What to do when hormone levels are "normal", when you have hormonal acne but your testosterone is normal. Does testosterone affect acne?

I Have Acne But My Hormone Levels Are Normal… help!

In Acne by Cheryl Woodman MChemLeave a Comment

Does testosterone affect acne? I bet you’ve done enough Google searches by now to know that heck yes, androgens are a key cause of acne. Androgens like testosterone. But the mind-blowing fact is you’ve just had a blood test from your doctor and your testosterone levels are normal. 100% normal.

So you’re thinking – does testosterone affect acne? Am I even human? Is my acne being caused by some needle-in-a-haystack trigger? Will I be stuck with acne forever?

Stop right there my friend and do nothing other than read the rest of this blog with me.

I’ve got your hand and there are simple (yet hidden) answers I promise to reveal to you in the next quick minutes.

Fact is, the acne hormone test you’ve just taken is likely not the full picture.

It’s like you’re seeing just Mona Lisa’s eye, not her full face.

Come with me as I guide you through – does testosterone affect acne plus how to heal from acne when your hormone levels are normal.

Does testosterone affect acne? What to do when hormone levels are "normal", when you have hormonal acne but your testosterone is normal.

Why Do I Have Acne If My Hormones Are Normal?

What the heck’s happening? I totally get it. Almost 8 years ago now I was struggling with hormonal acne. I felt too embarrassed to ask my doctor for help, so I never had my hormone levels checked. However, if I had, I bet you they would have come back as normal. 100% normal.

Which is a relief but also when you’re experiencing acne – it can be heartbreaking because all you want to do is find out the reason for these deep, red, painful breakouts you keep getting.

The first challenge is, that when you ask your doctor for hormone testing they have a budget to keep in mind and so your doctor is likely to request only the basics i.e. estrogen and testosterone checks (maybe also luteinizing hormone (LH) if you have a fab doctor). This is not the full picture, this is Mona Lisa’s eye.

See, in 2022 there was a pretty big study (relatively speaking) of hormone levels in women with acne. These researchers recruited 140 women, 70 of them had acne and 70 of them had clear skin – these clear skin ladies were the control group.

They found something shocking (but also something that’s been shown in many other acne studies);

[Psst – serum just means blood]

There was also no significant difference between the levels of serum testosterone in both the subjects and the controls.Pan Afr Med J. 2022; 41: 227.

No difference. Did you see that?

Does Testosterone Affect Acne?

This 2022 acne study might lead you to believe testosterone doesn’t affect acne – but wait, there’s more.

See this acne study only reports testosterone as total testosterone. Total testosterone is likely the test your doctor just ran for you (or will do if you request a hormone panel).

Psst – if you’re seeing no other words other than testosterone next to your blood test result then this is your blood result for total testosterone.

But there’s another big factor that’s super important to understanding if your androgen levels are elevated. Let me rewind a second to explain something amazing.

Not all the testosterone you have right now can be used by your body. Most of the testosterone you have is floating about as if it were a ghost, completely ‘un-seeable’ to your body.

This happens when testosterone is locked down (I like to think of it as testosterone being hugged :)) by something called sex hormone-binding globulin (SHBG).

When your testosterone is being hugged by your SHBG it can’t be seen or used by your body.

This acne science quote tells us something super interesting (note: T = testosterone);

In normal women, approximately 99% of plasma T is bound to serum proteins, predominantly sex hormone-binding globulin (SHBG) and albumin, leaving about 1% circulating free (or unbound) T.Arch Dermatol. 1983 Oct;119(10):799-802

Wowzer eh. 99% of the testosterone you have is being hugged and is not usable by your body. What actually matters most is how much free testosterone you have.

Free testosterone is testosterone your body can see and use.

Testosterone Levels & Acne

Many acne studies show it’s especially normal to be experiencing hormonal acne yet to have in-range total testosterone levels/levels which look exactly like those of someone with clear skin.

However, studies show free testosterone levels often correlate with acne symptoms. It may be that your free testosterone levels are out of range or that your free testosterone levels are much higher than those of a patient with clear skin (this can be technically ‘in-range’ but is still noticeably elevated).

This free-testosterone imbalance is exactly what an acne study from 1992 shows, it studied 97 women to find there is no difference in testosterone levels in women who have acne vs. women with clear skin however there was a significant difference in free-testosterone levels.

Now we’re starting to see the whole Mona Lisa 🙂

Does testosterone affect acne? Total testosterone is not a reliable hormone test for hormonal acne – you should ask your doctor to take free testosterone levels too.

