Even though many dermatologists would deny it, hormonal acne is a real and serious problem for women.
Gut health and inflammation are both major players in acne. (read more about causes of acne other than hormones in this post, or my brand new acne program, for 50% off this week!).
Yet hormones can be the biggest problem for women.
In today’s post I discuss all the variations of hormonal acne, where it comes from, and what to do about it.
Hormonal Acne: When and how it shows up
Hormonal acne for many women presents at certain times of the month. Popular times include 1) at ovulation, which occurs almost precisely smack in the middle of the cycle, two weeks after the first day of bleeding (read about how to pinpoint ovulation in this post), 2) the few days before a period, and 3) at the start of a woman’s period.
Hormonal acne can also be present all of the time. For women with hormonal problems such as PCOS (read here to start figuring out if you have PCOS) and Hypothalamic Amenorrhea (read here to figure out if you have HA), this is unfortunately the case.
When I had both PCOS and HA at the same time, I had terrible acne every day for three years.
Hormonal acne usually occurs in the form of cysts. Cysts are those lovely, pus-filled, painful and inflamed red bumps. They often culminate in a peak of white pus.
Hormonal acne also appears as more mild forms called comedones. These are those whitehead “bumps” that never break the surface.
Hormonal acne can even show up just as smaller lesions. These are not quite as angry and painful as full out cysts, and may appear more rash-like or just smaller than typical acne. Below is a photo of my own cysts (on a “good” day) back in 2011.
These are cysts, classified as “stage 3” acne by dermatologists. There are 4 stages of cysts in hormonal acne
Hormonal acne occurs first and foremost around the mouth. It shows up on the chin, below the nose, around the sides of the mouth, and sometimes up the jawline.
As hormonal acne worsens, however, it spreads to the cheeks and the forehead.
Other body parts can be affected, too. This usually includes the shoulders, back, and buttocks–where the body’s testosterone receptors are most prominent.
The physiological mechanism of hormonal acne
Hormonal acne is caused by increased oil production beneath the skin. Think of it like a river. Ordinarily there is a healthy flow of oil to the surface. This is important because it lubricates the skin.
But when there is too much oil – and when it combines with the normal skin cells and other debris on the surface of the skin – it can clog the pores.
When oil clogs pores, bacteria go on a feeding frenzy. This causes inflammation.
The worse inflammation is, the more irritated the oil gland can become, and thus the more red, and the more painful.
Yet it is important to remember that hormonal acne does not occur unless there is an oil problem.
This is the reason no amount of washing will ever completely eliminate hormonal acne. Admittedly, it can be helped by antioxidant cleansers, serums, or creams.
But it will never go away completely without curing the hormonal acne from underneath. The only way to fix it is from the inside out.
Hormonal Acne: Causes of increased oil secretion
The primary causes of oil secretion are male sex hormones, also called androgens. Testosterone is the primary culprit. Another androgen, called DHEA-S, is also very important. They both increase oil secretion.
This effect is worsened when female sex hormone levels – particularly of estrogen – fall. Estrogen balances male sex hormones in the skin. Without a healthy balance, problems occur.
1. The most prominent androgen is testosterone.
Testosterone causes oil production in the skin.
Why might you have high testosterone?
You might have it if you have PCOS.
(Acne is one of the clearest indicators of PCOS.)
You may also have high testosterone if you have diabetes or insulin resistance, because when the body produces insulin, the ovaries produce testosterone. It’s a very simple yet very damaging process.
When might you show hormonal acne from high testosterone?
If you still have a menstrual cycle, you may find that you break out around ovulation. This is the middle of your cycle. It is also when your testosterone levels are the highest.
But if you have a hormone condition like PCOS – you will probably have hormonal acne most of the time.
(If you struggle with PCOS or think that you may have it, you may want to check out my handy guide on overcoming PCOS.)
2. Another androgen, called DHEA-S, causes oil production as well.
Yet unlike testosterone, which is a sex hormone, DHEA-S is a stress hormone.
It is produced primarily in the adrenal (stress) glands. Whenever a woman is under any degree of stress, her body faces a choice: it has to decide if it wants to produce normal sex hormones like progesterone and estrogen, or if it wants to produce stress hormones like DHEA-S.
For this reason, Hypothalamic-Pituitary-Adrenal (HPA) Axis dysregulation is usually the first place to look to as the origin of DHEA-S problems. Women with a lot of stress – whether from emotions, poor sleep, or under-feeding – have higher levels of DHEA-S levels.
3. Estrogen fights acne.
Estrogen helps promote clear skin. It does this in a number of ways.
First, it has the power to off-set high testosterone levels in the blood. Estrogen increases levels of sex-hormone-binding-globulin (SHBG), which in turn binds testosterone and makes it impotent.
Second, the skin has many estrogen receptors in it, so estrogen directly performs a balancing and soothing function at the site of acne.
For women with chronically low estrogen, hormonal acne is often a consistent problem. They have acne 100% of the time.
In women with relatively healthy hormone systems, low estrogen can still be a problem. This is because estrogen levels fall at the end of each menstrual cycle, and are low at the beginning. Having such low estrogen levels during this time can lead to monthly breakouts.
Because hypothalamic amenorrhea is characterized by low hormone, and particularly low estrogen levels, boosting estrogen is one of the main and most helpful ways women with hypothalamic amenorrhea cure their acne.
Because menopause significantly decreases estrogen levels–almost to zero–this is also the primary reason women in menopause can see a re-emergence of hormonal acne after decades of clear skin.
4. Finally, progesterone can also play a role in acne. Progesterone, in high doses, acts as an inflammatory agent, and can cause acne to flare up. Progesterone levels are highest during the days leading up to menstruation, which explains why many women experience outbreaks at this time.
Synthetic progesterone, such as that found in birth control pills, can also cause acne.
Whether a certain variety of the pill causes acne for you or not, however, is entirely dependent upon your own body chemistry and how your body reacts to external hormones. Know only that if you noticed a change in your skin while experimenting with birth control methods, this is most likely why. You may want to consider a birth control method that has a different kind of progesterone in it, or one that has a different progesterone-estrogen balance, to see if it helps relieve your acne.
