5 Signs You Suffer from High Testosterone and 5 Reasons Why

5 Signs You Suffer from High Testosterone and 5 Reasons Why

High testosterone levels in women is one of the most common hormone disorders. Literally tens of millions of women suffer from it in the United States alone. So how do you know if you have high testosterone?

1. Acne

Testosterone is elevated around ovulation cycles if you are menstruating which can lead to hormonal acne breakouts commonly around your jaw or chin. If you have PCOS you may be suffering from breakouts like these most of the time. (If you suffer from acne, my brand new program, 50% off this week, Clear Skin Unlocked: The Ultimate Guide to Acne Freedom and Flawless Skincould be a great resource for you).

2. Irregular Menstrual Cycles

Having irregular menstrual cycles creates a hormonal balance allowing testosterone to become dominant or recessive. Another reason you may be having irregular menstrual cycles could be stemming from PCOS.

3. Blood Sugar Swings

Insulin encourages the ovaries to produce more testosterone.

4. Low Libido

Your testosterone levels can be high but if your other primary sex hormones are not balanced, then high testosterone will not result in higher libido.

5. Male Pattern Balding and Hair Growth

Another sign of high testosterone levels in women is male pattern balding and hair growth.


So what causes testosterone levels in women to be elevated?

1. Insulin Resistance and Diabetes

If you have type I or II diabetes or know that you are insulin resistant, high testosterone is probably a problem for you.

Approximately 25% of the testosterone in female bodies comes from the ovaries. This is natural. However, insulin in the bloodstream stimulates the ovaries to produce more testosterone. This can seriously increase the ovaries’ output of testosterone.Depending on the severity of the dysregulation, insulin can lead to a significant increase in testosterone in the bloodstream. This is as much as 2 or 3 times over the optimal and healthy testosterone levels.

This is very often the case in polycystic ovarian syndrome.

2. Thyroid Disorders

Sex hormone levels and thyroid hormone levels are intimately related in many ways.

One important way is through Sex Hormone Binding Globulin (SHBG). When thyroid function slows — as in hypothyroidism — SHBG levels fall. SHBG binds excess hormones to it in the blood. It is incredibly important for maintaining healthy hormone balance. When hormones like testosterone threaten to increase and there is bountiful SHBG then it can bind the testosterone and minimize its threat. Without SHBG, excessive hormones can become a real problem.

In healthy women, 80% of testosterone is bound by SHBG in the blood. With decreased SHBG however, significantly more testosterone runs free and causes testosterone-related issues.

3. Stress

Stress can have a wide variety of negative impacts on the female body. Many of these have the potential to elevate testosterone levels.For example, stress can cause hypothyroidism and the concomitant decreases in SHBG.Stress can also decrease levels of estrogen and progesterone in the blood. Estrogen and progesterone perform a counter-balancing function to testosterone. Without them, testosterone levels in women can rise to unhealthy levels.

Stress also causes a rise in DHEA-S, which is a male sex hormone produced by the adrenal glands. It is not testosterone – but it is one of testosterone’s closest cousins. It acts in a chemically similar way and will often cause the same hormone disruptions. Read more about this process here, and about how stress negatively impacts hormone production here.

sleep and stress effect testosterone, high testosterone levels in women

4. Fasting After Workouts

If you work out frequently and do not eat afterwards, your testosterone levels – specifically as a woman, can rise. After intense exercise, several hormone levels are elevated including Cortisol – the “stress hormone” – and testosterone.

Cortisol levels fall naturally after a workout. But testosterone levels do not. They remain very high and decrease much more slowly if you do not eat afterward. If you do this on a regular or even daily basis this can cause a chronic problem.

high testosterone levels in women increase from fasting

5. Polycystic Ovarian Syndrome (PCOS)

Finally, the most common cause of high testosterone in women is PCOS.

Read about the in’s and out’s of PCOS

Now, it is not altogether clear what causes what: does high testosterone cause PCOS, or does PCOS cause high testosterone levels in women? There is no certain answer. But what is certain is that the two are inextricably linked for many women. It may very well be the case that they both cause each other: high testosterone causes PCOS and PCOS causes high testosterone.

PCOS stands for Poly Cystic Ovarian Syndrome and is the condition of having multiple cysts on one’s ovaries. There are three criteria used in diagnosing PCOS. In order to be diagnosed you must meet two of the three criteria:

  • irregular or absent menstrual cycles
  • elevated testosterone or other male sex hormone levels
  • cysts on the ovaries as demonstrated by an ultrasound

PCOS affects as many as 15% of in America today, and is actually the leading cause of infertility, by a long shot.

So if you suffer from symptoms of high testosterone, from any of the above conditions such as hypothyroidism, stress, or insulin resistance / diabetes, you may want to investigate PCOS as a potential underlying cause or secondary effect of your condition.

PCOS may be a complex condition but this does not mean that it is insurmountable. I myself overcame my own PCOS (despite receiving terrible medical advice). So many of the women I have worked with on the issue have, too.

To read more of my work on PCOS and find out how it’s unique from what other people have done, check out any of these posts: What is PCOS? PCOS Treatment OptionsThe PCOS Diet, or my program on overcoming PCOS, PCOS Unlocked: The Manual.

To read more about acne and it’s relationship to testosterone and other hormones, check out my most popular posts on acne, or my program, Clear Skin Unlocked: The Ultimate Guide to Acne Freedom and Flawless Skin.

