Can Testosterone Be Causing Your Acne?

Can Testosterone Be Causing Your Acne?

Learn about Androgens – and Testosterone as a potential cause of acne

Ashok N. Vaswani, MD., FACE, FACN and Dr Agnes P. Olszewki PhD, MBA

Dr Vaswani who has recently joined Herborium and AcnEase Team is Board Certified Endocrinology and Metabolism Expert as well as Board certified in Clinical Nutrition. He completed his fellowship training at Yale University and was a research scientist at Brookhaven National Laboratories for two decades. He has a clinical practice in Garden City, New York where he specializes in hormonal and metabolic disorders. In addition, he has been immersed in herbal and Ayurvedic applications as alternative treatments for the management of number of health and wellness concerns and is a great proponent of Integrated and Customized medicinal and wellness approach that he shares with Herborium Team.

Our last post introduced the importance of cholesterol and how it relates to the general structure of cells and may affect your body, your health and your skin.

We will now focus our attention on another of the properties of cholesterol, as a precursor to steroid hormones. In this regard, it is important to note that ALL steroid hormones require cholesterol as a starting point. Since one of our major emphasis is on skin health, we continue this series on cholesterol with the introduction of the topic of “androgens” ,also known as male hormones, an example of which is Testosterone. We will look at how Testosterone may affect your skin health and what you can do about it. There are many intermediary steps in the synthesis of Testosterone and most of these intermediary products are androgens as well.

As the name suggests, Testosterone is a hormone that is made in the testes, and it Is naturally found in greater quantities in males. However, what may be a surprise for some is that it is also made by the ovaries and present in women in variable quantities. Androgens are also made by a group of specialized cells in the adrenal gland, along with other steroid hormones with very distinct functions (We will talk about these next time). Over synthesis of testosterone by the adrenal glands is the primary factor responsible for “androgen induced acne” in women.

To follow on these different hormones and their role in your body one needs to understand the basic way in which this hormone is produced. As already alluded to, the testes and ovaries (together called the gonads) synthesize testosterone. The gonads are steroid producing endocrine organs under the control of the pituitary gland, which is located at the base of the brain. This “master” gland holds the key to many hormones, two of which regulate the gonads. These two hormones are called Luteinizing hormone (LH) and Follicle stimulating hormone (FSH) which are generally recognized as important female hormones. This is only the simplified version of how the pituitary regulates these hormones, but it is sufficient for us to get to the crux of the matter.

It should be made clear that both men and women make LH and FSH and of course have the gonads appropriate for their gender. Thus, women have LH, FSH and two ovaries and men have LH, FSH and two testes. Now let us see what they control. In women, LH activates the uptake of cholesterol in the ovary and produces Progesterone and Estrogen, while the FSH is responsible for stimulating the follicles that produce eggs in the ovaries. On the other hand, in men LH activates the uptake of cholesterol and proceeds via Progesterone through the various intermediary androgens to eventually produce Testosterone, while FSH is responsible for the maturation of sperm in the testes. You can see that there is a parallel in both genders, but the useful point to remember is that LH and FSH are the common factors, present in both women and men even though their respective gonads produce a different final product (estrogen in the ovary and testosterone in the testes), the process to produce the end products remains the same. The starting point in both scenarios is cholesterol with a primary intermediary step the production of Progesterone in both women and men.

While LH stimulates the testes ( in males) to make Testosterone this substance can be released into the circulation in large quantities. However, in females, the androgens are preferentially converted to estrogen and therefore under normal circumstances lower production of testosterone. The quantity of estrogen released into the circulation is regulated by the day of the menstrual cycle governed by another set of rules for LH and FSH. Our body knows (under normal circumstances) that it is not unusual for testosterone to escape the ovary at improper times which creates some disruption in the menstrual cycle and can actually affect the skin .

In short- if such an unwanted release of testosterone happens due of too much production you may see hormonal (androgen induced) acne.

Once the Estrogen and Testosterone are released into the circulation, they are attached to a protein made in the liver, called sex-hormone binding globulins (SHBG) and transported though the blood stream. Most of the released hormones are tightly bound and only very small fractions of the hormones remain free in the circulation. It is this free hormone that binds to its receptors in the various tissues and carries out its effects. These free hormones may stimulate your sebaceous glands to produce too much sebum setting off the acne cascade . This is particularly important in the case of Testosterone especially at the time of puberty (in both boys and girls). In pre-pubertal children, the sebaceous glands, and the hair follicles adjacent to them are not yet fully developed. The hair is typically soft and vellus, unlike the stiff terminal hair that grows after puberty in adulthood.