(I discuss hormonal causes of acne with more complexity and depth in the program I just published, Clear Skin Unlocked: The Ultimate Guide to Acne Freedom and Flawless Skin.)
Aggravators of hormonal acne
There are many factors other than hormones that can worsen hormonal acne. Here is a list of the most common:
Stress: Stress plays an important role. It acts as an inflammatory agent, especially if cortisol levels remain high for a long time. Stress also decreases production of healthy, skin-supporting hormones like estrogen, and increases production of acne-causing stress hormones like DHEA-S. Stress is not necessarily the cause of hormonal acne, but does exacerbate it, and prevent proper healing.
Heat. Heat is inflammatory, and also causes sweat, which can clog pores.
UV Rays. The sun’s rays are some of the most potent acne inflamers out there. Protect the skin on your face with at least an SPF of 20, or consider wearing a hat in the summer months.
Inflammatory foods: grains, dairy, nuts, and omega 6 vegetable oils can all contribute to poor gut health and inflammation.
Dairy: While already mentioned for being inflammatory, dairy deserves special mention because it is a highly hormonal food. Pregnant cows produce several hormones designed for growth. Growth hormones can both cause androgen levels to rise as well as promote production activities that lead to acne.
I have seen enormous success with women with hormonal acne eliminating dairy for their skin. Many people at least anecdotally least respond to dairy with acne more strongly than any other food.
Phytoestrogens: soy and flax are the primary phytoestrogens to be concerned about, with legumes and nuts coming in a distant second place. Phytoestrogens (“phyto estrogen” is greek for “plant estrogen”) have the power to act as estrogens in the body. This may sound like a good thing for acne, but this role is ambivalent and should be treated with caution, especially with the skin. Different estrogen receptors read different kinds of phytoestrogens differently, such that phytoestrogens usually perform estrogen-lowering effects in skin tissue despite what they do in other locations.
Low carbohydrate diets: Having sufficient glucose stores is important for skin healing, and can speed the recovery of acne lesions. Glucose is also helpful for preventing hypothyroidism. Find out 8 of the most important signs you need to eat more carbohydrate here.
Poor sleep: Sleep both enables healing and promotes healthy hormonal production.
Hypothyroidism: Without sufficient levels of T3, the active form of thyroid hormone, in the blood, a woman’s skin cells lack the ability to heal properly. Many women who suffer hypothyroidism suffer chronic acne.
Dealing with hormonal acne
The best thing you can do for hormonal acne is get blood work done and figure out precisely what your underlying problem is. That way you can target the problem and treat it effectively.
Unfortunately not all of us can afford this, so it’s okay to guess. Nevertheless, the better an idea you have of what is going on in your body, the more specific you can be about what to do to fix it.
In general, hormone dysregulation that leads to acne can be broken down into a few broad categories:
1) high testosterone from PCOS (specifically the overweight and insulin resistant type of PCOS),
2) low estrogen from low body fat levels, chronic restriction, or living in an energy deficit,
3) low estrogen from menopause,
4) high progesterone from general hormone imbalance, possibly related to PMS,
5) any of these conditions worsened by stress or hypothyroidism, and
6) any combination therein.
The ultimate hormonal acne solution
The solution to all of these problems is to correct the hormone imbalance. I have discussed methods of doing so above and elsewhere.
So to get rid of hormonal acne for good, check out my manual that has now helped several thousand women overcome their PCOS, or some of my work on hypothalamic amenorrhea.
For women with menopause, it may just “take time” or perhaps medical interventions are appropriate, depending on the severity of the problem.
Medication for hormonal acne?
There are drugs designed to help with hormonal acne. Spironolactone and flutamide are the two primary ones that come to mind (though I don’t recommend taking either of them), as well as birth control.
The reason birth control pills are helpful for acne is because they enforce hormone regularity on a woman’s system. The precise pill that is helpful for each woman varies by her particular condition– but in general, BCPs are comprised of estrogen and of progesterone. BCPs can for that reason 1) raise estrogen levels–which either corrects an estrogen deficiency or helps balance the activity of runaway testosterone–and they can also 2) restore proper balance between estrogen and progesterone, which is important for keeping progesterone levels within their proper parameters.
Some BCPs also contain anti-androgenic substances, such as drospirenone, which is an added benefit for women who are living with androgen excess (but poses some health risks). In all cases, I do not generally recommend that women get on BCP, as it can cause worse hormonal dysregulation in the long run (sort of like handicapping a delicate hormonal system), and does not solve the underlying problem.
Flutamide acts in a similar way to spironolactone, but less effectively, and with more side effects. So spironolactone is typically the drug of choice.
Spiro has been hailed by many acne sufferers as God’s gift to womankind: it decreases testosterone activity. For many women this begets truly miraculous effects. Yet one should step cautiously with spironolactone. If a woman’s primary problem is not testosterone excess, spironolactone will very likely do more harm for her skin than good. (Check out the panicked discussion forums at acne.org to see what I’m talking about.) Moreover, even for those who have testosterone excess as their primary problem, spironolactone merits caution for a variety of reasons. First, spiro usually induces an infamous “initial breakout” which can last anywhere from weeks to months. This isn’t always the case– sometimes women improve immediately. Sometimes they never really do (I never did: in fact, my acne got worse on spiro.) But the typical case is for women to see an initial worsening of their acne, followed by relief in the upcoming months, especially if they increase their dosages.
Secondly, spiro cannot be taken by pregnant women because it induces birth defects, so women cannot stay on spironolactone indefinitely. This is problematic because spironolactone acts as a band-aid on the hormone problem, and does nothing to fix it whatsoever. What spiro does simply is block testosterone receptors. In most cases, if the underlying problem is not addressed while a woman is taking spironolactone, her acne will return once she comes off of the drug. This is why I recommend that women only consider taking spironolactone if they want a “quick fix” while they work on their diet and exercise in order to improve their PCOS.