Is Acne a Sign Of High Testosterone?

Yet there’s still more of Mona Lisa to see. Fun fact – your sebum glands which are intimately involved in causing your acne may just have extra sensitivity to free testosterone – this means your free-testosterone levels are ‘normal’ or ‘in-range’ but for you, this level of androgens cause hormonal acne breakouts.

Take a peak at this acne science with me and keep in mind as you read it that acne is a sign of hyperandrogenism i.e. high androgen levels;

Signs of hyperandrogenism despite normal levels of both total and free testosterone can be explained by the fact that there is an increased sensitivity of the receptors to androgen at the pilosebaceous unit.Clin Cosmet Investig Dermatol. 2016; 9: 241–248

Psst – pilosebaceous unit is just the part of your skin that makes oil – what us scientists call sebum.

This acne science tells us something to make you feel complete relief at your hormone levels being ‘normal’ – you can have acne even though your testosterone levels are normal, and that’s because your sebum glands aka oil-making glands are extra responsive/extra sensitive to androgen hormones.

‘Normal’ androgen levels may be like a forest fire to your sebum glands when instead they should be like a campfire.

Does testosterone affect acne? Androgen levels like free testosterone are linked with acne, however, androgen levels can be normal and you can still have painful adult acne. This is because your skin cells have extra sensitivity to androgens. Don’t worry, you can heal this imbalance naturally.

How Do You Reduce Testosterone Acne?

Now here’s the beautiful silver lining to your hormone levels coming back normal. If your hormone levels had shown out-of-range testosterone levels your doctor will have prescribed you Spironolactone – it’s an androgen blocker.

While spironolactone can get many women clear skin – it’s not a long-term acne cure. Instead, I like to describe it as an acne plaster – once you take it away, acne’s still underneath.

Instead of taking an acne plaster, you can get a long-term healing of your acne and feel confident in your skin again by identifying the root, triggering causes of your hormonal acne.

See when your body’s making extra androgens or what is above normal for you as an individual – it can feel like you have no control over these levels. They’re your sex hormone – there’s nothing you can do about it.

I have amazing news – you have big power and control here – there’s lots you can do to balance your hormone levels naturally and to finally get clear, calm, happy skin that has you feeling like the awesomesauce you are.

What to do when hormone levels are "normal", when you have hormonal acne but your testosterone is normal. Does testosterone affect acne?

See this acne study snippet;

In women, androgens are secreted mainly by two organs, the adrenal cortex and the ovary… It is thought that the ovary contributes approximately 40-45% of serum T while the adrenal cortex contributes 55-60%.Clin Cosmet Investig Dermatol. 2016; 9: 241–248

Your ovaries and your adrenals both make androgens. Both can cause acne.

And the amazing news is, there are science proven ways to shout at tell your ovaries and your adrenals to make fewer androgens.

When your ovaries and your adrenals make fewer androgens – you get clear, calm, healthy, happy skin that has you ready to go anywhere makeupless 😀

My online acne healing video course, Acne Warrior teaches you how to reduce the amount of androgens your ovaries and adrenals are making with natural changes to your diet and lifestyle.

Heal your acne online inside my online Acne Warrior video course. A scientist guide to healing acne for good.

Here are the top ways to reduce testosterone acne;

  1. Take an acne diet that reduces androgens and is science proven – psst – an effective acne diet specifically reduces the amount of androgens your ovaries are making and you can grab your copy of my free acne diet cheatsheet here to get a head start, there’s also a complete acne diet inside Acne Warrior
  2. Add androgen-reducing supplements that balance your hormone levels naturally – you might not know this yet but many acne patients are low in anti-androgen vitamins and minerals – I show you how to correct this inside Acne Warrior
  3. Use anti-androgen skincare – skincare that helps turn down the volume of androgens in your skin (I show you how to do this inside Acne Warrior)
  4. Make mindset changes – you are beautiful with or without acne, you are worthy with or without acne, you are amazing with or without acne – healing your acne is just about you being in control of your skin and body health again – Acne Warrior show you how to do this with one simple step after another simple step

Your next steps;

  1. Download your free copy of my science-proven acne diet here
  2. Consider enrolling in my acne healing video course, Acne Warrior – medications like spironolactone may get you clear for a few months but understanding why you’re breaking out will get you clear for life – enrol in Acne Warrior now and start feeling confident in your skin again – find out more and enrol here