How Hormones Drive Acne - and What That Means for Treatment

Not all acne is the same, and one of the most common reasons treatment doesn't work is that the wrong driver is being targeted. For a significant number of people - particularly women - hormones are behind the pattern. Here's how that works and what it actually changes about treatment.

The Hormone-Acne Connection

The sebaceous glands - the oil-producing glands attached to every hair follicle - are directly sensitive to androgens. Androgens are a group of hormones that includes testosterone and DHT (dihydrotestosterone), present in everyone but at different levels depending on sex, age, and individual variation.

When androgen levels rise or when the sebaceous glands are particularly sensitive to androgens, sebum production increases. More sebum means more of the oily environment that C. acnes bacteria feed on, more congestion in follicles, and a greater likelihood of inflammatory breakouts.

This is hormonal acne at its most basic: androgens tell the sebaceous glands to produce more oil than the follicle can clear, and the result is breakouts.

What Makes it Hormonal

The clearest sign that hormones are a significant driver is pattern. Hormonal acne tends to be cyclical - flaring predictably in the days before a period when progesterone is high and oestrogen is low, both of which shift the androgen balance. It tends to concentrate around the lower face: the jawline, chin, and sometimes the neck. Spots are often deeper, more painful, and slower to resolve than surface-level acne.

It also tends not to respond well to treatments that only target bacteria or surface congestion. Benzoyl peroxide and clindamycin can help manage the inflammatory component, but if the underlying sebum driver isn't addressed, new spots keep forming. This is why some patients find that topical antibiotics work for a while and then seem to stop - the bacteria are being managed, but the conditions that cause them to thrive are still in place.

How Treatment Changes

Addressing hormonal acne requires targeting sebum production itself - not just its consequences. There are two main approaches.

Topical spironolactone (found in Tretalone) is an androgen blocker. Applied to the skin, it reduces the effect of androgens on the sebaceous glands, directly lowering sebum production without the systemic effects of oral spironolactone. It's well suited to patients with clear hormonal patterns who want targeted treatment without systemic medication.

Oral spironolactone is sometimes prescribed by dermatologists for more severe hormonal acne. It works through the same mechanism systemically. This isn't a Nolla treatment, but if your pattern is severe and topical treatment isn't sufficient, it's worth a conversation with your clinician.

Retinoids are also relevant here: tretinoin and adapalene both reduce the size and activity of sebaceous glands over time, which lowers sebum production independently of the hormonal driver. This is part of why retinoid-based formulas are effective for hormonal acne even without a direct hormonal agent.

Tracking Your Pattern

If you think hormones are driving your acne, the most useful thing you can do is track it. Note where breakouts appear, when they appear relative to your cycle, and whether they're consistently cyclical or more random. This information is genuinely useful for your clinician -- it helps distinguish hormonal from other drivers and informs formula decisions. Your Nolla check-ins are a good place to record this.

The Bottom Line

• Androgens stimulate the sebaceous glands to produce more sebum -- the oily environment that acne-causing bacteria feed on
• Hormonal acne tends to be cyclical, concentrated around the lower face, and deeper and more painful than surface acne
• It often doesn't respond well to antibacterial-only treatments because the sebum driver isn't being addressed
• Topical spironolactone (in Tretalone) directly reduces androgen-driven sebum production without systemic effects
• Tracking your breakout pattern relative to your cycle is useful information for your clinician and can improve your treatment plan