Finally, spironolactone has a couple of other health concerns. First, it lowers blood pressure, since spiro is actually a blood pressure lowering drug proscribed “off label” for acne. Secondly, it acts as a diuretic, so women on it need to drink water constantly, may not be able to consume alcohol anymore, may have dysregulated salt cravings, and may never actually be properly hydrated. And finally, spiro acts as a potassium-sparing diuretic, such that women cannot eat potassium rich foods, lest they risk the chance of becoming hyperkalemic, which can lead to sudden death. It hospitalized me. An imbalance of electrolytes in the blood is no laughing matter, so women on spiro should limit their potassium rich foods as well as get their potassium levels checked periodically. Potassium rich foods include melons, bananas, potatoes, avocadoes, tomatoes, and leafy greens, among others.
For these reasons, spiro can help, but it cannot be relied on long term. It does not get at the root of the issue–drugs rarely do–and the true path to hormonal help is diet and lifestyle modifcation.
As a final note, bio-identical hormone supplementation can be helpful for women going through menopause. Estrogen patches can release small amounts of hormone into the bloodstream, and can lessen acne considerably. I do not think this is necessarily detrimental to a woman’s health, if it is in fact the case that her estrogen levels have simply dropped off during menopause. However, it does, in my opinion, make it difficult for estrogen levels to rise and hormone balance to re-establish itself on its own. This is a decision best left to the individual and to her doctor.
Hormonal acne is terrible, and for many women can seem incessant, and never ending. Girls are assured growing up that they will eventually out-grow their acne, yet many women see it persist throughout their twenties and thirties, and some actually do not even see the acne manifest until their twenties and thirties. Some women do not even see acne appear until after the birth of their first children, as their progesterone and estrogen levels are flying all over the map.
There are downsides to medication, and large ones. Medication is only ever a band-aid, and it can be a band-aid that in the long run leads to more harm than good.
Playing with hormones is like playing with fire. Sometimes things can go horribly wrong. For this reason, meds may be best left alone, depending on the circumstance and the level of risk a woman is willing to bear.
It is entirely possible as well as supremely healthy to cure acne from the inside out with good diet and lifestyle practices alone.
To do so with an experienced scientist (me!) walking you step-by-step through the process, check out my new program: 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.
You may also wish to check out my guide on weight loss, or my guide to overcoming PCOS. It may take experimentation and patience, but don’t all good things, in the end?
For some of my favorite topical solutions to acne, check out the antioxidant cleansers, serums, creams and topical probiotics I use.
One of the more esoteric but much beloved tools in the paleo dieter’s tool-kit is intermittent fasting.
What is intermittent fasting? I.F. is the practice of maintaining overall caloric intake while consuming those calories in fewer meals or in reduced time windows throughout the day. The goal is to create conditions of fasting in the body, but not for extreme lengths of time.
Some examples of intermittent fast strategies include 10, 8, or 5 hour eating windows throughout the day, or perhaps eating just two meals each day: one in the morning, and one at night. The evolutionary premise — the argument that proponents of intermittent fasting make — is that humans evolved to optimize their health under less-than-optimal conditions. Intermittent fasting, they say, is a natural and perhaps even necessary part of being human.
The modern-day scientific correlate appears promising, too:
Most people are nowadays aware that a calorie-restricted diet has the ability not just to decrease body weight but also to lengthen a human life. Emerging research is beginning to show, however, that intermittent fasting is just as effective as calorie restriction in ensuring these health benefits! Amazingly enough, this happens without any of the psychological crippling side effects of cravings and food obsession that practictioners of calorie-restriction often experience.
Intermittent fasting, proponents say, also may benefit the fight against cancer, diabetes, and autoimmunity. Here is an excellent, up-to-date review of the “benefits” of fasting. It is wholly understandable that fasting is all the rage these days.
Intermittent fasting women is a specific interest of mine because of what I have witnessed both in myself and in working with literally thousands of women in the PfW community.
Many women report to me (read more about that in this awesome book) that intermittent fasting causes sleeplessness, anxiety, and irregular periods, among many other symptoms hormone imbalance, such as cystic acne.
I have also personally experienced metabolic distress as a result of fasting, which is evidenced by my interest in hypocretin neurons. Hypocretin neurons have the ability to incite energetic wakefulness, and to prevent a person from falling asleep, in reaction to the body detecting a “starved” state. Hypocretin neurons are one way in which intermittent fasting may dysregulate a woman’s normal hormonal function.
After my own bad experience with IF, I decided to investigate intermittent fasting. I looked into both a) the fasting literature that paleo fasting advocates refer to, and b) the literature that exists out in the metabolic and reproductive research archives.
Intermittent Fasting Women: Problems in the Paleosphere
What I found is that the research articles cited by Mark’s Daily Apple (and others), focus on health benefits such as cancer-fighting properties, insulin sensitivity, and immune function.
However. I was struck by what seemed like an egregious sex-based oversight in that MDA post I linked to above. MDA cites this article as a “great overview” of the health benefits of intermittent fasting. This startled me because the article MDA cited was for me one of the strongest proponents of sex-specific differences in response to fasting.
Sex differences were relevant in two striking areas:
1) women in studies covered by the review did not experience increased insulin sensitivity with IF regimes and
2) intermittent fasting women actually experienced a decrease in glucose tolerance.
These two phenomena mean that women’s metabolisms suffered from IF. The men’s metabolisms on the other hand improved with IF across the board. Recall that the review was reported by MDA as “a great overview of benefits [of IF].”
Secondly, in another fasting post at MDA, of which there are many, the health benefits of fasting are listed and reviewed, but the sex-specific aspects of the hormonal response go unmentioned, and reproduction/fertility/menstrual health isn’t mentioned at all.
This is not to say that Mark is not attentive to who should and who should not be fasting. He knows very well and cautions people against the dangers of fasting while stressed. Still, the mere fact of being more sensitive to fasting simply by being a woman is, I would assert, pretty important for a woman who is contemplating or already practicing IF.
