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Why No One, Not Even Beyoncé, Can Avoid Acne

How your hormone levels impact the rise and fall of acne

Danielle Wright, MD
Danielle Wright, MD

Dr. Danielle Wright is an Assistant Professor in the Department of OB/GYN at the Uniformed Services University of Health Sciences.

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Why No One, Not Even Beyoncé, Can Avoid Acne

21 December 2020

In 2013 photos of an unfiltered, untouched Beyoncé, leaked onto the internet. Were you surprised that our Queen Bey had areas of mild acne? Well, not me! Though her voice is angelic and when on stage she embodies the spirit of musicality, at the end of the day, Beyoncé is a human being who has skin that reacts to hormones. And believe it or not friend, we share the same hormones of our songstress.

Unretouched images of Beyoncé leaked, and the BeyHive went berserk

Unfiltered photo of Beyoncé's 2013 L'Oréal commercial shoots and ad campaigns. She still looks flawless. Photo: L'Oréal

Let’s explore the effect testosterone, progesterone and estrogen have on our skin:

Testosterone

Testosterone (an androgen) is a steroid hormone made in the ovaries of females, testes of males, and adrenal glands of both sexes. Your skin harbors oil secreting tissue called sebaceous glands that surround the hair follicle.

When there is an overproduction of testosterone, we can see an increase in the release of oil which can lead to blocked sebaceous glands, bacterial colonization, and then acne [2].

In teenagers, the cause of acne can be multifactorial, but the increase in testosterone seen at this time can certainly contribute.  

Polycystic ovarian syndrome (PCOS) is a gynecologic condition characterized by high levels of testosterone, irregular periods, and polycystic ovaries on sonography. With this diagnosis, women can see not only acne but also unwanted facial hair (on the chin and upper lip; called hirsutism) due to elevated testosterone levels. For those not on cross-sex therapy, if hirsituism and acne develop in addition to scalp balding, cliteromegaly (an enlargement of the clitorus), or other signs of masculization, you should seek care from a gynecologist immediately for concern that testosterone levels are too high due to rarer conditions.  

Progesterone (and Birth Control)

There’s not enough data to definitively state the effect that natural progesterone, alone, has on sebum production. However, synthetic derivatives of progesterone seen in birth control pills can increase oil secretion from sebaceous glands [2].  

Sebum is an oily substance produced by your body’s sebaceous glands. It moisturizes and protects your skin, but when overproduced it can also be responsible for breakouts.

Let’s go back to the basics for a second; remember combination birth control pills contain the hormones ethinyl estradiol and a progestin. A lot of the variation you see in a birth control pill comes not only from the dosage of estrogen, but also from the type of progestin used. Progestins that are structurally derived from testosterone are classified as estranes or gonanes. Progestins that are structurally derived from progesterone are classified as pregnanes. The majority of progestins found in birth control pills are derived from testosterone; however, progestins can vary in their degree of androgenicity [1]. Fourth generation progestins, such as Drosperidone found in Yaz, are less androgenic and serve as a great option for those naturally with higher testosterone levels.

It’s also important to note here that combination birth control pills, in general, increase sex hormone binding globulin, which is a protein that binds free androgens and decreases their concentrations in the bloodstream. This process can help counteract high testosterone levels, as seen in PCOS, to improve acne and hirsutism. 

Estrogen

Locally, at the hair follicle, estrogen can reduce oil secretion from sebaceous glands and mitigate acne [5]. Systemically, acne can develop when estrogen levels are falling. In the menstrual cycle, estrogen levels fluctuate.

Acne can occur at that point when estrogen is decreasing and progesterone is increasingthis is the luteal phase of the menstrual cycle.

In menopause, as estrogen levels fall, due to a diminishing ovarian reserve, acne can develop as the estrogen to testosterone ratio flips [4].  

Three-step skin care systems (i.e. a cleanser, toner, moisturizer) can be helpful to combatting oily skin, in addition to a balanced lifestyle (you know, getting enough sleep, drinking water, eating clean). If you need additional help you can always start with your local queen or king of hormonesan OB/GYN.

 

References 

  1. Allen, Rebecca. “Combined Estrogen-Progestin Oral Contraceptives: Patient Selection, Counseling, and Use.” Uptodate, Nov. 2020, www-uptodate-com/contents/combined-estrogen-progestin-oral-contraceptives-patient-selection-counseling-and-use. 
  2. Bergler-Czop, B., & Brzezińska-Wcisło, L. (2013). Dermatological problems of the puberty. Postepy dermatologii i alergologii, 30(3), 178–187. https://doi.org/10.5114/pdia.2013.35621
  3. Fritz, M. A., & Speroff, L. (2011). Clinical gynecologic endocrinology and infertility (8th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
  4. Khunger, N., & Mehrotra, K. (2019). Menopausal Acne - Challenges And Solutions. International journal of women's health, 11, 555–567. https://doi.org/10.2147/IJWH.S174292
  5. Ju Q, Tao T, Hu T, Karadağ AS, Al-Khuzaei S, Chen W. Sex hormones and acne. Clin Dermatol. 2017 Mar-Apr;35(2):130-137. doi: 10.1016/j.clindermatol.2016.10.004. Epub 2016 Oct 27. PMID: 28274349.

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