T-zone pimples

What causes hormonal acne?

Puberty, menopause, periods and more can trigger hormonal acne.

As the name suggests, hormonal acne is brought on by hormonal fluctuations – which explains why it’s so prevalent in teenagers going through puberty. 


That said, it can come on at any age and is particularly prevalent in women, thanks in part to menstruation (“period acne”) and the menopause. It’s believed that 50% of women aged 20-29 have acne and 25% of women aged 40-49.


It is also common in transgender people who are taking hormones as part of their transition. It affects transgender men more than transwomen as the increase in testosterone can lead to severe breakouts.

Why is diagnosis so hard?

The Mayo clinic refutes the idea that hormones are a factor in adult acne, although it does concede that hormonal imbalances may contribute to acne in adults with underlying health conditions. Equally, it is possible for people with no measurable hormonal issues to have acne. This makes it challenging to diagnose and treat.

Hormonal acne isn’t a medical term. It’s been coined by the media rather than physicians and it refers to both inflammatory acne (pustules, papules, nodules and cysts) and non-inflammatory acne (blackheads and whiteheads).

What does hormonal acne look like?

Typically, hormonal acne appears around the T-zone, the lower half of the face, around the jawline and on the back and shoulders. It can take the form of whiteheads and blackheads, pustules and papules or cysts below the skin surface. 


Spots appear on the forehead more than other parts of the face, such as the cheeks, because sebum levels are higher in this area.

What causes hormonal acne?

There are a number of reasons why hormonal fluctuations – and therefore acne, may occur including: menstruation, polycystic ovarian syndrome, menopause, and increased androgen levels. 

These hormone fluctuations may aggravate acne issues by increasing: overall skin inflammation, oil (sebum) production in the pores, clogged skin cells in hair follicles,  and production of acne-causing bacteria called Propionibacterium acnes.

Is menopausal acne a form of hormonal acne?

Some women experience acne during menopause when their estrogen levels decline and their androgen hormones, like testosterone, increase.  


It’s even possible for women taking hormone replacement therapy (HRT) to develop menopausal acne if their particular HRT uses an influx of the hormone progestin to replace the estrogen and progesterone their body loses.