Sebum (Skin Oil)

The Role of Testosterone in Acne

Article Summary

Studies show that both males and females with acne tend to have more androgens (male hormones present in both males and females), including testosterone, than people without acne. Androgens are primarily male hormones, but they are also produced in females in smaller amounts. During puberty the amount of androgens in the body increases in both genders, so this raises their risk of developing acne once puberty hits. 

Increases in testosterone result in more skin oil production, and thus, more acne. This is settled science. It has been shown that giving males testosterone tends to result in an increase in acne, and it has also been shown that drugs that block the activity of testosterone reduce acne.

   

Role of Testosterone and Other Androgens in the Body

The word “androgen” comes from two Greek words, which can be roughly translated as “male maker” because in males, testosterone and other androgens begin influencing a male baby’s development before he is born and continue to regulate his body throughout his life. They also control the development and activity of the male sex organs as well as the development of secondary male characteristics, such as facial hair and the Adam’s apple.

But androgens are not only “male makers.” In both males and females, testosterone also regulates muscle growth, bone formation, and sex drive.1

Testosterone Production in the Body


Where in the Body Are Testosterone and Other Androgens Produced?

In both males and females, androgens are produced in the:

  • Sex organs—testes in males and ovaries in females
  • Adrenal glands—two glands found just above the kidneys2

The pituitary gland, which is found at the base of the brain, controls the production of androgens. When it sends a signal to the sex organs and/or adrenal glands, they begin producing androgens and releasing them into the blood.2


Types of Androgens

Androgens found in both males and females include (listed from least potent to most potent):

  • Dehydroepiandrosterone sulfate (DHEA-S)
  • Dehydroepiandrosterone (DHEA) 
  • Androstenedione 
  • Testosterone
  • Dihydrotestosterone (DHT)2,3

Testosterone is the primary and best-known androgen. It is called a “steroid” hormone because of its chemical structure, which is closely related to the anabolic—which some people take in order to build muscle mass. The image below shows the complex chemical structure of testosterone.1

All androgens are similar in chemical structure, and because of this the body can convert one type of androgen into another. Together, the sex organs and adrenal glands produce only three androgens: DHEA-S, androstenedione, and testosterone. Cells in other parts of the body, including cells in the skin, can convert them into the remaining two androgens, DHEA and DHT.2

Chemical Structure of Testosterone


Although all the androgens exhibit similar functions, some are more potent than others. The more potent a hormone is, the greater the effect that even a small amount can have on the body. The two most potent androgens are DHT and testosterone, and adult men retain a much larger amount of these androgens in their blood when compared to adult women.3 On the other hand, the weaker androgens DHEA-S, DHEA, and androstenedione are found in approximately equal amounts in the blood of men and women.3,4 

Interestingly, DHEA-Sthe weakest of all the androgensis the one most directly correlated with acne, meaning that people with acne are more likely to have elevated levels of DHEA-S than any other androgen.3

Androgen (Male Hormone) Levels in Men and Women


Androgens Increase Acne

Several clinical studies have clearly shown that increased levels of androgens, including testosterone, are linked to an increase in acne in both males and females.


How Do Androgens Cause Acne?

Testosterone and other androgens trigger acne primarily by increasing the production of skin oil. More skin oil usually means more acne. Once skin oil is over-produced, a domino effect results--leading to the beginning of acne.

How Androgens Increase Acne

Acne typically begins at puberty, which is when androgen levels rise in both males and females. Not coincidentally, this is also when sebum begins to be produced in a greater amount.

Free testosterone and other androgens from the blood can enter the cells of the skin oil glands, which are highly sensitive to androgens. Inside these cells, called sebocytes, the androgens head for the nucleus, which is the so-called “control center” of each cell. The nucleus contains the cell’s genes, which comprise the biological information instructing the cell what to do and how to grow. When androgens like testosterone enter the nucleus of a sebocyte, they “turn on” genes that “tell” the cell to start synthesizing more sebum.

