For so many of us, the battle with acne doesn’t end with our teenage years. It follows us into our relationships, professional lives, into our 30s, 40s, and beyond. I know this journey intimately. I struggled with acne from my teens all the way into my 40s, and I want to share my story—and the science that finally brought me clarity—with you.
My Story: From Shame to Validation
Like most teenagers, I had acne. However, even after Accutane, my acne continued. It was deep, painful and embarrassing.
The turning point came when I took matters into my own hands and picked up a book called "It's Your Hormones." {I had a masters in women's health at this point already and knew there was more to learn}
There it was: the root cause of my deep, cystic acne was a specific hormone conversion process that happens in some women's bodies.
I felt so validated. No more harsh skin treatments. I was going to address the underlying issue.
I went to a dermatologist and said, “I want to start Spironolactone.” Like magic, within a few weeks my skin cleared.
I can’t describe what it’s like to deal with the pain, scarring and shame of acne. To have it disappear felt like turning from a teenager into a woman overnight. My patients could now see me as a professional, and I could embody who I felt I was.
If I missed a day or two of the medication, a pimple would pop up. Not just a little one, but the under-the-skin deep painful ones. That’s because the androgenic conversion in my tissues did this. Spironolactone blocked it.
This pathway is also affected by insulin, inflammation, diet and sleep. If those were off, I’d get acne. If I improved them, I wouldn’t even need spironolactone.
The 40s brings a new adventure with hormonal acne
When I was 40 I started skipping the spironolactone. The pimples were rare. My hair thickness was the best it’s ever been too. Interestingly, this was my best hormonal balance– low enough testosterone, but still producing estrogen.
Fast forward to 44, and my estrogen decreased, allowing the DHT to cause problems… not as acne, but as severe hair thinning. I did not want to go back on spironolactone, but after 6 months of trying the pumpkin seed oil, the herbals, the rosemary hair massages… I did restart. It was a reminder that my body simply favors that DHT (dihydrotestosterone) pathway.
My journey has taught me that a combination of natural support and low-dose pharmaceuticals can be a powerful strategy. It’s about finding what works for your body and keeping medication at the lowest effective dosage
I do have theories about emotional roots in hormonal imbalances, and for me and other clients with androgenic acne or androgenic PCOS, I believe that emotional suppression and the adaption to be an "achiever" as little girls pushes our hormonal development more toward an androgenic state. There's a higher cortisol state, less embodiment of the developing breasts and menstruation and therefore a blockage to full estrogenic and ovarian expression. The emotional root is a whole other post... so let's refocus on the science of the androgenic acne type here.
A few things to understand about hormone labs testing for acne
Adult female acne is different.
Many adult women with acne have completely normal levels of androgens (like free testosterone) in their blood. The problem isn't in your blood; it's in your skin.
One theory describes how the skin's own glands can transform weak hormone precursors into potent androgens like testosterone and DHT right on site.
This process is called peripheral conversion. Your sebaceous glands contain all the enzymes needed for this "androgenic amplification". Because this conversion happens locally in the skin cells (sebocytes), only a tiny amount of these potent androgens ever reaches your bloodstream, which is why standard blood tests come back normal.
Furthermore, studies show that women with acne can have increased activity of an enzyme called 5α-reductase and a higher number of androgen receptors in their sebaceous glands. This makes the glands hyperactive and prone to inflammation even with normal androgen levels.
So, if standard blood tests aren't helpful, what is?
Research points to a different marker: androsterone glucuronate (ADT-G). One study on adult women (ages 26-44) with mild to moderate acne found that traditional biomarkers like testosterone and DHEA-S showed no difference between the women with acne and the control group. ADT-G was the only significant marker that could tell them apart.
ADT-G is a powerful biomarker because it reflects the total androgenic metabolism in your body, including the peripheral conversion happening in your skin.
Even better, the study found that as the women's acne improved with treatment, their ADT-G levels decreased, suggesting it could be a valuable tool for tracking treatment effectiveness. If your hormone tests have been inconclusive, it may be worth discussing androgen metabolite testing with your doctor. Salivary hormone testing can also be a powerful tool, as it is sensitive enough to detect elevations in testosterone or DHEA before blood tests do.
The DUTCH test is a great functional lab test to see your 5α-reductase enzyme conversion preference in the adrogenic hormone pathway.
Your Action Plan: Balancing Hormones from the Inside Out
My journey has shown me the power of a dual approach: targeted medical support combined with foundational lifestyle changes.
1. Metabolic & Hormonal Support: Since androgens need to be metabolized by the liver to be safely excreted from the body, supporting these detoxification pathways is key. A process called glucuronidation is essential for this. You can support this pathway through diet:
◦ Cruciferous Vegetables: Sulforaphane, found in the highest levels in broccoli sprouts, is known to increase glucuronidation.
◦ Green Tea: Rich in a polyphenol called EGCG, green tea has been shown to improve acne through its anti-inflammatory, antioxidant, antimicrobial, and anti-androgenic properties. It also supports glucuronidation.
◦ Herbals: As teas or capsules, nettle and peppermint are great for balancing the androgenic pathways.
◦ Other Powerful Foods & Nutrients: You can also boost this pathway with soy foods, resveratrol, citrus, rooibos and dandelion teas, rosemary, and curcumin. Magnesium is also a critical mineral for these detoxification reactions.
One of my favorite supplements is Testoquench for Women by Douglas Laboratories.
2. Medical Support: For those of us whose bodies are strongly predisposed to that androgenic pathway, medication can be a game-changer. A low-dose medication like spironolactone can block the effects of androgens on the skin with minimal side effects. The goal should always be to use the lowest dosage that works for you. You may start on 75-100mg daily for a month and then try tapering down to see if 25mg works for you. (this is a medication in my prescribing protocols for my clients)
You don't have to live in shame or feel defined by your skin. By understanding the unique way your body works, you can finally get the answers and the clear skin you deserve.