The Inside-Out Approach
If you’ve been dealing with stubborn breakouts, especially along your jawline or cheeks, and nothing seems to work—it’s time to stop blaming your skincare routine. The real culprit might be deeper: your hormones, insulin levels, and liver function.
Hormonal acne isn’t just about excess oil; it’s a signal that your body is out of balance. Let’s break it down and talk about how you can finally get your skin back on track.
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Why Is Your Skin Breaking Out?
When hormones like testosterone and DHEA-S run high, they crank up your skin’s oil production, leading to clogged pores and inflammation. But that’s just part of the story. Other factors like insulin resistance, liver function, and stress all play a role in hormonal acne.
Key Hormonal Acne Triggers:
✅ High androgens (like DHEA-S and free testosterone) → more oil = more acne
✅ Insulin resistance → triggers androgen production & inflammation
✅ Liver stress → poor hormone detox = hormone buildup
✅ Chronic stress → raises cortisol, which throws everything off balance
✅ Nutrient deficiencies (zinc, magnesium, omega-3s) → weak skin barrier & more inflammation
Even if your bloodwork looks "normal," small imbalances in these areas can be enough to keep your skin stuck in an acne cycle.
Case Study A: The Fit & Healthy Woman with Persistent Acne
Sarah, 29, ate a clean diet, worked out regularly, and still struggled with deep, painful jawline breakouts.
Her labs showed:
Fasting insulin of 7 (technically “normal” but higher than optimal)
DHEA-S of 275
Elevated ALT and AST (liver enzymes)—a sign that her liver was under stress.
After tweaking her diet, adding in myo-inositol for insulin sensitivity, and supporting her liver with NAC and cruciferous veggies, her skin started clearing up in weeks
How Insulin Resistance Fuels Acne
Your insulin levels don’t just affect blood sugar—they also impact your skin.
When insulin is even slightly high, it:
❎ Increases DHEA-S, leading to oilier skin
❎ Decreases SHBG, freeing up more acne-triggering testosterone
❎ Drives up inflammation, making breakouts worse
❎ Triggers post-meal blood sugar spikes, keeping the acne cycle going
Even if your fasting insulin is “normal,” post-meal spikes can still wreak havoc.
The goal? Keep insulin stable to prevent hormonal chaos.
Case Study B: The Woman with Acne & Fatigue
Jessica, 32, was constantly tired and dealing with acne flares before her period. Her liver enzyme ALT was slightly elevated, suggesting sluggish detox pathways.
By cutting back on processed foods, focusing on protein and fiber to stabilize her blood sugar, and using liver-supportive supplements like milk thistle and NAC, her skin calmed down, and she felt more energized.
Liver Detox & Hormonal Acne: What You Need to Know
Your liver processes hormones, toxins, and inflammatory byproducts—and if it’s not working optimally, all that junk builds up in your system, leading to:
❎ Increased androgens = more oil production
❎ Poor estrogen metabolism = worsening hormonal acne
❎ Slow detox pathways = acne-prone, inflamed skin
Supporting your liver can make a huge difference.
5 Steps to Clear Your Skin from the Inside Out
-1- Balance Blood Sugar & Lower Insulin
Eat protein & fiber at every meal to prevent blood sugar spikes
Try myo-inositol—shown to improve insulin sensitivity & reduce DHEA-S
Cut back on refined carbs & dairy, which can spike insulin
Drink apple cider vinegar before meals for better glucose control
Add flaxseeds & chia seeds for fiber support
-2- Support Liver Detox
Eat cruciferous veggies (broccoli, kale) to help detox hormones
Take NAC to support liver function & lower inflammation
Drink spearmint tea—shown to reduce androgens naturally
Reduce toxins (plastics, synthetic fragrances) to lighten your liver’s load
Use milk thistle for additional liver support
-3- Reduce Androgen-Driven Acne
Take zinc (30mg daily)—reduces oil production & inflammation
Try DIM—helps balance estrogen & testosterone
Use omega-3s—lowers inflammation & regulates hormones
Manage stress—adaptogens like Ashwagandha can lower DHEA output
Exercise smartly—strength training improves insulin sensitivity
-4- Upgrade Your Skincare Routine
Use niacinamide for oil control & inflammation
Apply azelaic acid—great for hormonal breakouts & post-acne marks
Skip harsh cleansers—gentle is better!
Try a clay mask weekly to absorb excess oil
Balance your skin microbiome—a healthy microbiome is key for clear skin. Using probiotic skincare like BioJuve helps restore beneficial bacteria, reduce inflammation, and support your skin’s natural defenses against acne-causing bacteria. This inside-out approach works synergistically with your diet and lifestyle changes.
-5- Prioritize Sleep & Stress Management
Aim for 7-9 hours of sleep—poor sleep = cortisol spikes = acne
Take magnesium glycinate before bed to relax & stabilize blood sugar
Limit caffeine, especially in the afternoon, to avoid stress hormone surges
Frequently Asked Questions (FAQs)
Does hormonal acne mean I have PCOS?
Not necessarily! PCOS is one cause, but many women with hormonal acne don’t have PCOS. Insulin resistance, liver sluggishness, and stress hormone imbalances can also drive breakouts.
Can supplements alone fix my acne?
While supplements help, they work best alongside diet, stress management, and skincare changes. Think of them as a tool, not a magic bullet.
How long does it take to see results?
Most people notice changes in 4-8 weeks, especially when addressing insulin resistance and liver health.
Hormonal acne isn’t just about what you put on your skin—it’s about what’s happening inside your body. By balancing insulin, supporting your liver, and managing stress, you can get to the root cause of breakouts and finally achieve clear, healthy skin.
👉 Want a customized plan? Book a consultation for personalized hormone testing and acne solutions in San Diego & Southern California!
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*Dr. Francesca works only with patients physically located in California.*
*Disclaimer: Although I am a doctor, I may not be your doctor. The information contained within the pages of this site is for educational purposes only and should not be used to treat conditions. Please consult with your doctor before implementing any of the treatments, diets, supplements, etc. mentioned in this blog.*
Some links in these blog posts are affiliate links, which means I might earn a small commission if you make a purchase—at no extra cost to you! It’s a little way to support my practice while you shop smarter. For all the details, check out my Affiliate Disclosure.