So that’s it for common causes of high testosterone levels in women. Do you have other ones in your own experience? Questions, concerns? I’d love to hear about it – please let me know!

The Acne and Vitamin B12 Link: How Healthy Food Can Give you Pimples

The Acne and Vitamin B12 Link: How Healthy Food Can Give you Pimples

Bacteria are incredibly important for the quality of your skin. (I have talked about this on the blog previously in this post: Topical Probiotics: Can applying bacteria to your face cure acne?)

Recent studies have shown that they are even more important than we ever thought.

It has also been rumored in the dermatological community since the 1950s or so that vitamin B12 causes acne.

Molecular pharmacologist Huiying Li decided to investigate both phenomena at once. Is there a relationship between vitamin B12 and skin bacteria?

Li and team examined the gene expression of bacteria on people’s skin, and then injected them with B12 and examined them again.

They found that vitamin B12 altlers the metabolic activity of the skin bacteria propionibacterium acnes.

These bacteria, propionibacterium acnes, naturally secrete vitamin B12. They create it on their own. Yet when the supply of B12 to the skin from the human host increases beyond natural levels–such as when injected with B12 or when taking a multivitamin–the bacteria stop producing their own B12.

When they stop producing their own B12, they begin producing porphyrin molecules.

Porphyrins cause inflammation, and therefore acne.

This effect was witnessed by Li and team when they injected people with clear skin with B12. Before the injection, their skin was clear and the genetic expression normal. After the injection, the genetic expression was altered and the skin was no longer clear.

In fact, the amount of genetic expression of the propionibacterium acnes of this B12-related gene decreasedd in these people who had previously had clear skin to levels of genetic expression Li and team saw in people who already had acne.

Basically, vitamin B12 injections made clear skin become acne prone skin.

A week after receiving the vitamin B12 injection, one of the 10 participants broke out in pimples. That person’s P. acnes gene-expression pattern also changed, the researchers found. Before the B12 injection, it was similar to those of the other healthy participants, but 14 days after the vitamin B12 shot, it looked much more like an acne patient’s pattern.

The researchers also did experiments on P. acnes growing in lab dishes.They found that when they added vitamin B12 to the bacteria, the microbes started producing compounds the porphyrins, which promote inflammation and acne.

What to do about it

-Do you suffer from acne? If you eat a nourishing, high-quality whole foods diet and do not take any supplements, you probably don’t have anything to worry about from vitamin B12. 

In case you are curious, however, foods that are naturally high in vitamin B12 are liver, eggs, red meat, shellfish, crab, cheese, mackerel, low fat dairy products, tuna, turkey, poultry, and all seafood products.

Basically, B12 is found in high quality animal products. Liver is the highest dose of B12.

I always wondered why I broke out when I ate liver, even though it was supposed to be such a healthy food. This problem with B12 explains why. Knowing this reassures me about my health when I eat liver. The reason I was breaking out wasn’t because I was unhealthy, but was rather because of the genetic expression of the bacteria in my skin. I should keep eating liver (or taking desiccated liver supplements!) like I always have been, despite the occasional zit.

-If you take a multivitamin that contains B12, a B-complex with B12, or Brewer’s yeast, you may wish to lower your dose or to stop taking the supplement for 2 weeks, to see if you notice any changes in the quality of your skin.

-I highly recommended considering a high-quality topical probioitic which will increase the amount of “good” bacteria in your skin and reduce its level of inflammation. You can use a probiotic spray like I do. This is the one I personally use, by the company Probiotic Action, here.

-You can also use a probiotic moisturizer. My favorite is the Eminence Clear Skin Probiotic Moisturizer, which you can get on Amazon here.

-If you want to learn more about acne, check out my post on the topic: Everything You Need to Know about Acne in 3000 Words, the very popular Hormonal Acne: Where It’s Coming From and What to Do About it or The Ultimate Hormonal Acne Treatment Plan. You could also take a look at my page on acne, and see all my favorite acne links!

Most of all I recommend checking out my 100% risk free program, Clear Skin Unlocked: The Ultimate Guide to Acne Freedom and Flawless Skin. It is the most comprehensive acne and skincare program I have found to date. 


What do you think? Might there be a relationship between B12 and acne in your experience?

PCOS and Acne: The Paleo Way to Overcome Both at Once

PCOS and Acne: The Paleo Way to Overcome Both at Once

Poly Cystic Ovarian Syndome (PCOS) is a fertility condition that affects between 10 and 15 percent of women in the Western world.

All of these women suffer from at least some of the symptoms of PCOS: irregular menstrual cycles, weight gain, difficulty with weight loss, low libido, facial hair growth, balding, and, perhaps most popular of all, acne.

PCOS and acne are inextricably linked. Why? Because PCOS is caused by an underlying hormone imbalance. The very same underlying hormone imbalance causes acne. It is possible to have PCOS without acne, and possible to have this kind of acne without PCOS. But quite frequently they occur together.

Here in this post I explain the hormone imbalance that causes PCOS, and the ways in which it also causes acne.

Also, and importantly: after figuring out how to overcome my own PCOS and acne, I wrote a manual on overcoming PCOS. It’s PCOS Unlocked: The Manual, and you can read all about it here.

PCOS and acne: the underlying hormone imbalance

Most medical professionals understand the hormone problem that underlies PCOS to be quite simple: elevated insulin levels cause the ovaries to produce excess testosterone, which throws a wrench in the menstrual cycle and causes irregularity, cysts on the ovaries, and infertility.

