Hormonal acne
Specialist assessment and treatment for hormonal acne
Hormonal acne is common in adult women and can be persistent, recurrent and difficult to control with standard acne treatments alone. At Midland Skin, our Consultant Dermatologists assess hormonal and adult female acne and develop an individual treatment plan.
Quick Facts about hormonal acne
Best for
Persistent adult female acne
Appointment
Initial dermatology assessment
Treatment
Individualised acne treatment
Symptoms
Spots, cysts & breakouts
Provider
Consultant dermatologist
Price
See below
What is hormonal acne?
Hormonal acne is particularly common in women after puberty and during adulthood. It may flare predictably before, during or after a menstrual period, although not everyone with hormonally influenced acne experiences cyclical breakouts.
Hormonal acne resembles other forms of acne but may cause persistent inflammatory spots, deeper nodules and cysts, sometimes called cystic acne. The chin and jawline are commonly affected, but spots may also occur around the mouth, temples and cheeks or involve the whole face and back.
Some women develop large numbers of comedones or blocked pores, particularly around the temples, cheeks and jawline giving rise to uneven texture.
Persistent acne can leave redness for prolonged periods and cause pigmentation and permanent acne scarring.
Hormonal acne may begin during the teenage years and continue into the 20s and 30s, or develop for the first time during adulthood. It can also develop or change during the 40s, perimenopause and menopause.
When should I see a dermatologist for hormonal acne?
A specialist dermatology assessment can be particularly worthwhile when:
- acne has persisted into adulthood or developed for the first time as an adult
- breakouts repeatedly occur around the menstrual cycle
- you are developing painful, deep or persistent spots, nodules or cysts
- acne is causing pigmentation or scarring
- creams or repeated courses of antibiotics have not controlled it adequately
- acne has returned after previous treatment, including isotretinoin
- you are considering treatments such as spironolactone or isotretinoin
- acne occurs alongside irregular periods, increased facial or body hair or scalp hair loss
- your acne has changed around perimenopause or another hormonal change
- you are concerned that contraception may be affecting your acne
- you are unsure whether your acne is actually hormonally driven
You do not need to know whether your hormone levels are abnormal before attending. Part of the dermatologist’s role is to assess the pattern of your acne, decide whether hormonal factors may be relevant and determine whether further investigation would be useful.
Scarlett Greenwood
Why getting the diagnosis right matters
The position or timing of spots alone cannot establish whether acne is hormonally driven.
Other conditions can sometimes resemble acne, including rosacea, perioral dermatitis and Malassezia folliculitis, sometimes called fungal acne. Malassezia folliculitis, for example, tends to produce smaller, more evenly sized spots that are often itchy.
Different conditions require different treatment, and more than one condition can sometimes be present at the same time.
Hormonal acne may also occur alongside other patterns of conventional acne. A Consultant Dermatologist can assess the type of spots present, their distribution, previous treatment response, medications, contraception and relevant hormonal symptoms before recommending treatment.
Treatment pathway
Initial dermatology assessment
Your dermatologist assesses your acne and reviews its pattern, hormonal and menstrual history, contraception, previous treatments and any relevant symptoms.
Care plan
An individual treatment plan is discussed, which may include topical treatment, oral medication, hormonal treatment, physical treatments or investigations where appropriate.
Review consultation
A review consultation is required to assess your response, decide whether treatment should be continued, changed or stopped, and plan ongoing management.
Hormonal acne in your 20s, 30s, 40s and around menopause
Hormonal acne is not limited to teenagers or younger women.
For some women, acne that began during adolescence simply continues into adulthood. Others develop acne for the first time in their 20s or 30s.
Acne can also develop or change during the 40s, perimenopause and around menopause as the balance between different hormones changes.
The significance of adult-onset acne depends on the individual. Your dermatologist will consider your age, menstrual and hormonal history, medications, contraception and any other relevant symptoms when assessing your skin.
Hormonal acne, birth control pills and the Mirena coil
Hormonal contraception can affect acne differently depending on the preparation.
Some combined oral contraceptive pills can improve acne and are used as part of acne treatment in appropriate women. Different progestogens have different effects on androgen activity, and preparations containing anti-androgenic progestogens such as drospirenone may be useful for acne in appropriately selected women.
