Hormonal Acne: Expert Answers to Common Questions

Written by Timothy Gower
Medically Reviewed by Zilpah Sheikh, MD on August 06, 2025
8 min read

You may have thought pimples were in your past, but one day you look in the mirror and discover that a zit has sprouted on your chin. Or maybe a crop of unsightly reddish bumps has popped up on your cheeks and neck. If so, the culprit is likely hormonal acne. 

“People assume that acne is just a teenage problem,” says dermatologist Susan Massick, MD, associate clinical professor of dermatology at The Ohio State University Wexner Medical Center in Westerville, Ohio. “But we explain to patients that acne can occur at any age.”

Hormonal acne (also known as “female hormonal acne” or “adult acne”) primarily affects people assigned female at birth. According to some estimates, about half of females in their 20s and 1 in 4 of women in their 40s get hormonal acne. “It can really have a significant impact on how people feel about themselves,” Massick says. “Patients come in very self-conscious about their skin, especially if they have a lot of breakouts.” Fortunately, she adds, hormonal acne “is quite treatable.”

Your skin has glands that produce oil called sebum, which keeps it from getting dry. But if you make too much sebum, pores in your skin can become clogged. “That causes bacteria within those pores to be trapped, which results in inflammation that can lead to acne breakouts,” says Massick. 

What causes your skin to make too much sebum? Blame your hormones. Women make hormones called estrogen and progesterone, which you need for normal sexual and reproductive health. “But women also make testosterone,” the so-called “male” hormone (also known as androgen), Massick says. “Fluctuations in levels of these hormones leads to the cascade that causes you to develop acne.” 

Alterations in testosterone levels explain why a small number of men develop hormonal acne. They include males who use prescribed testosterone therapy to treat certain medical conditions and men who use testosterone supplements to build muscle. Also, people receiving gender-affirming therapy who use testosterone therapy can develop hormonal acne. 

Hormonal acne usually causes reddish bumps called nodules, says Massick. They often form on the lower portion of the face, such as on the jaw and chin, as well as the neck. The bumps can be painful. Hormonal acne is less likely to cause blackheads and whiteheads that you may have developed as a teen, says Massick.

Hormonal acne is sometimes confused with fungal acne. The latter occurs when yeast gets into hair follicles, which can produce small bumps on the skin. Fungal acne usually pops up along the forehead, says Massick. While it’s less likely to be painful, fungal acne can be itchy, she adds. 

You may see the phrase “bacterial acne,” but that’s not a medical term, explains Massick. Bacteria that get stuck in clogged pores play a role in hormonal acne. 

“We often see this form of acne in women in their 20s and 30s,” Massick says. 

One key influence on women in this age group is childbirth. “When a woman goes from pregnancy to the postpartum period, they can have fluctuations in hormones” that may result in breakouts, Massick says. 

However, women in their 40s are vulnerable, too, during the years that precede menopause, known as perimenopause. During that time, “you can have a decrease of your estrogen and progesterone levels, but you may have the same level of androgens,” Massick says. “Then you may notice some of those breakouts happening.”

How long does hormonal acne last?

No two cases of hormonal acne are alike. The bumps and redness on your cheeks may fade in a few days, while a friend might struggle with pimples for weeks or even months. Getting an effective treatment plan in place can help speed your way to clearer skin. 

Fluctuations in your hormones that cause hormonal acne can make your zits come and go. For example, many women develop acne right before their period. But roller coaster hormone levels that occur throughout the menstrual cycle can leave you blemished, too. 

Do you find that your acne worsens as the weather warms up? “Some people tend to have more breakouts in the summer months,“ Massick says. The reason: Heavy sweating can contribute to clogged pores that cause acne. 

If you’re struggling with hormonal acne, several over-the-counter (OTC) products are available. And a dermatologist can prescribe potent treatments to zap your zits. 

OTC treatments

Retinol. Many nonprescription acne and “anti-aging” treatments contain retinol, which is available in creams, gels, and other topical treatments. “We often encourage patients to use retinol products,” says Massick. Retinol, which is a form of vitamin A, is related to tretinoin, which requires a prescription. 

Adapalene. Like retinol, this medication is also derived from vitamin A. Adapalene (Differin) comes in the form of a gel and is usually recommended for mild to moderate acne. (Stronger prescription versions of adapalene are also available.)