This does indeed happen to be the case for many women with PCOS. Testosterone is their biggest problem. In my PCOS manual, I call this “type I PCOS”.

Yet there are other types of PCOS.

Low female sex hormone levels are another cause of PCOS.

Why? Because–even though most medical professionals don’t understand this–PCOS is not just about high testosterone, but is rather about a fundamental imbalance between testosterone and the female sex hormones.

When estrogen and progesterone levels fall, they get out of fundamental balance with testosterone, which also throws a wrench in the menstrual cycle.

Estrogen and progesterone levels fall for any number of reasons, though by far the most popular reasons have to do with stress and with starvation. 

The thing about the female body is that it is highly sensitive to any conditions that may impair it’s ability to healthfully bear children. If you imagine life millions of years ago back on the savannah, it would be quite common for natural disasters or tribal conflict to create stressful times that could hinder a healthy pregnancy. It would also be quite common to come into a period of famine, in which case pregnant women would not be able to get enough food to sustain their pregnancies.

In periods of stress and starvation, pregnant women die more easily.

In order to prevent this from happening, the female body shuts down hormone production when it detects the slightest bit of stress or starvation. Shutting down hormone production prevents the body from becoming pregnant, which would have saved an ancestral woman’s life in the long run.

Our bodies do the same thing.

If we count calories, resrict food intake, limit carbohydrates or fat too much, yo-yo diet, or excercise excessively, our sex hormone levels fall, and our estrogen and progesterone levels become too low both for a healthy menstrual cycle and for clear skin.

You can read more about the female body and psychological stress in this post: psychological stress and hypothalamaic amenorrhea, and more about the female body and starvation-type stress in this post: metabolic distress and hypothalamic amenorrhea.

There is yet one more popular hormone problem that causes PCOS. It’s what happens when DHEA-S levels rise.

Elevated levels of DHEA-S contribute to PCOS because DHEA-S is also an androgen, or male sex hormone.

DHEA-S and testosterone act very similarly in the female body. The primary difference is that testosterone is produced by the ovaries, and DHEA-S is produced by the adrenal glands.

DHEA-S levels rise in response to stress. Whenever you feel stressed out, your body has a choice to make: it can continue to direct it’s hormonal resources toward sex hormone production, or it can divert those resources toward stress hormone production.

This process is often called “pregnenolone steal.” The reason we call it a “steal” is that hormonal resources are literally stolen by the adrenal glands and used for sex hormone production.

Thus you end up with lower hormone levels (like estrogen, progesterone, and the pituitary signalling hormones LH and FSH), as well as elevated DHEA-S levels, which can cause testosterone-like symptoms in the body: PCOS, infertility, facial hair growth, and acne.

So in sum, there are several hormonal factors that may be at play in PCOS:

Testosterone levels may be too high largely due to insulinemia

Estrogen and/or progesterone levels may be too low due to psychological and physical stress

DHEA-S levels may be too high due to psychological stress

Causes of PCOS and causes of acne

So in a very brief, very simplified nutshell: PCOS is caused by and large by an imbalance between male sex hormones and female sex hormones. If testosterone or DHEA-S is elevated, PCOS may result. If estrogen or progesterone is low, PCOS may result. Any of these things can happen at the same time, and often do.

(For more on the details of how all this happens, check out the PCOS manual here.)

This hormone imbalance is also one of the primary causes of acne.

How hormones and acne work

There are three separate layers to the skin, and pores traverse these layers. In order to adequately protect your body and keep toxins on the outside, the outer layer of the skin has to be hydrated and strong.

Pores deliver oil to the out layers from the bottom up. In healthy skin, oil comes up through the pores and oozes onto the surface, lubricating the skin and making it look soft and glowy. Think of it like a well, or a hot spring, or an oil rig.

In acne-prone skin, debris from the surface clogs pores, bacteria clog pores, and oil coming up from the bottom clogs pores. Then all this oil oxidizes and bacteria go on a feeding frenzy – which makes the pores become infected and inflamed.

The problem for women with PCOS is that male sex hormones increase oil production.

Estrogen performs an opposite function, and helps sooth the skin.

When estrogen levels are low, and when oil production increases from elevated testosterone or DHEA-S, acne is often the result.

The kind of acne that usually accompanies PCOS is around the chin, the mouth, and the jaw. It can spread to other areas of the face and the body, particularly the shoulders, buttocks, and back of the thighs, because these are the areas where the skin has the most testosterone receptors. If you have acne in these places there is quite a decent chance that your hormones are at least a bit  out of balance, PCOS or no.

For more on hormones and acne, check out this post: cystic acne and hormones: everything you need to know.

PCOS and acne: what to do about it

So what do you do about your acne and PCOS?

For one, tackling PCOS should be a priority.

You can do so by utilizing the manual for overcoming PCOS I’ve mentioned a few times that I’ve used with thousands of women, which you can read all about here.

You can also read some other posts I have on PCOS:

What is PCOS?

The PCOS Diet

5 Things I wish I knew when I was diagnosed with PCOS

PCOS and hypothalamic amenorrhea: What’s wrong with the contemporary understanding and how you can have both

You may also wish to consider tackling your acne from more than one angle. PCOS and underlying hormone problems are in all likelihood a significant factor in your acne, yet there are probably other factors at play. To that end you may wish to check out the posts:

The ultimate hormonal acne treatment plan

Acne: thinking beyond hormones

And, most of all, I highly recommend the remarkable acne program by my favorite thinker on the topic of acne, Seppo Puusa. I have learned so much of what I know about acne from Seppo. You can read all about his work, his program, and what he has to offer HERE. 