This goes nearly unmentioned in the blogosphere.
Intermittent Fasting Women: Problems in the Literature
Beyond reporting biases in the blogosphere, there remains an even greater problem of a significant testing bias in the fasting literature. Searching “men” + “intermittent fasting” in a Harvard article database yields 71 peer-reviewed articles. Searching “intermittent fasting women” yields 13, none of which are a) solely about women b) controlled studies or c) about more than body weight or cardiovascular benefits.
The animal studies are more equitable, but also a bit less applicable to human studies.
It is well-known in both the research and the nutritional communities that caloric restriction is horrible for female reproductive health. This is not news. There is an infertility condition – called hypothalamic amenorrhea – that millions of women suffer from due to being overly restrictive. But what of fasting?
Intermittent Fasting Women: Should we Fast?
The few studies that exist point towards no.
It is not definitive, since the literature is so sparse, and it necessarily differs for women who are overweight versus normal weight (and who have different genetic makeups), but when it comes to hormones, women of reproductive age may do well to err on the side of caution with fasting.
What follows first is a brief review of what can be gleaned in sex-specific responses to fasting in animal studies. Afterwards I talk about what has been concluded by the few relevant human studies.
Mice & Rats
First up is a study that demonstrates the hippocampal changes of calorie restriction and intermittent fasting for both male and female rats. In this study, they do alternate day fasting, which entails free eating on one day and a fast day on the next.
The study found that brain states while fasting were different for male and female rats. For male rats the change in hippocampus size, hippocampal gene expression, and ambulatory behavior was the same no matter what kind of restricted diet they were on – but for female rats, the degree of change in brain chemistry and in behavior was directly proportional to degree of calorie intake, demonstrating the unique sensitivity of female rats to the starvation response.
” The organization of the females’ response to the energy restricted diets is suggestive of some underlying mechanism that may allow for an organized, pre-programmed, response to enhance survival in times of food scarcity. Comparatively, the males’ genetic response was less specific, suggesting that the males respond to a general stressor but they seem to lack the ability to discriminate between a high energy and low energy stressor.”
Moreover, “IF down-regulated many gene pathways in males including those involved in protein degradation and apoptosis, but up-regulated many gene pathways in females including those involved in cellular energy metabolism (glycolysis, gluconeogenesis, pentose phosphate pathway, electron transport and PGC1-α), cell cycle regulation and protein deacetylation.” In this study, both male and female rats gained small amounts of weight on IF diets.
For female rats, even in the most innocuous form of restriction–intermittent fasting–significant physiological changes take place. Male rats do not experience as dramatic hippocampal and general brain chemistry change as female rats do, and their behaviors, specifically their cognition and their dirunal and nocturnal activity, do not change.
Female rats, on the other hand, “masculinize.” They stop ovulating and menstruating. They become hyper-alert, have better memories, and are more energetic during the periods in which they are supposed to be sleep. Theoretically, according to these researchers, this is an adaptive response to starvation. The more the female rats need calories– or at least the more their bodies detect a “starvation” state– the more they develop traits that will help them find food. They get smart, they get energetic, they get active, and they stop sleeping.
In a follow-up study conducted by the same researchers who explored the masculinzation of female rats, the researchers analyzed the gonadal transcription of male and female rats subjected to IF regimes.
This study found that male reproductivity up-regulates in response to metabolic stress. Female reproductivity down-regulates.
Completely opposite to the female rats becoming infertile while fasting, male rats become more fertile. In the researchers’ own words: “our data show that at the level of gonadal gene responses, the male rats on the IF regime adapt to their environment in a manner that is expected to increase the probability of eventual fertilization of females that the males predict are likely to be sub-fertile due to their perception of a food deficient environment.”
In the final relevant IF rat study I could find, researchers subjected rats to the same diets– to 20 and 40 percent Calorie-Restricted (CR) diets, as well as to alternate-day fasting diets, and monitored them over the long term for hormonal responses. The results were striking. Below is the abstract in full because it’s so powerful:
Females and males typically play different roles in survival of the species and would be expected to respond differently to food scarcity or excess. To elucidate the physiological basis of sex differences in responses to energy intake, we maintained groups of male and female rats for 6 months on diets with usual, reduced [20% and 40% caloric restriction (CR), and intermittent fasting (IF)], or elevated (high-fat/high-glucose) energy levels and measured multiple physiological variables related to reproduction, energy metabolism, and behavior.
In response to 40% CR, females became emaciated, ceased cycling, underwent endocrine masculinization, exhibited a heightened stress response, increased their spontaneous activity, improved their learning and memory, and maintained elevated levels of circulating brain-derived neurotrophic factor. In contrast, males on 40% CR maintained a higher body weight than the 40% CR females and did not change their activity levels as significantly as the 40% CR females. Additionally, there was no significant change in the cognitive ability of the males on the 40% CR diet.
Males and females exhibited similar responses of circulating lipids (cholesterols/triglycerides) and energy-regulating hormones (insulin, leptin, adiponectin, ghrelin) to energy restriction, with the changes being quantitatively greater in males. The high-fat/high-glucose diet had no significant effects on most variables measured but adversely affected the reproductive cycle in females. Heightened cognition and motor activity, combined with reproductive shutdown, in females may maximize the probability of their survival during periods of energy scarcity and may be an evolutionary basis for the vulnerability of women to anorexia nervosa.
They also found this:
The weight of the adrenal gland was similar in rats on all diets; however, when normalized to body weight CR and IF diets caused a relative increase in adrenal size, the magnitude of which was greater in females, compared with males.
The testicular weight was unaffected by any of the diets. In contrast, both CR diets and the IF diet caused a decrease in the size of the ovaries.
And this, bearing in mind that “daytime” for nocturnal rats is “nighttime” for humans:
The daytime activity of females was doubled in response to IF, whereas the IF diet did not affect the activity level of males. Nighttime activity levels of males and females were unaffected by dietary energy restriction.