Although all androgens can cause increased sebum production, DHEA-S—which is the weakest androgen—actually seems to correlate most strongly with acne. Sebum-producing glands in acne patients contain more DHEA-S than any other androgen,and research suggests that an increase in DHEA-S tends to go hand-in-hand with the early stages of acne. The reasons for this are currently not well understood.2


Is Acne Always Caused by Androgens?

As we have seen, research suggests that testosterone correlates positively with acne. However, more acne does not always mean there is increased testosterone. Instead, some people may simply be more sensitive to testosterone.

Journal of German Dermatological Society (JDDG)

According to an article published in the German scientific journal Journal der Deutschen Dermatologischen Gesellschaft in 2007, most patients whose skin produces too much sebum actually have normal levels of androgens in their blood. The scientists speculate that some people’s sebum-producing glands may be unusually sensitive to androgens, so that even normal amounts of testosterone can trigger acne.3


In Females: Androgen Receptor Blockers as a Treatment for Acne

Androgen receptor blockers, also called “antiandrogens,” are a type of hormonal therapy that can treat acne in females. They are not used for treating acne in males because they produce unwanted side effects, such as gynecomastia (enlarged breasts) and sexual dysfunction.

Androgen receptor blockers work to treat acne by preventing the activity of androgens: specifically, testosterone and DHT. Three androgen receptor blockers have been approved for treating acne patients: cyproterone acetate (CPA), spironolactone, and flutamide. Cyproterone acetate is normally a part of oral contraceptives (birth control pills), and spironolactone and flutamide are normally standalone medications. However, each of these drugs potentially comes with severe side effects.9

Androgen Receptor Blockers as a Treatment for Acne

Oral prescription treatments


The Bottom Line

In both males and females, more testosterone and other androgens tend to lead to more skin oil production and more acne. In males, there is not much that can be done about this. However, properly treating acne is normally strong enough to keep acne at bay even during times of increased androgen production, such as during adolescence. 

Females can also normally keep acne at bay with proper treatment even if they encounter brief times of increased androgen production. However, if androgen levels stays chronically high in females, this can be the sign of disease, such as poly-cystic ovary syndrome (PCOS), and in this case, acne can be treated with androgen receptor blockers, but this comes with 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. Androgen, <https://en.wikipedia.org/wiki/Androgen>.
  2. Toyoda, M. & Morohashi, M. Pathogenesis of acne. Med. Electron. Microsc. 34, 29–40 (2001).
  3. Degitz, K., Placzek, M., Borelli, C. & Plewig, G. Pathophysiology of acne. J. Dtsch. Dermatol. Ges. 5, 316–323 (2007).
  4. Cleare, A. J., O’Keane, V. & Miell, J. P. Levels of DHEA and DHEAS and responses to CRH stimulation and hydrocortisone treatment in chronic fatigue syndrome. Psychoneuroendocrinology 29, 724–732 (2004).
  5. Leyden, J. et al. A systemic type i 5 α-reductase inhibitor is ineffective in the treatment of acne vulgaris. J. Am. Acad. Dermatol. 50, 443–447 (2004). 
  6. Lawrence, D., Shaw, M. & Katz, M. Elevated free testosterone concentration in men and women with acne vulgaris. Clin. Exp. Dermatol. 11, 263–273 (1986).
  7. Bagatell, C., Heiman, J. R., Matsumoto, A. M., Rivier, J. E. & Bremner, W. Metabolic and behavioral effects of high-dose, exogenous testosterone in healthy men. J. Clin. Endocrinol. Metab. 79, 561–567 (1994).
  8. Bhasin, S. et al. The effects of supraphysiologic doses of testosterone on muscle size and strength in normal men. New Engl. J. Med. 335, 1–7 (1996).
  9. Thiboutot, D. & Chen, W. C. Update and Future of Hormonal Therapy in Acne. Dermatology 206, 57–67 (2003).
See More References

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