And that’s it! Please let me know your thoughts, your problems, your experiences in the comments! I and everyone else in our community would be honored to learn through your life and wisdom 🙂


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PCOS and Acne - Paleo for Women

Dairy and Acne: Everything You Need to Know

Dairy and Acne: Everything You Need to Know

One of the first things I ask women when they tell me they struggle with acne is: “Have you tried eliminating dairy yet?”

I ask because I personally struggle with dairy, because I’ve met and worked with so many people who struggle with dairy, and because I have read the studies. If Nestle admits that dairy is a problem, then there’s a fairly good chance that dairy is a problem.

Dairy and acne are quite closely linked. There are two primary reasons for this: dairy is hormonal, and dairy affects the gut. I will first talk quickly about how acne is formed, then I will highlight how the hormonal and intestinal aspects of dairy affect this process.

Dairy and acne: how acne is formed

Acne is caused by a combination of many different factors in the layers of the skin.

There are three layers to the skin. Pores and hair follicles traverse these layers. In healthy skin, a nice, lubricating oil is delivered to the surface of the skin from the bottom up through the pores. You may want to think of it like a river. Oil flows through the pores passing by the lower layers of the skin and ends up on top, and spreads out over the skin to moisturize it.

Unfortunately, in acne prone skin, the river becomes dammed.

On one end, the oil production increases. When this happens, there can be too much oil trying to push up through the pore, and it will get stuck.

On the other end, skin cells from the top layer of the skin fail to separate and shed properly. This is a process known as keratinization. Sometimes skin cell keratinize too much, clump together, and get stuck in pores and hair follicles.

With all of this extra material in the pores, from both the oil “below” and the keratinized skin cells “above,” this creates an excellent breeding ground for p acnes bacteria.

The bacteria infect the clogged pore, and then the immune system attacks the bacteria. This looks like inflammation, and will usually result in a red sore, often with a hard white pus that is difficult to resist popping.

So in sum (and acknolwedging that there is a whole lot else going on, more about which at this brilliant site), the primary problems affecting skin health are oil production, keratinization, and inflammation.

Dairy and acne: how dairy increases oil production

Dairy, moreso than any other food, increases oil production in the skin.

This is because dairy is a product of nursing cows (which are always in a cycle of nursing and pregnancy). Nursing cows (in fact, all nursing animals) have tons of hormones in their milk that are designed to promote growth and proliferation. These growth- and proliferation- forming hormones are necessary to stimulate the development of infants.

They also, unfortunately, stimulate the production of oil in the skin.

One such hormone is insulin. 

Insulin is a growth hormone. When the sebum-producing cells near the surface of the skin (called sebocytes) detect insulin in the bloodstream, their activity increases. Insulin causes oil production to increase in pores.

Insulin levels ordinarily spike in the blood in response to eating carbohydrates, and, to a lesser extent, protein. Medical professionals have a scale they used called the insulin index value for foods. The foods which have the highest insulin index values spike insulin the most and tend to be refined carbohydrates. White bread, for example, is benchmarked at an index value of 100. Apples are 60.

Milk and yogurt, on the other hand, have values higher than 100. Milk is near 100 (and higher in skim than in full fat milk). Yogurt (I’m assuming with sugar added) is a whopping 115.  This study found that when milk or yogurt is added to a meal it has no effect on blood sugar but  does significantly increase insulin levels.

Insulin-like growth factor (IGF-1) may be even worse than insulin. 

IGF-1 is one of the primary growth hormones responsible for cell proliferation and production in human beings. It is quite healthy much of the time and can be helpful for people who are trying to build muscle and the like. It is found in super high concentrations in milk, as milk is the one thing we consume that is specifically designed to spur cell growth.

IGF-1 works together with insulin much of the time and we find that whenever one of them increases so does the other. IGF-1 makes skin cells grow faster which will speed up the rate of keratinization and pore clogging before normal skin cleaning mechanisms have a chance to intervene.

IGF-1 and insulin also directly stimulate testosterone production in the ovaries. 

Testosterone is a big problem for women’s health because even a slight imbalance between testosterone and other female hormones will lead to irregular periods, infertility, poly cystic ovarian syndrome, facial hair growth, balding, low libido, mood dysregulation, insomnia, and, of course, acne.

Testosterone (and other male sex hormones, called androgens) causes acne because it increases oil production in the skin, stimulates the growth of skin cells, and, importantly, increases the body’s inflammatory response. This means that testosterone is implicated not only in clogging pores, but also in inflaming them, and turning them into large red sores on the face.

You can often tell if you have testosterone driven acne if it is cyclical and seems to regularly occur during ovulation (around day 14) or some other time in your menstrual cycle. Other indicators of testosterone-driven acne are location: testosterone-driven acne is located most commonly around the mouth, on the chin and jaw, and in more severe cases on the shoulders, upper back, buttocks, and lower thighs. This is where the skin has the greatest number of testosterone receptors.

Moreover, it appears as though testosterone may play a role in weakening skin barrier function. It appears as though caffeine, when applied to the surface of the skin, may be able to mitigate this effect. This company has some excellent, clean skin care products with caffeine in them.