Uterine activity was monitored daily with vaginal smear tests; cyclicity was scored as regular, irregular, or absent. The mild energy-restriction diets (20% CR and IF) significantly increased the proportion of animals displaying irregular cycling patterns, whereas the 40% CR animals displayed an almost complete loss of estrous cyclicity.
In males, corticosterone levels were elevated only in response to the 40% CR diet, whereas in females corticosterone levels were significantly elevated in response to all three energy-restriction diets, suggesting a relative hyperactivation in females of the adrenal stress response to reduced energy availability.
For lipids, all the rats did well: “Collectively, these data suggest that atherogenic profiles of both males and females are improved by dietary energy restriction.” Interestingly, too, as they pointed out in the abstract, human females also perform cognitively much “better” (memory and alertness) on CR and IF diets than on normal feeding schedules.
There are of course some caveats to this study: A) They are rats. B) They are somewhat “metabolically morbid” rats, which may make them more susceptible to disease. C) The rats were allowed to eat ad libitum on the IF days, but they simply did not meet their caloric requirements this way. So while it is a somewhat natural form of IF, it is still calorically reduced, such that that must be taken into account when gasping in horror at the hormonal responses of IF-ing female rats.
The Few Human Studies
I mentioned above that through the same review that MDA used as a “great overview” of IF benefits for all sexes, I found harmful metabolic effects for women subjected to alternate-day fasting regimes.
This is the study:
Heilbronn et al found that with IF, insulin sensitivity improved in men (21 participants) but not in women (20 participants): after three weeks of alternate day fasting, insulin response to a test meal was reduced in men. Women experienced no significant change. “It is interesting that this effect on insulin sensitivity occurred only in male subjects,” they report.
With respect to other health markers female health actually declined, specifically with respect to glucose tolerance:
“Another diabetes risk factor that has shown a sex-specific effect is glucose tolerance. After 3 weeks of ADF, women but not men had an increase in the area under the glucose curve. This unfavorable effect on glucose tolerance in women, accompanied by an apparent lack of an effect on insulin sensitivity, suggests that short-term ADF may be more beneficial in men than in women in reducing type 2 diabetes risk. ” The opening line of their discussion reads: “Alternate day fasting may adversely affect glucose tolerance in nonobese women but not in nonobese men.”
In a follow up study, Heibron et. al studied the effects of alternate-day fasting on cardiovascular risk. When human subjects fasted on alternate days for another three week period, circulating concentrations of HDL cholesterol increased, whereas triacylglycerol concentrations decreased. This is a good thing. However, the shifts in lipid concentrations were shown to be sex specific: ie, only the women had an increase in HDL-cholesterol concentrations, and only the men had a decrease in triacylglycerol concentrations.
The most recent review of IF agrees with my conclusion: sex-specific differences in metabolism exist and need to be studied further.
This study of alternate day fasting included 12 women and 4 men. In eight weeks, body weight decreased by about 10 pounds, and body fat percentage decreased from 45 to 42. Blood pressure decreased, total cholesterol, LDL cholesterol, and traicylglycerol decreased. These people were significantly obese, which limits the results of this study to an obese population. However, “perimenopausal women were excluded from the study, and postmenopausal women (absence of menses for >2 y) were required to maintain their current hormone replacement therapy regimen for the duration of the study.” (Their words, my emphasis)
The one, big study of intermittent fasting conducted on men and women looked at differences between isocaloric feeding schedules: 3 meals/day feeding versus 1 meal/day.
The study focused on body weight composition, blood pressure, and body temperature in subjects. Subjects were fed isocalorically either one meal each day or three meals each day. All subjects were between 40 and 50 years old (excluding women of reproductive age), and between BMIs of 18 and 25. They ate, so far as I can tell, a healthy diet with 35 percent fat, PUFA < MUFA < SFA. Only 15 of the original 69 completed the study (which goes to show just how fun everyone thought fasting was). As for the results,
“Systolic and diastolic blood pressures were significantly lowered by ≈6% during the period when subjects were consuming 3 meals/d than when they were consuming 1 meal/d. No significant differences in heart rate and body temperature were observed between the 2 diet regimens. Hunger was enormously larger in the one meal/day than in the three meals/day group. “The 1 meal/d diet was significantly higher for hunger (P = 0.003), desire to eat (P = 0.004), and prospective consumption (P = 0.006) than was the 3 meals/d diet. Feelings of fullness were significantly (P = 0.001) lower in the 1 meal/d than in the 3 meals/diet.” Body weight dropped only four pounds after several months. Cortisol dropped, but Total, LDL, and HDL cholesterol were 11.7%, 16.8%, and 8.4% higher, respectively, in subjects consuming 1 meal/d than in those consuming 3 meals/d.
In sum: patients on the one meal/day regiment were unhappy, hungry, lost a little bit of weight, increased cholesterol. This was a small sample, included somewhat menopausal women, and all people of normal body weight.
Intermittent Fasting Women: In Conclusion
All that being said, that’s it. That’s all that exists! Women don’t have much to go on.
There are a few rodent studies. They found that when alternate-day fasting,female rats and found significant negative hormonal changes occurring in the females.
There are even fewer human studies. Human studies on alternate day fasting have not been conducted on women of reproductive age at all, nor have any studies analyzed reproductive responses to fasting.
Moreover, the few studies that have been conducted on non-obese women have demonstrated that their metabolic responses are not nearly as robust as those of men, and may in fact be antagonistic to their health.
This post has focused on sex-specific responses to fasting, specifically intermittent fasting women. Another important distinction to make is between different body weights. Overweight and obese patients appear to experience significant improvements with IF regimes, but normal weight patients do not show the same across-the-board benefits. For women this may be a particularly sensitive issue. Overweight women may experience metabolic benefits, whereas normal weight women do not. I suspect that that may roughly be the case, but who knows. Honestly, no one at this point.
The practical solution, then, I believe, is to look at options, to be honest about priorities, and to listen to one’s body with awareness and love.
