Ever notice your skin acting up at certain times in your cycle? Or wondering why you're breaking out more than usual? Your hormones, specifically testosterone, progesterone, and estrogen, play a huge role in what's happening with your skin. Let's break it down.

Testosterone and Your Skin

Testosterone is a steroid hormone made in your ovaries (if you're female), testes (if you're male), and adrenal glands (everyone has these). Your skin has oil-secreting tissue called sebaceous glands that surround your hair follicles.

When your body produces too much testosterone, you can see an increase in oil production. This can lead to blocked sebaceous glands, bacteria buildup, and then—you guessed it—acne.

For teenagers, acne can happen for a bunch of different reasons, but the spike in testosterone during puberty definitely contributes to breakouts.

What about PCOS?

Polycystic ovarian syndrome (PCOS) is a condition characterized by high testosterone levels, irregular periods, and polycystic ovaries. If you have PCOS, you might notice not just acne but also unwanted facial hair (especially on your chin and upper lip—this is called hirsutism) because of those elevated testosterone levels.

If you're developing hirsutism and acne along with other signs like scalp balding, clitoral enlargement, or other masculinization symptoms (and you're not on hormone therapy), you should see a gynecologist right away. These could be signs that your testosterone levels are too high due to rarer conditions.

Progesterone and Birth Control

There isn't enough research yet to say exactly how natural progesterone alone affects oil production. But synthetic versions of progesterone (called progestins) found in birth control pills can increase oil secretion from your sebaceous glands.

Quick reminder: sebum is that oily substance your body produces to moisturize and protect your skin. When you make too much of it, that's when breakouts happen.

Let's talk about birth control

Combination birth control pills contain two hormones: ethinyl estradiol (an estrogen) and a progestin. The differences you see between birth control pills come from both the dosage of estrogen and the type of progestin used.

Most progestins in birth control are actually derived from testosterone and can be classified as estranes or gonanes. Some are derived from progesterone and classified as pregnanes. Because most are derived from testosterone, they can vary in how androgenic they are, meaning how much they act like testosterone in your body.

Fourth-generation progestins, like drospirenone (found in Yaz), are less androgenic and can be a great option if you naturally have higher testosterone levels.

Here's something important: combination birth control pills increase a protein called sex hormone binding globulin (SHBG), which binds to free androgens and decreases their levels in your bloodstream. This can help counteract high testosterone levels (like in PCOS) and improve acne and hirsutism.

Estrogen and Your Skin

Estrogen can actually reduce oil secretion from your sebaceous glands and help prevent acne. But when estrogen levels drop, that's when breakouts can happen.

During your menstrual cycle, estrogen levels fluctuate. Acne often pops up when estrogen is decreasing and progesterone is increasing. This is called the luteal phase, which happens in the week or two before your period.

In menopause, estrogen levels fall because of diminishing ovarian function. As the estrogen-to-testosterone ratio shifts, acne can develop even later in life.

What Can Help

A good three-step skincare routine (cleanser, toner, moisturizer) can help manage oily skin. Along with that, the usual lifestyle stuff makes a difference too, such as getting enough sleep, drinking water, and eating nutritious foods.

If you need more help managing hormonal acne, start with an OB/GYN. They're basically the experts on hormones and can help you figure out whether birth control, other medications, or different treatments might work for you.

Remember, hormonal acne is super common and nothing to be ashamed of. Your skin is just responding to what's happening inside your body. 💜