Dairy and acne: how dairy can cause inflammation

Some people have adverse reactions to milk and other dairy products not because of the hormones but because of the sugars or the proteins in milk.

The primary carbohydrate (or sugar) in milk is called lactose. Many humans become lactose intolerant throughout the course of their adult lives for one reason or another. Lactose intolerance is characterized by an inability to break down lactose properly, which results in feeding bad bacteria in the gut. It causes disruptions in digestion which can lead to constipation, diarrhea, bloating, irritable bowel syndrome, and a disrupted gut flora population. All of these things, taken together, can cause irritation and inflamation in the gut lining, which goes on to send inflammatory molecules all throughout the body, including the skin.

The two primary proteins in milk and other dairy products are called casein and whey. Many people develop a significant sensitivity to these proteins, which function in the gut in a way not unlike that of gluten. They can irritate the gut lining and may be identified by the body as foreign invaders, which then causes an autoimmune-like attack and systemic inflammation. Any kind of disruption to the gut lining will cause an inflammatory response, which has a negative impact on the skin by increasing the amount of inflammatory molecules available to acne to become inflamed.

Dairy and acne: recap

So far, we have seen how acne occurs when pores become clogged from the bottom up by oil and from the top down by keratinized skin, and then gets attacked by the immune system. Certain hormones, particularly testosterone and other male sex hormones, insulin and insulin-like growth factor 1 increase oil production and clog pores. The sugar lactose and the proteins casein and whey may cause gut irritation and therefore increase the number of inflammatory molecules in the bloodstream.

What to do about it

So far as food options go, not all dairy is created equal. Milk is the worst offender for acne, and skim milk the worst of all, since it is so high in sugar and hormones without any fat in it to dampen their effect. Cream has high amounts of hormones but is full fat so may decrease the impact of insulin, and if it is full-fat cream then it has not been proccessed and therefore may be healthier. There’s some reason to believe that yogurt doesn’t have as strong hormonal effect as pure milk does. For example, fermentation deactivates a large portion of IGF-1 in milk. The same would go for kefir. Some cheese is high in casein but not in whey and vice versa. Hormones will still be present in cheeses but due to its processing not quite as much.

Butter may be the safest bet of all dairy, since almost no sugars or proteins are left in it. However, the best dairy to consume of all is gheewhich is butter that has been clarified by being boiled and having all of the leftover proteins and solids skimmed off and removed. Hormones will still be present to some extent but less so, and sugars and proteins least of all.

This is my favorite ghee.

There are also dairy alternatives.

You may wish to try almond or soy milk, though I personally find those problematic as they can also have strong hormone effeccts since they contain not insignificant amounts of phytoestrogens for someone with as sensitive a hormone system as I have.

My favorite “alternative” is coconut. Coconut yogurt is especially delicious, and they even make coconut kefir now.

You may also wish to combat the hormonal effects of dairy.

Spearmint tea has been rumored to reduce testosterone levels in women.

An  enzyme called 5-alpha reductase can convert testosterone to a hormone called DHT which is up to 10 times more potent than testosterone. One powerful 5-alpha reductase inhibitor is green tea.

To learn more about green tea and how to best steep it for it’s acne-fighting effects, check out the brilliant research of Seppo Puusa.

If you have PCOS or suspect that you may, since many women who suffer from testosterone-related acne do, check out my post What is PCOS?, PCOS treatment optionsor my step-by-step manual or overcoming PCOS, PCOS Unlocked: The Manual.

And, again, I really cannot recommend highly enough the resources you can find at AcneEinstein.com, which is where the only person I have ever anything new about acne from writes.


Cystic Acne and Hormones: Everything You Need to Know

Cystic Acne and Hormones: Everything You Need to Know

Contrary to popular belief, acne doesn’t go away once you turn 18.

In fact, for many women, acne doesn’t even get started until their 20s, 30s, 40s, or even in menopause.

For me, I had some acne throughout my teenager years, though it didn’t become unbearable until I was about 22 or so.

What gives? Why do so many women get acne later in life? Why do women suffer from acne at nearly twice the rate of men?

The answer is hormones. It’s always hormones.

Fortunately, I have done enough research, experimented enough on myself, and worked with enough clients to figure out exactly where acne comes from and what to do about it.

Here’s everything you need to know.

These key things are causing your Cystic Acne

Acne – including the cystic sort – comes from many different sources.

Dermatologists would have you believe that acne is caused by bacteria overgrowth in the pores of your skin. This is somewhat true -bacteria does play a role. Yet this is a very limited understanding of the processes that cause acne. Every person in the world has bacteria all over their skin. Yet some people get acne, and others do not.

How do we account for that difference?

It’s not simply because of genetics.

Acne is caused by many different internal factors. You can think of these factors like the trigger on top of genetics: genes predispose you to acne, but you only get acne if you “trigger” them with the right signal.

Contributing factors:


You may have a set of genes that codes for hypersensitivity to inflammation in the skin, for the “stickiness” and therefore clumping quality of skin cells, and for the rapid production of skin cells which can accelerate pore clogging.


Bacteria is also important (you can read more about bacteria and their role in acne in this post). Bacteria help modulate inflammation levels in the skin. They can also, interestingly, be aggravated by excessive vitamin B12.

How can healthy food give you acne?

Inflammation in the Pores:

Perhaps more than anything, acne is caused by inflammation in the pores of your skin. This is typically a result of systemic inflammation in the body. You wouldn’t be able to inflame a cyst without inflammation.

