Acne often starts when testosterone levels change because this hormone ramps up oil production in the skin. These shifts happen during puberty, hormone treatments, or other life stages, leading to clogged pores and breakouts.
Testosterone is a key hormone that affects the skin’s oil glands, called sebaceous glands. When testosterone rises, these glands work harder and make more sebum, a thick oily substance. Too much sebum mixes with dead skin cells and blocks hair follicles, creating the perfect spot for bacteria to grow. This blockage turns into pimples, blackheads, or cysts.[1][2][3]
Boys and girls both see big testosterone jumps at puberty, which is why acne hits teens so hard. In adults, hormone replacement therapy like testosterone pellets can cause sudden peaks in levels. These peaks lead to oily skin and acne, especially if the dose is too high or absorption is uneven.[4] Women on such treatments might notice acne along with other signs like extra hair growth or mood changes from excess testosterone.[4][5]
Fluctuations matter too, not just high levels. Surges in testosterone can spark inflammation in the skin, making pimples red and sore. Bacteria like Cutibacterium acnes thrive in the oily, blocked pores and release chemicals that worsen swelling.[2][3] Stress can play a role here, as it boosts cortisol, which teams up with testosterone to push oil production even higher.[1]
In women, hormonal imbalances with androgens like testosterone often cause stubborn adult acne. Things like irregular periods or premenstrual flares point to this link. Treatments that block testosterone’s effects, such as certain pills, cut sebum and calm breakouts.[3][6]
Sources:
https://valhallavitality.com/blog/does-tadalafil-cause-acne
https://pmc.ncbi.nlm.nih.gov/articles/PMC12735603/
https://pmc.ncbi.nlm.nih.gov/articles/PMC12691598/
https://www.injxbar.com/blog/truth-about-hormone-replacement-therapy-pellets
https://www.forhers.com/labs/biomarkers/free-testosterone
https://www.oanahealth.com/post/spironolactone-endocrine-disruptions-what-to-know