Benzoyl peroxide. This medication is found in many OTC acne treatments that are applied directly to the skin in the form of a cream, gel, or lotion. Benzoyl peroxide reduces inflammation and stops the growth of bacteria on the skin. It’s often combined with prescription medicines to treat acne. 

Prescription medications

Tretinoin. This product, which you apply to your skin, is available under various brand names (Altreno, Atralin, Avita, Retin-A). “We prescribe a lot of tretinoin,” says Massick. Tretinoin reduces overproduction of oil in the skin and helps your skin shed dead skin cells, she says, which can contribute to clogged pores. If you try tretinoin, your acne may look worse for the first week or so, but should improve over time. 

Isotretinoin. This medication is a powerful oral retinoid form of vitamin A and doctors prescribe it for more severe forms of acne. Like tretinoin, isotretinoin (Accutane and others) may worsen the appearance of your acne at first, but can produce clearer skin after a few weeks. 

Antibiotics. Massick sometimes prescribes topical (applied to the skin) antibiotics such as clindamycin or erythromycin, to treat acne. “We use antibiotics in conjunction with an anti-inflammatory, such as benzoyl peroxide,” she says. Combination products containing clindamycin and benzoyl peroxide and erythromycin and benzoyl peroxide are available. Massick limits treatment with these bacteria-fighting medications to no more than a few months in order to avoid antibiotic resistance. 

Birth control pills. People with hormonal acne who are still menstruating can often clear up their skin by taking birth control pills, Massick says. “I typically prescribe a pill with a combination of estrogen and progesterone,” she says. She usually prescribes a “monophasic” pill, meaning that it maintains steady hormone levels during your cycle. 

Spironolactone. This drug is usually used to treat high blood pressure and heart failure, but some doctors prescribe it “off label” (meaning the FDA hasn’t approved this use) for acne in adults. “It can be extremely effective in female hormonal acne,” Massick says.    

Do supplements help treat hormonal acne?

You can find a variety of dietary supplements marketed for fighting acne for sale online and in stores. Some common ingredients include probiotics, vitamin A, vitamin B complex, and zinc. However, there’s little evidence that these products will clear up your skin. In particular, Massick cautions that taking high doses of vitamin A (as some websites suggest) could be dangerous. She suggests taking a standard multivitamin to be sure you’re getting all the nutrients your skin needs. 

Taking some simple steps can help you smooth out your complexion, says Massick. 

  • Wash your face in the morning and evening. Clean your face after working out, too. Use a gentle facial cleanser with the words “non-comedogenic” and “hypoallergenic” on the label, meaning it doesn’t promote acne or allergic reactions, Massick says. 
  • Eat a healthy, balanced diet. Dairy products can be a problem for some people, but don’t restrict too much in order to get proper calcium, Massick says. She adds that sugary products like candy and soda can be acne triggers, too. 
  • Don’t use acne products containing essential oils. “They’re popular, but I encourage people not to use them,” says Massick. Not only can they worsen acne by clogging skin pores, but many people are allergic to these oils, she cautions.   
  • Don’t use exfoliants. They can be abrasive and promote excess oil production, which you don’t want. 
  • Don’t pop zits. It’s a myth that you’ll make them go away faster, warns Massick. “You can actually cause more inflammation under your skin, which leads to skin discoloration,” she says. 

Massick suggests seeing a dermatologist about your acne if:

  • You’re having a breakout that lasts several months.
  • You have developed any skin discoloration or scarring related to acne.
  • OTC products aren’t working.
  • You’re frustrated and concerned about your acne. 

Massick recommends some simple steps that have other important health benefits to help prevent and manage hormonal acne. 

  • Control stress. “Stress is a big culprit and a big trigger,” Massick says. When you’re feeling stressed out, your body ramps up production of a hormone called cortisol, which can increase production of pore-clogging sebum and promote acne. Find a way to manage stress, such as meditation or yoga. 
  • Get plenty of sleep. Lack of sleep can increase your stress level. 
  • Exercise regularly. Working out is a great stress buster.  
  • Don’t smoke. “Smoking is not only terrible for your overall health, but it actually ages your skin,” Massick says. 

Hormonal acne is a common problem that primarily affects women who have passed their teenage years. Fluctuating levels of naturally occurring hormones can cause the skin to overproduce oil, which clogs pores and promotes acne. For milder cases, over-the-counter products can help clear your skin. More severe acne often requires prescription medicine, so see a dermatologist if you’re struggling to banish blemishes. Simple lifestyle changes, such as face washing and controlling stress, can help clear up hormonal acne, too.