Poor Nutrient Status:

Acne is also caused by poor nutrient status. Vitamins like A, D, and K are critical for maintaining healthy skin cell membranes and pores. Replenishing stores of those vitamins can help. Things like eating liver, or taking desiccated liver capsules, and/or taking a vitamin A, D, and K rich cod liver oil supplement – can go a long way towards healing many skin problems, including cystic acne.


Finally, acne is caused by hormones. Hormones play a critical role in oil production in the skin. Some hormones – particularly the male sex hormones like testosterone – cause more oil production. Some hormones – like estrogen – cause less. 

Causes of Cystic Acne

Cystic acne and hormones: The imbalances that can occur

There are two primary hormones that cause cystic acne: testosterone and DHEA-S.

Testosterone is a male sex hormone that is still produced by healthy female bodies in small amounts. Testosterone levels often become unhealthfully elevated, mainly because of insulin resistance. (Insulin – the molecule that’s responsible for storing sugar in the blood as fat – can become unhealthfully elevated in the blood when there is a problem with gut health and/or inflammation.)

When insulin is high, the ovaries produce excess testosterone.

This causes many problems – including the fertility condition Poly Cystic Ovarian Syndrome.

Other reasons for elevated testosterone:

DHEA-S is another hormone that acts like a male sex hormone in the body and which stimulates oil production. It is different from testosterone however because it is not produced in the ovaries. It is produced by the adrenal (stress) glands.

When you are stressed out, DHEA-S levels rise.

This is a problem for many women with PCOS, since it exacerbates symptoms like cystic acne. It is commonly a problem for women with hypothalamic amenorrhea, too, since women with HA have already put a lot of stress on their bodies.

Hypothalamic Amenorrhea

This is an even greater problem for women who may have both hypothalamic amenorrhea and PCOS (like I did – read about how that is possible and what to do about it here).

Then there is one more hormone that causes acne, though not as much as testosterone and DHEA-S. It’s progesterone.

Progesterone does not increase oil production in the skin, so it is not quite as cystic as testosterone and DHEA-S are. But it does block estrogen activity in the skin. Estrogen is protective to the skin, so many women who have high progesterone levels – often because of the pill or the progesterone IUD – suffer from increased acne. You can read more about birth control options and how to manage their health effects in this PDF I wrote on birth control, here.

Finally, estrogen heals the skin. It reduces oil production and calms down inflammation in the pores. This is a great hormone for helping sooth hormonal imbalanced cystic acne.

Yet if testosterone levels or DHEA-S levels are so high, not even high estrogen will be enough to curb their effects.

Cystic acne and hormones: oil production in the skin

There are three separate layers to the skin, and pores traverse these layers. To adequately protect your body and keep toxins on the outside, the outer layer of the skin must be hydrated and strong.

To do this, pores deliver oil from the bottom layer to the top of the skin. In healthy skin, oil comes up through the pores and oozes onto the surface, lubricating the skin and making it look soft and glowy. Think of it like a well, or a hot spring, or an oil rig.

In acne-prone skin these 3 things can clog pores:

1) Debris from the surface

2) Bacteria

3) Too much oil rising from the bottom layer of skin

Then all this oil oxidizes and bacteria go on a feeding frenzy – which makes the pores become infected and inflamed. This is acne.

When there is an excessive amount of oil and a bigger, deeper-feeling infection, this is cystic acne.

What is cystic acne? Cystic acne is a normal little pimple on hyperdrive.

Cystic acne comes about often when inflammation is particularly high – or when an infection is particularly bad – or, as is the case with so many women, when hormone imbalance causes oil production to really be in excess.

When oil production is really high, it becomes easy for pores to become clogged, and for there to be a lot of material stuck there in the pores to hurt, get infected, and just be begging to be popped.

So cystic acne may arise as a result of many factors – and in fact it most likely is a result of many factors – but the most important cause for women is hormone imbalance.

Cystic acne and hormones: Is your acne caused by hormone imbalance?

These factors may indicate a hormone imbalance:

  • The cysts are located around the mouth, chin, and jaw. This is where most, or at least the worst of, hormone-imbalance acne occurs because it’s where the skin has the most hormone receptors.
  • The shoulder blades, buttocks, and thighs contain hormone receptors, so this is another place to look for cystic, hormonal acne.
  • Oily skin is the result of hormone imbalance, too. If you have a lot of oil on your skin this may point to hormone imbalance, probably excess testosterone or DHEA-S levels.

Other symptoms of this kind of hormone imbalance include:

  • male-pattern hair growth like facial hair
  • male-pattern hair loss like balding
  • increased irritability
  • low libido
  • and maybe even irregular menstrual cycles.

Cystic Acne and Hormones: What now?

If you suspect your cystic acne is hormone-related (and it almost certainly is, to some extent), I recommend first and foremost getting as many tests done as possible.

Get bloodwork done – you can test your testosterone, DHEA-S, progesterone, estrogen, LH, FSH, and thyroid hormones T3, T4, and TSH to get a good idea of what is going on in your body hormonally. You may suspect then that you have PCOS. If so, I couldn’t recommend my own highly detailed guide to PCOS which you can check out here. If you are curious about treatment options, I have elaborated on a few here.

Check out the risk-free PCOS Unlocked Manual Here for everything you need to know about PCOS


You also may find that you do not have PCOS, but that you still need to correct your insulin issues, your stress issues, or your hypothalamic amenorrhea issues. You can read more about stress and hormones here, and about  overcoming hypothalamic amenorrhea here.