In contrast, acne may develop or become worse in some women using progestogen-only contraception, including the mini pill or hormonal intrauterine systems such as the Mirena coil.
Acne can also flare after stopping a combined oral contraceptive pill if an underlying tendency to acne remains active.
If your acne started or changed after starting, stopping or changing contraception, this is useful information to discuss during your assessment.
You should not stop or change contraception solely because of acne without appropriate medical advice.
Why do androgens cause hormonal acne?
Androgens are a group of hormones that include testosterone and dihydrotestosterone (DHT). Although often described as male hormones, women normally produce small amounts of androgens and they have important normal functions.
Women also produce androgen precursors including dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulphate (DHEAS) and androstenedione.
Testosterone is produced by the ovaries and adrenal glands, but androgen metabolism also takes place within the skin. Cells within the skin can convert androgen precursors into more active hormones, and sebaceous glands can convert testosterone into the more potent androgen DHT.
This is important because hormonal acne is not simply a question of whether the testosterone level measured in a blood test is high.
In many women with hormonal acne, circulating androgen levels are normal. The sebaceous glands and other cells within the skin may instead be particularly sensitive to normal androgen activity.
How do androgens affect the skin?
- Increased sebum production. Sebaceous glands contain androgen receptors. Androgen activity can increase sebum production, contributing to oily skin and the accumulation of sebum within follicles.
- Blocked pores and comedones. Androgens can influence changes within the hair follicle that contribute to the development of comedones or blocked pores.
- Inflammation. Androgen signalling can also influence inflammatory processes involved in the development of acne lesions.
The relationship between hormones and acne is therefore more complex than simply having “too much testosterone”.
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Hormonal acne and PMOS / PCOS
Polyendocrine Metabolic Ovarian Syndrome (PMOS) is the new name for the condition previously known as Polycystic Ovary Syndrome (PCOS).
Hormonal acne does not mean that you have PMOS/PCOS. For many women, adult acne occurs despite regular periods and normal circulating androgen levels.
However, PMOS/PCOS is an important cause of androgen excess and acne can be one of its features.
Other features that may be relevant include:
- irregular or infrequent periods
- increased facial or body hair
- scalp hair thinning
- other reproductive or metabolic features
Your dermatologist will consider whether the overall pattern suggests that hormone testing or further assessment may be worthwhile.
Where acne occurs as part of PMOS/PCOS or another endocrine disorder, management of the underlying condition may also form part of the treatment strategy.
Are testosterone and other androgen levels raised in hormonal acne?
Not necessarily.
Studies investigating androgen levels in women with adult acne have produced varying results. Some studies have found raised levels of at least one androgen in around half or more of the women studied, while other studies have found little or no difference compared with women without acne.
Studies have reported abnormalities involving hormones such as DHEA, DHEAS, testosterone and other androgens in women with adult acne. However, the proportion affected has varied considerably between studies.
Differences in the populations studied, definitions of androgen excess and methods used to measure hormones make these studies difficult to compare directly. The severity of acne also does not necessarily correspond to the degree of androgen elevation.
The important point is that hormonally influenced acne can occur with either raised or normal circulating androgen levels.
Can I have hormonal acne if my hormone tests are normal?
Yes. A normal testosterone or androgen blood test does not necessarily mean that hormones are irrelevant to your acne.
There are two important reasons for this. First, sebaceous glands and other cells in the skin can be particularly sensitive to normal circulating androgen levels. Second, androgen metabolism occurs locally within the skin. Blood tests measure circulating hormones but do not directly measure the activity of androgens within individual sebaceous glands.
This is why the decision about whether hormonal treatment is appropriate cannot be made from a blood test result alone.
Testing androgen and testosterone levels
Hormone blood tests are not required for every woman with acne, and approaches to testing differ between clinical guidelines and expert groups.
The Multidisciplinary Androgen Excess and PCOS Committee has recommended measurement of total testosterone, free testosterone and DHEAS in women with adult acne.
In clinical practice, the usefulness of testing is also considered alongside the individual patient’s history and symptoms.
Depending on the clinical situation, investigation may include testosterone, DHEAS and other androgen or hormonal measurements.