Is fasting worth trying if a woman is overweight and trying to improve her metabolic markers, and so far hasn’t had much success? Perhaps. Should it be undertaken if a woman is of normal weight? What if she is a light sleeper? What if her periods begin to dysregulate? Or stop? What if she starts getting acne, getting a stronger appetite, or losing her appetite altogether? These things happen, and I see them in women who fast and contact me time and time again.
We women (people!) should be honest with ourselves about our priorities, and act constantly with our mental and physical health foremost in our minds. All women are different. But the literature is so sparse in this area that we cannot make any real statements or predictions about the effects of fasting, other than that we just don’t know, and that we should continue to emphasize the centrality of awareness, caution, and loving nourishment in moving forward.
IF is one realm in which the female body has unique characteristics and needs that demand attention. There are boatloads of others. If you’re interested in reading about the collective set of them and learning how to optimize female skin, weight loss, and hormone balance, for a few examples, you could do worse than my best-selling book, Sexy by Nature, here.
And that’s a wrap! What do you think?
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?
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 Skin, could 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.
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.
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.
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 Options, The 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!
Sex is one of the most important things we do.
Desiring sex, therefore, is one of the most important things we can feel.
According to a Journal of the American Medical Association (JAMA) study reported on in February 1999, about 43 percent of women (compared to 31 percent of men) suffer sexual inadequacy for one reason or another. Interestingly, this is thought to actually underestimate the real level of sexual dysfunction in the U.S. Yikes.
What follows is a description of the physiological components of female libido, how to maximize those components, and then a discussion of the psychosocial components. The psychosocial components are the trickiest to get a handle on, but they are also treatable with proper therapy (if necessary), love, empowered embodiment, and raging, well-deserved confidence.
Need more information to find you raging, well-deserved confidence? Check out my bestselling book on women’s health.
What factors play a role in female libido?
Specific foods are not in reality relevant for female libido, except for how they may temporarily increase testosterone levels (a la oysters). Instead, all of the physiological factors that influence female libido boil down to long-term sex hormone levels and balance.
First, absolute levels of hormones are important: for example, the greater amount of sex hormones in the blood, the sexier a woman will feel.
Secondly, balance is also crucial. For example, estrogen is not typically considered important in arousing a woman’s sex drive. But having clinically low estrogen levels–that is, estrogen levels below the baseline for proper sexual function–prohibits absolutely any kind of sensation a woman might have in her clitoris. That’s scary.
This is the effect that all hormones have on sex drive, generally:
1.Testosterone: Increases female libido. Testosterone is the hormone primarily responsible for sex drive in both men and women. When women with hypoactive sexual dysfunction disorder are treated with testosterone, for example, they often experienced increased sex drive.
Higher testosterone levels also enlarge the clitoris (good to know if yours is shy!), but unfortunately if other hormone levels do not rise along with testosterone, symptoms of hyperandrogenism such as facial hair and acne may manifest themselves. For this reason, testosterone supplementation is not an advisable method of increasing female libido.
2. Estrogen: Crucial at baseline for sexual function. It is also the primary hormone responsible for vaginal lubrication. However, estrogen is a testosterone antagonist, so the more estrogen a woman has in her system, the less testosterone she has available to pump up her libido. Estrogen dominance therefore is one of the greatest culprits in contemporary Western sexual dysfunction.
3. Progesterone: Another testosterone antagonist. Having elevated progesterone levels relative to the rest of the sex hormones prevents a woman from achieving orgasm.
4. Prolactin: Not talked about very often, since it’s primary role is in lactation, but it is also involved in pituitary-ovary signalling. Increasing prolactin levels increase vaginal lubrication and sex drive.
5. Luteinizing Hormone: Highly correlated with sex drive. LH is a pituitary hormone that triggers ovulation in a woman. Many researchers believe LH is one of the primary game-makers in sexual arousal.
Because of the role each of these hormones play in female libido, the menstrual cycle demonstrates a clear pattern in fluctuating libido for most women.
So how does the menstrual cycle affect female libido?
Testosterone levels rise gradually from about the 24th day of a woman’s menstrual cycle until ovulation on about the 14th day of the next cycle, and during this period women’s desire for sex has been shown, in general, to increase consistently. The 13th day (the cusp of ovulation) day is generally the day with the highest testosterone levels. It is also the day on which LH spikes. Ovulation, therefore, and no surprise here, is typically the randiest time of the month for a woman. In the week following ovulation, the testosterone level is the lowest and as a result women experience less interest in sex.
During the week following ovulation, progesterone levels increase, and this often results in a woman experiencing difficulty achieving orgasm. Although the last days of the menstrual cycle are marked by a constant testosterone level, women’s libido may boost as a result of the thickening of the uterine lining which stimulates nerve endings and makes a woman feel aroused.
Also, estrogen levels are at their lowest throughout menstruation and into the follicular phase (the first two weeks of the cycle) so women experience the least vaginal lubrication at this time. Because testosterone and estrogen are both increasing, however, sexual desire is ramping up again in time for ovulation.
What factors influence these hormone levels, and how do we make the best of them?
Estrogen Dominance: As I mentioned above, estrogen is a testosterone antagonist. When estrogen levels are too high relative to testosterone levels, female libido plummets. Women can become estrogen dominant by consuming too much soy (since soy acts as an estrogen in the body), by being overweight (since estrogen is produced in fat cells; see my book on healthy weight loss here), and by being stressed out (since estrogen can act as part of the inflammatory response). Women with estrogen dominance often experience symptoms of PMS, too, which does nothing to help libido.
Birth Control Pills: Birth control pills are another way that women can become estrogen dominant. But that is not the only way they negatively effect female libido. Progesterone levels are often elevated out of the normal range on birth control pills, and testosterone sometimes plummets.
Yet the effects of birth control pills on women is wholly unpredictable. Increasing levels of one hormone might decrease another, or might increase them exponentially, depending on how the woman’s HPA axis and ovarian feedback mechanisms work. Women also experience a whole range of side effects on birth control pills ranging from acne to suicidal depression. Birth control pills are no laughing matter, and their effect on female libido is wide ranging.
