Although other hormones (e.g., pituitary and adrenal) influence sebaceous gland production of sebum, androgens exert the most control in both males and females.² Hormone imbalances, especially androgens, trigger sebum production that the glands cannot secrete fast enough, which leads to blockages in the hair follicle.³

Acne is most common during puberty when an increase in androgen hormones (e.g., testosterone, dihydrotestosterone, and dehydroepiandrosterone sulfate) causes the follicular sebaceous glands to enlarge and make more sebum, which then gets trapped under unshed skin cells that clog pores .¹ Androgens also prolong the inflammation that accompanies acne.³

Hormonal activities (e.g., menstrual cycles or hormonal disorders like polycystic ovarian syndrome ) may trigger acne in some women by increased or unmasked androgen expression.^1,3 As estrogen hormone levels drop when women approach menopause, for example, the effects of androgens like testosterone become more pronounced and stimulate sebum production.³ Combining the increases in androgens and sebum with the decrease in estrogen’s anti-inflammatory effects can makes the years approaching menopause ripe for the development of acne and accompanying inflammation.³

Other non-androgen hormones linked to acne include insulin and insulin-like growth factor 1 (IGF-I). Dysregulation of these hormones can cause insulin resistance and stimulate 5α-reductase activity. This is important because the 5α-reductase enzyme converts testosterone to dihydrotestosterone, which promotes androgen activity in the skin—including the increased sebum production associated with acne. Researchers suggest that the influence of insulin and IGF-1 on androgens may explain some of the dietary effects of milk and high-glycemic index foods on acne.⁴