Testing can be particularly relevant when acne occurs alongside features suggesting androgen excess or PMOS/PCOS, such as irregular or infrequent periods, increased facial or body hair or scalp hair thinning.
Importantly, normal hormone blood tests do not exclude hormonally influenced acne. Whether investigation is worthwhile, and which tests are appropriate, will be discussed during your initial dermatology assessment.
A K
How is hormonal acne treated at Midland Skin?
There is no single treatment that is right for every woman with hormonal acne.
Treatment depends on the type and severity of acne, previous treatments, risk of scarring or pigmentation, hormonal history, contraception, other medical conditions and your treatment preferences.
Hormonal acne is often treated using a combination of conventional acne treatment and, where appropriate, treatment that reduces the effects of androgens.
Topical acne treatments
Prescription topical treatments, including topical retinoids and other acne treatments, may be used to reduce blocked pores and inflammatory acne.
Spironolactone
Spironolactone is an anti-androgen treatment commonly used by dermatologists for persistent acne in women.
It reduces the effects of androgens within the skin and can be particularly useful where hormonal factors appear to be contributing to acne. Contemporary clinical trial evidence supports spironolactone as an effective treatment option for adult women with persistent acne.
It is not suitable for everyone. Whether spironolactone is appropriate, and the monitoring or contraceptive considerations relevant to you, are discussed during your assessment.
Combined oral contraceptive pill
Combined oral contraceptive pills can improve acne in some women and may be considered where medically appropriate.
Preparations containing progestogens with anti-androgenic properties, such as drospirenone, are sometimes used. Co-cyprindiol, which contains ethinylestradiol and cyproterone acetate, may also be considered for selected women with androgen-sensitive acne where appropriate.
The choice depends on the individual because contraceptive requirements and medical risks must also be considered.
Antibiotics
Oral antibiotics may sometimes form part of treatment, particularly where there is significant inflammatory acne. Where acne is persistent or recurrent, however, the aim is to avoid repeated or unnecessarily prolonged courses of antibiotics when another longer-term treatment strategy may be more appropriate.
Isotretinoin
Isotretinoin remains an important treatment for appropriate patients with severe, scarring or treatment-resistant acne.
Acne can recur after successful isotretinoin treatment. Where an underlying tendency to adult female or hormonally influenced acne remains active, longer-term maintenance or hormonal treatment may sometimes need to be considered.
AviClear acne laser
AviClear acne laser treatment may be considered by some patients looking for a drug-free treatment approach.
Whether it is appropriate depends on the type and severity of your acne and the treatments you have previously received.
Treatment of comedones
Some women with hormonal acne develop persistent comedones or blocked pores, particularly around the cheeks, temples and jawline.
Where appropriate, physical treatment such as hyfrecation of comedones may be considered alongside medical acne treatment.
Will I need other acne treatment as well?
Often, yes.
Hormonal treatment is usually one part of an acne treatment plan rather than necessarily being used in isolation.
Depending on the acne present, treatment may also include topical retinoids or other prescription creams, treatment of persistent comedones or other medical acne treatments.
Hormonal treatments work progressively rather than immediately, so combination treatment can also help control acne while the hormonal treatment begins to take effect.
Not everyone responds to the same treatment, which is another reason treatment may need to be adjusted over time.
What are the benefits of anti-androgen treatment for hormonal acne?
For women whose acne is hormonally influenced, anti-androgen treatment targets an important driver of the condition.
This can be particularly useful where acne continues despite conventional topical treatment, repeatedly returns after other treatment or where avoiding repeated courses of oral antibiotics is desirable.
Anti-androgen treatment may also improve other androgen-related symptoms, such as unwanted facial or body hair, in some women.
It does not work for everyone and is not appropriate for every patient. The decision to use hormonal treatment is therefore made after assessment rather than simply on the location of the acne or the result of a hormone blood test.
Long-term control and recurrence
Hormonal acne can be a persistent or recurrent condition.
The aim of treatment is not simply to settle the current breakout. A longer-term strategy may be needed to keep acne controlled, reduce repeated courses of antibiotics and limit the development of pigmentation and permanent scarring.
Acne can also recur after treatments that previously cleared it, including isotretinoin, if the underlying tendency to adult female acne remains active.
