Acne is a common skin condition often associated with the hormonal changes of puberty. However, it can persist or first appear in adulthood for many men. This persistent or adult-onset acne often has a strong connection to hormonal influences within the body. Understanding these factors is important for effective treatment.
Defining Hormonal Acne in Men
Hormonal acne in men typically presents as deep, painful lesions rather than superficial pimples. These include cysts (deep pimples without an opening) or nodules (large, firm, painful lumps under the skin). Such breakouts commonly appear on the lower half of the face, including the jawline, chin, and neck. It also frequently extends to the chest, shoulders, and back, areas where men have a higher density of oil-producing glands. This acne is rooted in hormone fluctuations or imbalances affecting skin processes.
These deep, inflamed lesions differentiate hormonal acne from more superficial forms like whiteheads or blackheads, which are less painful. While all acne involves hormones, “hormonal acne” specifically refers to breakouts directly influenced by shifts in hormone levels or the skin’s sensitivity to them.
The Central Role of Androgens
Androgens, often called male hormones, play a primary role in the development of acne in men. Testosterone and its more potent derivative, dihydrotestosterone (DHT), are the main culprits. These hormones stimulate the sebaceous glands (small glands beneath the skin) to produce sebum, an oily substance that lubricates the skin and hair.
When androgen levels are elevated, or when sebaceous glands are more sensitive to them, there is an overproduction of sebum. This excess sebum can mix with dead skin cells and clog hair follicles, creating an environment where bacteria, particularly Cutibacterium acnes, can thrive. This bacterial proliferation, combined with clogged pores, triggers an inflammatory response, leading to acne lesions.
DHT is particularly impactful, as it activates androgen receptors in sebaceous gland cells (sebocytes) and skin cells (keratinocytes). This disrupts normal skin cell shedding within the hair follicle, leading to abnormal keratinization and plug formation. This clogged, low-oxygen environment is ideal for C. acnes overgrowth, which breaks down sebum lipids, attracting immune cells and amplifying inflammation. Androgen activity can fluctuate due to various factors, contributing to periodic flare-ups of acne.
Other Hormonal and Internal Contributors
Beyond androgens, other internal biological factors and hormones can influence or worsen hormonal acne in men. Insulin-like Growth Factor 1 (IGF-1) is one such factor, as elevated levels of IGF-1 correlate with increased sebum production and acne severity. IGF-1 can also enhance the activity of androgen receptors, further contributing to the acne process.
Cortisol, often known as the “stress hormone,” is another contributor. Elevated cortisol levels, particularly during periods of chronic stress, can increase sebaceous gland activity and sebum secretion, thereby exacerbating acne lesions.
Genetic predisposition also plays a role in acne development. Individuals with parental acne are more likely to experience it, suggesting an inherited sensitivity of sebaceous glands or variations in skin processes. While rare, underlying medical conditions like adrenal gland disorders can directly cause hormonal imbalances that manifest as acne. These conditions can lead to overproduction of certain hormones, impacting sebum regulation and skin health.
External Factors Influencing Hormonal Activity
External lifestyle and environmental factors can indirectly affect hormonal balance and acne severity in men. Dietary choices, for instance, have been linked to acne. Diets high in glycemic index foods (e.g., refined carbohydrates and sugars) can lead to elevated insulin and IGF-1 levels, potentially stimulating sebum production and aggravating acne. Dairy intake has also been weakly associated with acne, with some studies suggesting a connection.
Chronic psychological stress is another external factor impacting the body’s hormonal environment. Prolonged stress increases the production of cortisol, which stimulates sebaceous glands and worsens acne. Certain medications can also alter hormone levels or skin processes, leading to acne. Anabolic steroids (often used for muscle building) are a notable example, as they can directly increase androgen levels and cause severe acne. Some anti-seizure drugs may also have similar effects.
Environmental toxins, particularly endocrine-disrupting chemicals (EDCs), are another external influence. EDCs can interfere with the body’s natural hormonal pathways, including those involving androgens and IGF-1, by mimicking hormones or blocking their receptors. For example, certain EDCs like bisphenol A (BPA) may upregulate genes involved in lipid production, potentially exacerbating sebum synthesis. Limiting exposure to such chemicals (found in some plastics and pesticides) may be a consideration.