At puberty, testosterone can promote the maturation of hair follicles and sebaceous glands of the skin by its conversion to a more potent hormone called Dihydrotestosterone or DHT. The hormones bind to their specific receptors, which are abundantly distributed on the chin, scalp, chest, groin, extremities and lower back. Of course, if women have more androgen production or circulating testosterone for any reason which binds the androgen receptors in these locations, this may manifest itself in thicker hair growth in these areas, similar to men. This process is also true for transgenders who take injections of testosterone during their required treatment. Recall that the androgens in women come from two sources, the Ovaries which produce Testosterone in small quantities, and the adrenal glands which produces androgens, that can be easily converted to Testosterone in the peripheral tissues. Thus, at the time of puberty, both boys and girls are prone to develop acne and the excess activity of Testosterone can lead to hirsutism (unwanted hair growth) on the face, back, arms etc. . Of course, boys who make extra hair growth early in puberty feel privileged and “cool”, but one sprout of extra hair growth or an inkling of a budding blemish can throw the teenage girls into despair. In some cases where there is a marked excess of androgen production, the sebaceous glands over production of sebum can not only lead to clogged pores but bacterial growth and inflammation which if it spreads beyond the single pore in the skin manifests itself as hormonal cystic acne.

Of course, the appearance of acne and changes in the hair follicles and sebum production are simply heralding the onset of puberty and progression of young boys and girls into mature adults. This is also accompanied by a linear growth spurt in both genders, increases in muscle mass and strength, development of secondary sex characteristic, onset of menstrual cycles in girls and so on. As the gonads mature, they tend to have better control of hormone production and generally the problems with acne and/or hirsutism is limited to only a short phase during puberty.

It is when these issues persist beyond puberty and even recur during adulthood that require a thorough evaluation of any potential underlying medical disorder and for the skin this can mean adult acne and even chronic adult acne. Please note- that will apply to both males and females alike. .

Skin issues arise when there is an abundance of androgens being produced and circulating at inappropriate levels. Let us now take a common example to explain this. We all have major expressways in or around our hometowns that take us from point A to point B and hopefully we do not have to change plans and get to point C. Now picture a day that there is congestion, bad weather, an accident, or anything that makes the traffic flow very slowly. Having left point A you quickly reroute yourself through your best known shortcuts to get past the blockage on the expressway to get to point B but may only eventually reach it after stopping at point C.

The gonads are no different. Remember that there are several steps that start with Cholesterol (point A in our example) and suppose we are making estrogen (our point B in this example). There are steps involved in making estrogen that require enzymes, nutrients, cofactors and so forth, which can be affected. Thus, the cholesterol pathway may migrate more towards making testosterone (point C in our example). Eventually, the testosterone can be converted to estrogen, but the extra testosterone that was already produced and is circulating in the blood binds with its receptors and nurtures the growth of hair or enhances sebum production. Thus, there are some genetic disorders that can cause excess androgens, polycystic ovaries may also produce extra androgens and cause irregular menstrual cycles, many diseases that are not related to the gonads can cause the same problems. Several medications can also produce more androgens. These are some of the potential medical problems that need to be determined.

So how do we approach the management of these problems? As we have already discussed, extra androgens are the hallmark of puberty and usually self-limited. Controlling acne during puberty, may involve taking a natural , safe product that limits the impact of fluctuating hormones on the sebaceous glands and some lifestyle measure which include avoidance of oily and greasy foods, and good hygienic practice, washing the areas with soap and warm water, avoiding creams or lotions that could potentially plug up the openings of the pores or those that will over stimulate the glands ( highly drying products will do exactly that) . There is certainly more of an issue if these problems persist beyond puberty into the adult life. In this case acne is prolonged or persistent.

For all other persistent problems with acne or hirsutism, infections or scarring of the skin, it is best to seek medical advice and get a complete evaluation from your medical practitioner, dermatologist, or gynecologist. There are medications available that can prevent the activity of testosterone on it’s receptors, thereby blocking the effect of androgens on your skin as well as prevent more long-term health issues.

The ingredients in AcnEase have several beneficial attributes to help prevent acne pimples from forming. In the above examples we discuss how androgens (testosterone and DHT) stimulate excess sebum production by the sebaceous glands which leads to oily sin, the formation of comedones ( black heads and white heads) and ultimately pimples. Each symptom represents a stage of the acne cascade starting with excess sebum production. Once you have clogged pores this can trap dirt and allow bacteria to grow causing inflammation and pus formation. In severe cases the inflammation spreads beyond the confines of the pore and cystic acne bumps form under the skin. The pivotal event is the excess production of sebum by the sebaceous glands. The ingredients in AcnEase decrease sebaceous gland secretions the very first step in the cascade. This action prevents new pimples from forming the most important property of AcnEase. The all natural ingredients also have some anti-inflammatory properties to help with existing acne pimples. AcnEase has been shown to be a very effective agent in the treatment of androgen induced acne.

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