All that said, since birth control really is so unpredictable, birth control can play a stimulatory role on female libido, especially if she has chronically low levels of sex hormones in her blood. Some women feel like a million bucks on estrogen pills. If that is the case, however, birth control pills are only putting a band-aid on the problem, rather than solving it at its core. That often requires looking at physiological problems that deplete sex hormone levels such as low body fat, stress, and energy deficits.
See Birth Control Unlocked for more information on birth control options outside of the pill.
Testosterone blockers: Some women get on testosterone blockers to help them with symptoms of hyperandrogenism or problems in their menstrual cycles that come from high testosterone production. However, blocking testosterone is as good as eliminating it entirely. Spironolactone and flutamide are the two most commonly used testosterone blockers.
Hypothyroidism: Up to ten percent of women have clinical or sublicinical low thyroid issues. Hypothyroidism is significantly linked to low libido. T3, the active form of thyroid hormone, is crucial for the proper functioning of cells and organs. Without T3, the reproductive system barely manages to inch forward. Sex hormones suffer greatly, both at the ovarian level as well as in production at the hypothalamic and pituitary levels.
Hypothyroidism is caused by a wide variety of problems. Hashimoto’s thyroiditis is a an autoimmune condition that accounts for the vast majority of Western hypothyroidism. This can be mitigated by eliminating modern toxins, specifically wheat, dairy, and omega 6 vegetable oils, from the diet, and also by paying attention to gut health with gut-healing diets such as the GAPS diet or the one I recommend in Sexy By Nature.
Iodine-deficient diets can cause hypothyroidism. This used to be uncommon in western countries, since western countries iodize their salt, but sea salt often does not contain much iodine in it. Moreover, many Americans are now eschewing salt for “health benefits” (this is misguided), so their iodine levels are suffering. The solution to this is to consume iodized salt, or to perhaps supplement with kelp for a while. Iodine supplementation is tricky, however, and should build up slowly a la the recommendations of Paul Jaminet.
High intake of raw cruciferous vegetables can hurt an already suffering thyroid gland. Yet more importantly, low-carbohydrate diets contribute to hypothyroidism. Glucose is required for the conversion of T4 to T3 in the liver, so without adequate glucose supplies the body’s thyroid functioning suffers. This is a problem that many paleo women wrestle with. Adding just 50 or 100 grams of starchy carbohydrate to a daily diet, however, can increase energy, improve sleep quality, improve quality of skin and hair, and also boost reproductive function.
Repairing sub-clinical hypothyroidism has also been shown to remove ovarian cysts and help anovulatory women both ovulate and menstruate. For more on hypothyroidism, see Chris Kresser‘s work.
Stress: Stress is a psychological libido-killer, but it also has a physiological analog. When stressed, the body produces cortisol. Cortisol has a negative feedback effect on the hypothalamus, and it can inhibit all of the hormonal signalling that comes out of the hypothalamus. The hypothalamus is responsible for inciting pituitary function, so stress plays a very real role in inhibiting reproductive function. As many as five percent of women suffer reproductive symptoms of chronic stress.
Low Dopamine: Dopamine is the most important neurotransmitter for sexual prowess and reproductive function. Fortunately, dopamine deficiencies are very often corrected with the introduction of exercise into someone’s daily life. Almost nothing increases dopamine levels as well as exercise does. (Although sex also has potent dopamine-releasing effects: skin-to-skin contact shoots dopamine levels through the roof. But then dopamine levels plummet post-orgasm, creating withdrawal-type symptoms. This is how the body reinforces sexual behavior.)
Some women have reported to me personally the return of menstruation from amenorrhea after resuming regular sexual activity. They were as surprised as I was. Yet perhaps we should not have been so surprised. Dopamine is a potent neurotransmitter and, coupled with serotonin, can significantly up-regulate sex hormone production.
Low serotonin: Though excess serotonin has been linked to decreased arousal, serotonin also increases prolactin levels. Prolactin is important for vaginal lubrication and for sexual arousal. Ways to increase serotonin levels include adequate protein ingestion (.5 g/lb of lean body weight each day), adequate sun exposure, and perhaps most important of all, adequate sleep.
Low Body Fat/Excess Exercise/Energy Deficits: These three phenomenon almost always manifest in tandem. Yet the end result is the same: with low body fat, with excess exercise, and with caloric deficits, the body detects starvation. Leptin levels plummet, and the hypothalamus stops thinking that the body is sufficiently fed. Without leptin, the entire pituitary sex hormone cascade is not enacted. No LH, no testosterone, no estrogen, no prolactin, no progesterone. Body fat is unquestionably crucial for all reproductive function. Female libido just happens to be the one that’s the most fun to explore once proper body fat levels are restored.
Psychological factors effecting female libido:
There remain the psychological aspects to increasing female libido. And of them there are many. Perhaps a woman’s libido has been killed by a negative sexual experience. Or perhaps the woman is too stressed out by other factors to care about sex…or perhaps sexual relations between two people are strained because they can’t stand each other outside of the bedroom even more than they can’t stand each other inside the bedroom. Perhaps a woman’s lover is an ugly lump.
Many of those factors are outside my realm of expertise.
Some of them are inside of it, however, and fiercely.
Women need first to think they are sexy. I am so tired of women comparing themselves to others, and always thinking that beauty is relative. Beauty is not relative. It is everywhere. And in everyone. If she is beautiful it does not mean that you are less so. Period. I don’t care if you have a chubby stomach. I don’t care if you think your hair is boring. I don’t care if your right boob is larger than your left. Not a single other person cares either. At all. The only person who cares is you. No one wants to make you “perfect” but you.
You don’t have a single thing in the world to apologize for. No one is looking for apologies.
Instead, people are looking for statements. They are looking for fun. They are looking for inspiration, for character, and for life.
In that way, what other people want from each other is not necessarily for them to meet some ridiculous standard but instead to make them feel good. Whether that’s through sharing of your self-love, through your wicked personality, or through your liberated and unapologetically wild fantasies is totally up to you. The point being that confidence and self-love are the most important factors for actually being attractive. Sure, classic “looks” may follow, but only after a woman has convinced others that she is worth looking at.
