Acne that does not respond to hormonal therapy can feel frustrating, especially when treatments like birth control pills or spironolactone fail to clear it up. This kind of stubborn acne often stems from causes beyond simple hormone imbalances that those therapies target.
One main reason is menopause. During menopause, estrogen and progesterone levels drop sharply, letting androgens like testosterone take over and boost oil production in the skin. This leads to clogged pores and breakouts that resist standard hormonal fixes because the root issue is this specific shift in hormone balance.[4][8]
Thyroid problems, such as hypothyroidism, can also play a role. Thyroid hormones interact closely with reproductive hormones, and when they are out of whack, it can cause cystic acne that topical or hormonal treatments alone cannot fix.[3][4]
Adrenal gland issues are another factor. After menopause or in some adults, the adrenals may produce excess androgens, which turn into strong forms like DHT. These drive deep, persistent acne not fully addressed by typical hormonal therapy.[4]
Certain medications keep acne going despite hormonal treatment. Drugs like corticosteroids, lithium, or even some steroids mess with hormone levels or directly irritate the skin, leading to ongoing breakouts.[2][5]
Skin care habits and products often worsen the problem. Heavy creams, comedogenic makeup, or harsh cleansers clog pores and trap bacteria, making acne tougher even if hormones are managed.[5][6]
Diet can fuel resistance too. High sugar foods, dairy, and processed items spike insulin and inflammation, which ramps up oil and blocks hormonal therapies from working fully.[2][3][5]
Stress adds to the mix by raising cortisol, a hormone that increases oil and inflammation deep in the skin where surface hormonal treatments may not reach.[2][3][5]
Finally, normal skin care reaches only the surface, while this acne starts deeper from bacteria, biofilm, and ongoing inflammation that hormonal therapy overlooks.[1][6]
Sources
https://pmc.ncbi.nlm.nih.gov/articles/PMC12691598/
https://drankitmehra.com/blogs/hormonal-acne-causes-treatment-dermatologist-guide
https://www.medicaldaily.com/hormonal-acne-adults-acne-causes-skin-hormones-explained-474128
https://www.restartmed.com/menopause-acne/
https://www.westchestercosmeticdermatology.com/blog/adult-acne-why-it-happens-and-how-to-treat-it/
https://www.shoplamarue.com/pages/6-reasons-why-cacp-hormonal-acne
https://www.womenshealthmag.com/beauty/a69690102/hrt-skin-effects-menopause/
https://www.newriverdermatology.com/blog/how-to-manage-hormonal-acne-during-menopause
https://pubmed.ncbi.nlm.nih.gov/41384221/?fc=None&ff=20251221162358&v=2.18.0.post22+67771e2
