When I’m at a crossroads for anything in life, I order Chinese food and get a fortune cookie. I follow the advice to the letter. It may explain why my life is full of fits, sputters and jumps. Anyways, the same held true with picking the next topic for this blog to cover. The fortune cookie said: “discuss hormonal acne on your blog,” and who am I to disagree with a cookie.
This is me right after the Chinese buffet. Of course, thirty minutes later I’m ready to eat again. Go figure.
Intro to Hormonal Acne
This will be a basic overview of hormonal acne. There’s mountains of material that could be covered, but for the sake of simplicity and better understanding, it will be brief. This means only a superficial view of the topic will be presented.
I know some of you out there with the folded arms, furrowed brows and a scowl from hell, mumbling about leaving this and that out, or making the material too easy, will move right to the x in the corner. This isn’t to say the rest of the audience is a cat mesmerized by a laser pointer, incapable of understanding the intricacies and nuances the subject demands. Hardly.
That’s why when I put it to a poll, and the majority wanted the material presented in fashion somewhat akin to the following:
Now if this looks like the takeout menu from a restaurant in another star system, rest assured. The material will be presented with limited emphasis on the chart, and maybe a doctorate in chemistry or biology will not be a prerequisite for reading the rest of this post. Once more, you can see by studying the chart that mothers shouldn’t let their babies grow up to be biochemists. Look at all the zany shenanigans those biochemists must get into, but I digress.
Remember, each branch of science is like its own language with its own vocabulary. The trick is to simplify the big words and put them into ideas, metaphors and analogies you can understand.
Hormonal acne causes—what’s going on?
You don’t need to know how a car runs or how its put together in order to drive it. By the same token, many people see the zit on their face and could care less about how it got there. They want a cream, pill or powder to fix it and they want it now, like I’m some Willy Wonka with a factory full of Oompa-Loompas ready to dispense the secrets to skin care to all that hold a lucky golden ticket. Well, you’re going to have to wait. The tickets aren’t ready yet.
This presentation will work in reverse, detailing the problem and working our way back to some of the causes. With that in mind, it’s usually not hard to spot a zit or feel a cyst forming. How did it get there?
The body mounts a response to the infection getting out of hand. Typically, this response is what we see in the skin inflammation, manifested as a zit, whitehead, blackhead, hormonal cystic acne, etc. Everyone’s body has different triggers, sensitivities and responses to stimuli.
It depends on pore size, genetics and some of the signaling pathways the body uses to communicate. Too little response from the body and the infection may get out of hand, spread and do some damage you might not walk away from. Too great a response and the body risks devoting too many resources, which posses a problem if those resources are needed elsewhere.
An analogy would be having the fire department send most of its force to get a pet out of tree. Meanwhile the other side of town has a small fire that burns the town down because not enough resources were available to contain it.
This is part of the reason inflammation plays a crucial part in acne and its severity. Foods, chemicals, pollutants and many more items can cause inflammation. Once more, the inflammation response isn’t merely contained in the final stage of acne but plays a factor throughout all phases. 
The pimple bacteria
If it were a simple matter of the bacteria alone on our skin causing the issue, anti-biotic creams would work across the board and have broader impact. They can work at eliminating or alleviating the infection, allowing it to be contained, but they do little, if anything, for what caused the infection in the first place.
Our skin is teaming with bacteria. P. Acne has been pinned as the main culprit, but all kinds of strains exist on the skin. Some counterbalance other strains. This is why when we overuse certain creams it cause irritation, chaffing and make the biome a mess for the good and bad facial flora. Some of that irritation can exacerbate the condition by plugging the pores.
This isn’t to say this is the case with all creams or even most, only that when applying anything to the skin, oils included, that care be taken not to overdo it or be aware of complications that can result.
The breeding ground
Our pores have numerous types of skins cells and glands and they also have hair follicles. These follicles have special cells which make them up called keratin. Keratin isn’t contained only to the follicles but for our purposes, we’ll concentrate on only the types that are.
Keratin is a fancy way of saying cells made up of a special type of protein. When the hair follicle is growing, the cells that make it up are multiplying in varying amounts. This is important because too slow multiplication and the follicle hardly grows and is unable to perform an adequate function. Too fast, and the cells risk being overrun by one another, some compounding on top of others, with more sloughing off to the side of the pore and accumulating in greater and greater number.