Not a single person in the world wants to sleep with an apologizer. “Sorry, I don’t like who I am,” does not necessarily read like a 5-star resume. People won’t be throwing themselves at that. What they will instead throw themselves at is: “I am different from what you expect. But that’s an asset. I am worthy like you wouldn’t believe, and I am going to rock your world.”
Confidence is key. Beauty is key. And the thing is– damnit–it’s not faked confidence. It’s not faked beauty. You really are beautiful. You really are unique. You really are a natural, sexual, alive, vibrant woman. You do not have a thing in the world to apologize for. You are who you are, and you love being yourself, and you can share yourself powerfully and joyfully with others through sex.
This kind of self-love is why people get laid. It’s not because they have perfect torsos and racks as big as wombats. It’s because they have hot souls.
So confidence is important. So important, I wrote a book on how to find it through food and lifestyle. There’s one other crucial aspect I can speak to. It’s this:
SEX IS AWESOME.
IT IS NOT DIRTY.
Look. Sex is natural. Sex is so natural, in fact, that it’s the very reason we all exist. And sexual desire is natural. It is, by extension, the very reason we all exist. For that reason, along with many others, there is not a single immoral aspect to having sexual desire or having sex. Period.
And sex is not gross.
And a woman’s desire is not gross.
And a woman’s vagina is not gross.
And a woman having sex is not gross and not a slut.
Or maybe she is a slut, but that’s cool because that’s natural, too.
Men who don’t understand any of that are not real men.
The whole point being that American culture is a culture in which sexuality, and female sexuality in particular, is a dirty thing.
That is not okay.
It’s so not okay.
It is, in fact, plain old wrong. Sex is natural. If a woman (or man!) wants to be delighting in it, and more power to her. She is embracing her natural body. She is embracing her natural desires. She is owning her own confidence. And she is exalting in the vibrancy of her very existence.
If that’s not hot, I don’t know what is.
High fives for sex!
Vitamin D is one of the most important vitamins, and one we are most likely to be deficient in as Americans. Some estimates say anywhere from 80-90% of the population may have sub optimal levels of Vitamin D in the blood.
This is worrying because Vitamin D plays such an important role in health. From reducing autoimmune issues and inflammation, to preventing disease, Vitamin D is a nutrient we shouldn’t neglect.
Here are 3 important reasons to make sure you’re getting enough, and even supplement if you are at risk for deficiency.
#1 Immune System
The major reason to supplement with Vitamin D is its importance in the immune system- with everything from upper respiratory infections to cancer.
Vitamin D has a protective effect on the immune system, helping T-cells and B-cells to to fight immune threats while also preventing autoimmune issues.
Several autoimmune diseases (including Lupus and MS) have a high range of deficiency and supplementation with Vitamin D has been shown to improve health in these individuals.
Having sufficient Vitamin has been shown to reduce upper respiratory infections in both summer and winter. Those with deficiencies of Vitamin D are found to suffer from upper respiratory infections much more often, even accounting for the seasons.
Fun fact: before they knew about Vitamin D, tuberculosis patients were sent to sanitariums. They were prescribed lots of sunlight which they believed cured the tuberculosis.
People have also taken cod liver oil for ages for its health benefits. Cod liver oil is a great source of Vitamin D.
Vitamin D also reduces inflammation in the body, making it important for people with many health conditions like diabetes, infertility, autoimmunity, or metabolic syndrome.
#2 Bone Health
It’s a well accepted fact in the medical community that Vitamin D is just as important for bone health as calcium because of the role it plays as a calcium cofactor.
Vitamin D helps maintain calcium homeostasis in the body. That’s why so many calcium supplements now also have Vitamin D.
Vitamin D promotes mineralization of the collagen matrix in bone.
Both women and men commonly don’t get enough calcium or Vitamin D through the diet and may need to consider supplementation.
Another important Vitamin for bone health, and still relatively unknown, is Vitamin K2. Many supplements don’t contain all three and may not be as effective.
The last and best reason to supplement with Vitamin D is that it promotes happiness and emotional stability.
It is very common for people to feel sad, depressed, or anxious during the winter and to feel happier in summer.
Likewise, those who work outside or have ample sunshine time during the day report happier moods than those stuck in dark offices all day.
There’s something to this besides the fun of swimming and eating ice cream.
Vitamin D, the sunshine vitamin, is primarily processed through the skin rather than through food. During the summer, we wear less and tend to spend more time outdoors, and this increases the amount we produce. In turn, we get sick less often and feel altogether happier.
Vitamin D deficiencies are associated with lower mood and decreased cognitive function.
Since Vitamin D is a fat soluble vitamin, it’s important not to take too much, since the body does store some.
However, Vitamin D needs range depending on specific conditions. Recommendations for average adults age 19-50 are about 600 i/u a day to prevent deficiency. This can come from sunlight, diet, or supplements, but it may take up to 1500 or 2000 i/u a day, depending on the individual, to keep blood levels about the recommended 30 ng/ml.
Obese individuals, those with active infections, or those taking certain medications may need twice as much Vitamin D. Excess fat actually shuffles Vitamin D into the fat so that the body cannot use all of it.
Many in the natural health community recommend even higher levels. They probably have a point since with the use of sunscreen, we may not be getting enough Vitamin D even during summer and food provides relatively little.
A Vitamin D blood test is relatively inexpensive and easy to order. I’d recommend asking your doctor to run it the next time you have blood run so you can see where you’re at.
Also recommended is to get at least 30 minutes of direct sunlight to a majority of skin per day.
If that’s not possible, I recommend taking a supplement like this one which contains Vitamin D, A, and K, all necessary cofactors. Find it here.
Be careful if you also take other supplements or a multivitamin as these often contain Vitamin D as well and make sure you aren’t taking too much.
When looking for a vitamin D supplement, look for Vitamin D3, the form that is best absorbed by the body.
Do you take Vitamin D? How has it helped you?
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.
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.
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.
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
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.
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!