You can read more about hormonal acne, it’s causes, and treatment in this blog post: Hormonal Acne: Where It’s Coming From and What to Do About It. Or in this one: The Ultimate Hormonal Acne Treatment Plan.

Most of all, I direct you to the program I wrote specifically for women suffering from cystic and hormonal acne: Clear Skin Unlocked: The Ultimate Guide to Acne Freedom and Flawless Skin.

Clear Skin Unlocked was written specifically for women like you in mind. It’s for when you’re frustrated, looking for answers, and tired of falling through the cracks. In Clear Skin Unlocked I discuss everything I did in this blogpost here at much greater depth, as well as provide a Four  Week Jumpstart to Acne Freedom to get you on your way to robustly healthy and radiant skin, for good.


And that’s a wrap! With all the links I provided here at the end you should have a good chunk of reading available to you for your cystic acne needs. In the meantime – what do you think? What is your experience with cystic acne and hormones? I would love to hear all about it!

The Ultimate Hormonal Acne Treatment Plan

The Ultimate Hormonal Acne Treatment Plan

If you suffer from hormonal acne, you are not alone. Up to 23% of adult women experience acne! This number is nearly twice that of men.

Why do women suffer acne twice as much as men do?

Because of hormones.

Now there are many different factors that affect acne. Inflammation is very important. Gut health is important. Anti-oxidant status is supremely important (learn all about these factors in my program for overcoming acne Clear Skin Unlocked: The Ultimate Guide to Acne  Freedom and Flawless Skin).

But hormones make all the difference for women.

Today, I provide you with the hormonal acne treatment plan that I used to personally overcome my own hormonal acne, and which I use today to cure my clients all over the globe.

Here it is:

Hormonal Acne Treatment Step 1: Is Your Acne Hormonal?

How do you know if your acne is hormonal or not? This is a very important question to ask. You don’t want to try to fix something that isn’t broken.

Here are some things to look out for to determine if your acne is hormonal:

-if your acne fluctuates with your monthly cycle

-if your acne is cystic and located around your chin, mouth, and jaw

-if your acne has also spread to your shoulders, upper back, and buttocks

-If you experience other hormonal symptoms like irregular menstrual cycles, male pattern hair growth (facial hair), balding, PMS, mood swings, hypothyroidism, or difficulty maintaining or losing weight

You can read a more in depth description of hormonal acne and things that cause it in this popular post.

Hormonal Acne Treatment Step 2: Learn about causes

This is the hardest part of hormonal acne treatment, but it is the most important, and the aspect that makes your healing the most effective in the long run.

Hormonal acne is caused by an underlying hormone imbalance. Period, that’s it, no questions about it!

The only questions remaining are: what type of imbalance is it, and what caused the imbalance?

Hormones can become imbalanced a number of different ways. The fastest way to heal is to figure out why your hormones are imbalanced, and then correct that problem.

The most likely problems affecting you are:

1) Elevated testosterone

Testosterone is one of the primary causes of female acne. Testosterone causes oil production in the pores of your skin to increase. Excess oil causes pore-clogging. This in turn creates more food for bacteria to eat, and therefore more possibilities for infection.

How does testosterone get elevated? Insulin signals to the ovaries to produce testosterone. Testosterone often becomes unhealthfully elevated as a result of insulin spikes and insulin resistance. 

This means that insulin-related problems are one of the primary causes of hormonal acne for women!

As an important side note:

Usually when testosterone levels get high women develop a fertility-threaning hormone condition called Poly Cystic Ovarian Syndrome. I personally had PCOS and figured out how to overcome it (which finally made my acne go away!).

I share the secrets I learned in my journey overcoming PCOS in a manual I wrote that has now been used successfully by thousands of women all over the world. You can read about the success I and my readers have been having at this page or in this program.

2) Elevated DHEA-S

DHEA-S is another male sex hormone, so it has the same oil-enhancing effects on the skin as testosterone does.

DHEA-S is unique however because it is produced by the stress glands, instead of reproductive organs.

DHEA-S rises in response to all different kinds of stress, from the mental to the physiological. You can read about the health effects of mental stress at my blog here, or of physical stress here. You can read about the biological mechanism “pregnenolone steal” that makes DHEA-S rise here.

DHEA-S is another big problem for women with PCOS. My own DHEA-S levels were personally through the roof, due to the level of stress I was putting on my body. I talk about the intersection of stress and hormones at great length in that manual on overcoming PCOS I mentioned.

3) Reduced estrogen

Estrogen is important for clear skin because it provides a counterbalance to testosterone. It is one of the best molecules out there for creating dewy, radiant skin.

Estrogen levels can fall for any number of reasons.

Menopause is one big reason.

Low body fat percentage, extreme weight loss, excessive dieting, calorie restriction, and excessive exercise are some others. These are often related to hypothalamic amenorrhea or PCOS – and were a big factor in my own PCOS, despite the fact that most medical professionals refuse to recognize this.

Estrogen levels may also fall as a result of birth control pill usage (especially when you come off of the pill. For more on how to deal with side effects of the pill, check out my quick guide to birth control.)

4) Hypothyroidism

Hypothyroidism is not a hormone problem in the sense that sex hormones are produced by the reproductive cycle, but it is a hormone problem in the sense that thyroid function is intimately tied to reproductive function. The components of the thyroid system that are the most important for effective thyroid function are considered hormones, too.