It’s this excessive growth process called hyperkeratinization that creates a favorable environment for the P. acne bacteria to flourish and thrive. These excess protein cells can clump together with excess oil/lubricant and create a plug called a comedone, which the bacteria can use to establish a base to ramp up operations.
This gland is your gland
What are some factors that can control cell growth in the hair follicle or the pore in general? Each pore has several tiny little glands called the sebaceous gland, located adjacent to the pore and follicle. They are pumping out all kinds of lubricant (called sebum) to help the growth of the follicle and keep the overall balance of the pore stable.
What happens is that when they produce too much or too little lubricant, problems arise. If the oil is flowing too fast or in too great a volume, it can overfill the pore and plug it up, creating nutrient rich environment for bacteria to party like rockstars. Too little and the pore isn’t properly lubricated, meaning inflammation can occur.
Hormonal Acne or what this post is really about
With the basics out of the way, we can describe why hormones are important. All of our bodies have trillions upon trillions of cells. The blind watchmaker did a fantastic job constructing this creation. If the majority of the cells are locked in place, how can anything get done? The answer is a complicated chemical signaling system.
Some of these signals are hormones. Think of them as floating keys with an elaborate GPS system to track where they need to go. Along from creation to journey to destination, the hormones are being affected by countless chemicals, some of which can send it off the intended target.
To counteract this possibility, the body has a coping mechanism. Remember, the body thrives off balance, which is why so many of these hormones are able to be converted or switched into other types of hormones. It’s an efficient recycling process that regulates the amounts and assures that too much of one hormone isn’t being created to the detriment of another. It’s far from perfect and mistakes arise.
Entire branches of literature and art have been devoted to their expression. Life wouldn’t be possible without them. I’m not going to overly complicate this because the amount of info on this sub-topic alone is mind blowing.
What I do what to emphasize is that both men and women have testosterone, estrogen, and progesterone albeit in obviously different amounts and ratios. This is important because how the hormones cause and affect acne can be tricky and somewhat differs in the sexes but commonality exists, too.
Here’s a few videos to explain the basics of Estrogen and Testosterone.
Basics of Estrogen
Sex hormones play a role in the creation of acne, but does estrogen cause acne? What’s interesting is that when a study was conducted, it found elevated serum levels of testosterone and progesterone (another sex hormone), but decreased amounts of estrogen.  This imbalance may play a significant role, especially for women, which is a potential reason that oral contraception may be so effective at fighting acne because they elevate estrogen levels.  Though keep in mind, unintended consequences may arise from taking oral contraception. 
Androgens are types of hormones that express male characteristics. Testosterone is featured prominently amongst this group. In addition, androgens are one of the most important hormones in acne creation.  The sebaceous glands have androgen receptors. Think of receptor as merely a fancy word for a keyhole. Remember that hormones are floating keys.
Too many androgens or having an imbalance in ratios, can cause an excess amount of sebaceous gland receptors to get turned on or off, depending on the signaling along the way. Keep in mind, other hormones (sex and non-sex) play a role as well. 
Once more, other glands experience an androgen sensitivity like the hair follicle, sweat glands, epidermis, and dermis.  This further reinforces the role androgens play in acne creation.
Conclusion–how to get rid of hormonal acne
The point of this article was to cover the basics of hormonal acne. This will lay the groundwork for the subsequent posts that will discuss some of the hormonal triggers as well as discuss solutions and hormonal acne treatments.
 The Role of Inflammation in the Pathology of Acne
 Role of hormones in acne vulgaris
 Hormonal contraceptives for acne management.
 50 years of hormonal contraception—time to find out, what it does to our brain
 The Role of Androgen and Androgen Receptor in the Skin-Related Disorders
Hormonal Treatment of Acne in Women
While this article dealt with some of the main questions about hormonal acne (why do hormones cause acne, how do hormones cause and which hormones cause acne), it’s meant to be taken as a primer. The amount of info on hormonal acne causes is significant. Several books could be filed if we got into the minutiae of all the biochemistry.
My hope is that basic knowledge about acne from hormones is conveyed and the groundwork for future articles detailing how to prevent hormonal acne is laid.