Some treatments can eventually be reduced or stopped, while other patients benefit from maintenance treatment.
The review consultation allows your dermatologist to assess what has actually worked, whether treatment is being tolerated and what should happen next.
Why choose Midland Skin for hormonal acne?
Hormonal acne can require more than simply prescribing another acne cream or course of antibiotics.
At Midland Skin, your acne is assessed by a Consultant Dermatologist who can consider the type and pattern of acne, previous treatment response, menstrual and hormonal history, contraception and whether investigation is worthwhile.
We can provide prescription topical and oral acne treatments, consider hormonal treatments such as spironolactone where appropriate, and combine medical treatment with treatments for associated comedones or AviClear acne laser where useful.
If treatment does not work as expected, the diagnosis and treatment strategy can be reconsidered rather than simply repeating the same treatment.
The aim is to develop an individual treatment strategy that controls the acne while reducing the risk of persistent pigmentation and permanent scarring.
Your hormonal acne appointments: FAQs
Who will assess me?
Your initial assessment is with a Consultant Dermatologist who can diagnose and medically treat acne and other conditions that may resemble it.
Will I receive a prescription at my first appointment?
Where the diagnosis and appropriate treatment are clear, prescription treatment can usually be discussed at the initial assessment. A particular medication cannot be guaranteed before you have been assessed.
Will I need hormone blood tests?
Not necessarily. Your dermatologist will decide whether blood tests are likely to provide useful information based on your acne, menstrual and hormonal history and any other relevant symptoms.
What should I bring to my appointment?
Please bring or have available details of treatments you have previously tried, including prescription creams, antibiotics, isotretinoin, hormonal treatments and relevant contraception.
Do I need to stop my pill or remove my coil?
No. Do not stop or change contraception simply because you are attending for acne assessment. Your dermatologist can discuss whether your contraception may be relevant and whether any change should be considered.
Why do I need a review consultation?
The review is required to assess how your acne has responded, check treatment tolerance, decide whether treatment should be continued, changed or stopped, and plan longer-term management.
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Ready to get started? Book a consultation with our team at Midland Skin. Friendly, expert advice tailored to you.
Fees
Hormonal acne Show pricing
Book ConsultationInitial acne assessment
Up to 25 minutes
Blood tests
Review consultation
Standard, up to 20 minutes
Georgia Mccluskey
References used for this article
- Carmina E, et al. Female Adult Acne and Androgen Excess: A Report From the Multidisciplinary Androgen Excess and PCOS Committee. J Endocr Soc. 2022;6(3):bvac003.
- Santer M, et al. Effectiveness of spironolactone for women with acne vulgaris (SAFA): pragmatic, multicentre, phase 3, double blind, randomised controlled trial. BMJ. 2023;381:e074349.
- Reynolds RV, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2024.
- National Institute for Health and Care Excellence. Acne vulgaris: management (NG198).
- da Cunha MG et al. Dermatology. Androgenic hormone profile of adult women with acne. 2013;226(2):167-171.
- Seirafi H, et al. Assessment of androgens in women with adult-onset acne. Int J Dermatol. 2007;46(11):1188-1191.
- Levell MJ, et al. Acne is not associated with abnormal plasma androgens. Br J Dermatol. 1989;120(5):649-654.
- Aizawa H, et al. Adrenal androgen abnormalities in women with late onset and persistent acne. Arch Dermatol Res. 1993;284(8):451-455.
- Cibula D, et al. The role of androgens in determining acne severity in adult women. Br J Dermatol. 2000;143(2):399-404.
- Uysal G, et al. Is acne a sign of androgen excess disorder or not? Eur J Obstet Gynecol Reprod Biol. 2017;211:21-25.
About the Author
This page has been written and/or medically reviewed by Dr Sajjad Rajpar, Consultant Dermatologist and Medical Director of Midland Skin, Birmingham.
Dr Rajpar is on the GMC Specialist Register in Dermatology and has over 20 years’ experience in clinical dermatology. He provides clinical oversight to ensure the information on this page is accurate, balanced and consistent with current dermatology practice.
Dr Sajjad Rajpar
Date last updated: 28th Sep 2026
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