Hypothyroidism causes cells to weaken and be susceptible to DNA damage and inflammation. It can be caused by a low carbohydrate diet, by stress, or by an autoimmune condition called Hashimoto’s Thyroiditis.

Hormonal Acne Treatment Step 3: Figure out your cause

Which of the forementioned causes of hormonal acne is yours? It could be just one of them, or it could be all four. For me, personally, it was all four.

You could simply guess which problem is your own based on the information I provided.

You can also get tests done. Here are the things you would want to test:

Free testosterone (bad for acne if elevated)

Fasting insulin (bad for acne if elevated – is a likely cause of elevated testosterone and indicates what I call type I PCOS)

Estrogen (estradiol and estrone) (bad if low)

LH (bad if improperly balanced with FSH or bad if low)

FSH (bad if improperly balanced with LH or bad if low)

DHEA-S (bad if elevated)

And for thyroid hormones test:

TPO (indicates Hashimoto’s Thyroiditis if high)

TSH (indicates Hashimoto’s Thyroiditis or other thyroid issue if high)

T4 (indicates Hashimoto’s Thyroiditis or other thyroid issue if low)

T3 (indicates hypothyroidism if low)

Your doctor or another health professional can help you go over these tests. Basically they will tell if you have elevated testosterone or low estrogen and the like. Then you can work on overcoming these issues.

Hormonal Acne Treatment Step 4: Overcome the issue

Now that you know which hormone imbalance issue you have, you can work on correcting it.

Depending on your results, you may have PCOS. This is possible if your testosterone and DHEA-S are elevated, and likely if your fasting insulin is high. If this is the case, you could honestly do no better than my innovative guide to PCOS, PCOS Unlocked.

You may have hypothalamic amenorrhea, which would be indicated by low levels of estrogen, progesterone, LH and FSH, or hypothalamic amenorrhea coupled with PCOS, which would have those problems too but also perhaps elevated DHEA-S or testosterone (generally speaking). It’s complicated. Most medical professionals don’t recognize that hypothalamic amenorrhea and PCOS can occur at the same time. I do.

You may have hypothyroidism. If you have Hashimoto’s then you will want to try healing your autoimmunity and gut with an autoimmune protocol diet like this one (it’s the best one out there). If you do not have Hashimoto’s but still suffer low thyroid levels you may want to consider reducing stress and exercise and increasing the carbohydrate content of your diet.

You may not have any of these conditions specifically. You can suffer from high testosterone but still not technically have poly cystic ovaries. In this case you would still want to address insulin resistance by eating an anti-inflammatory, lower-carbohydrate diet. (More about which here.)

Many women have a lot of success simply eliminating dairy and sugar from their diets, since these are both highly hormonal foods.

Hormonal Acne Treatment Step 5: Address other factors

Hormones are a big factor in acne, but they are not the only one. As I mentioned in the introduction to this post, inflammation is a big factor. Antioxidant status is a big factor.

In this post I talk about the effects on acne by stress, UV rays, heat, dairy, inflammatory foods, phytoestrogens, topical irritants, sleep, and low carb diets.

In this program – Clear Skin Unlocked: The Ultimate Guide to Acne Freedom and Flawless Skin  – I discuss inflammation, hormones, antioxidants, irritants, UV rays, foods, various supplements, how certain renowned “health” foods are actually causing acne, and more. It’s the most in depth, comprehensive acne resource I’ve encountered to date.

Hormonal Acne Treatment Step 6: Supplement wisely

While you heal your underlying hormone imbalances, it is also important to attack acne from other angles. One is to use the best topical regimens and products possible.

For some of my favorite topical treatments for acne, check out the antioxidant cleansers, serums, and topical probiotics (my absolute fave!) I use.

Several supplements have also been shown to be very helpful with acne, sometimes reducing acne by up to 50% over the course of six weeks! Zinc, selenium, and N-acetyl cysteine have been shown to be the best antioxidants for acne.

Hormonal Acne Treatment Step 7: Experiment with patience

Overcoming acne takes time. Many different things can affect acne, so it will take you a little while to figure out which ones are the most important for you to address. Here is the trick to doing so:

Only test one thing at a time.

Hold your diet steady, and remove one food. Give it two weeks. Do you see a difference?

Or hold your diet steady, and add in 100 grams more of carbohydrate every day. Give it two weeks. Do you see a difference?

You should definitely eat as healthfully as you can in the “steady” periods. Focusing on fresh fruits and vegetables, wild-caught and grass-fed animal products, and healthy fats like olive oil and coconut oil is an excellent place to start. Organ meats are great (here’s a supplement in case you do not like to eat liver), as are eggs, fermented foods (here are my favorites) and the rockstar super-suppelment that destroys acne, fermented cod liver oil.

But too much of anything can throw an already imbalanced skin environment even further out of balance.  (Did you know that the “superfood” liver, and the “superfood” goji berries can actually cause acne?) This is why I published Clear Skin Unlocked – I wanted to provide you with the most in depth information possible, so you’ll stop falling through the cracks. It’s 50% off this week, and, even better yet, fully refundable if you don’t like it for any reason.


And… that’s a wrap for my hormonal acne treatment plan! Following those steps (and doing years of research to finally figure out how to cure my PCOS) is what made my skin go from this on a good day:

stefanis acne before

To this:

stefani ruper

On every day!

So believe me when I say that if I could do it… you can too!