199: The Many Hormonal Triggers of Acne w/ Vivien Allred, NTP, CNHC, BANT

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Acne is frustrating, especially when you can't pinpoint what's causing it. But did you know that your hormones — and not just sex hormones like estrogen and testosterone — can be a huge trigger for acne?

Or, listen on your favorite app: iTunes (Apple Podcasts) | Spotify | Stitcher | TuneIn | Subscribe on Android

My guest today is Vivien Allred, NTP, CNHC, BANT.

She studied to become a Naturopathic Nutritional Therapist after struggling with many health issues during early adulthood. Getting no answers from conventional medicine, Vivien decided to take her health into her own hands and is now thriving.

Her passion is to help other women identify and address the root causes of their symptoms, including acne, hair loss & period problems. Vivien provides a ton of health education on her social media accounts and website. She also hosts a women’s health podcast ‘Hormones in Harmony’ where she interviews expert guests in the healthcare & nutrition industry.

Join us as we talk about how hormones trigger acne.

Has your acne improved with hormone support? Tell me about it in the comments!

In this episode:

  • General connection between hormones and acne
  • Vivien's take on dairy
  • How is cortisol involved in acne?
  • What are androgens?
  • In women, how do high testosterone levels contribute to acne?
  • How is the thyroid related to acne?
  • Vivien's tip for relieving stress


“When people think hormones, they think estrogen, progesterone and testosterone, and they really do influence the skin, but there are other hormones like cortisol and insulin that can also be involved.” [1:28]

“I usually see high cortisol being the most problematic because when your body is pumping out cortisol from the adrenal glands, it's also coming out things like adrenaline and some of these androgens as well, like DHEAS and these things can increase sebum production in the skin.” [11:37]


Find Vivien online here

Healthy Skin Show ep. 034: Diet Solutions For Adult Acne w/ Brie Wieselman

Healthy Skin Show ep. 067: Best Stress Relief Tips For Skin Rashes (contains some different breathing exercises you could try)

Healthy Skin Show ep. 183: Adult Acne: Gut, Topical Products + Nutrient Issues w/ Vivien Allred, NTP, CNHC, BANT

The Upside of Stress: Why Stress Is Good for You, and How to Get Good at It by Dr. Kelly McGonigal

Download Vivien's FREE guide: Acne Root Causes

Jen's appearance on Vivien's podcast: Healing Chronic Skin Rashes from the Inside Out

Follow Vivien on Instagram | Facebook | YouTube

199: The Many Hormonal Triggers of Acne w/ Vivien Allred, NTP, CNHC, BANT FULL TRANSCRIPT

Jennifer: Hi, Vivien, thank you so much for being back with us on the Healthy Skin Show.

Vivien: Hey Jen. Good to be back.

Jennifer: Yes. So the reason that we're having this conversation is because we had so much to talk about the first time that we didn't even get through everything that I wanted to cover with you. So I wanted to have you back to talk more about the connection between all these different root causes and what could be driving acne issues, and if you guys didn't listen to Vivien's first episode, we'll put the link in the show notes, that way it's really easy to find. It would probably be a great precursor to this episode. But today I wanted to dig into this whole connection between hormones and acne because some of the things that you shared with me, and Vivien was kind enough to supply me with a nice list of things that she wanted to discuss with you guys and I just found the number of potential hormone connections, and when we say hormones, it doesn't necessarily have to mean sex hormones. There are a lot of different types of hormones, but so basically Vivien, what is the general connection between hormones and acne? And it's not just sex hormones, correct?

Vivien: Yeah. When people think hormones, they think estrogen, progesterone and testosterone, and they really do influence the skin, but there are other hormones like cortisol and insulin that can also be involved. But I think in some way, acne, there's always a hormonal component, but it doesn't need to be around menstrual cycle for example, if someone has acne all month long and people usually think hormonal acne is just on the lower part of the face, that's not always the case either. I think with any acne, there's always a hormone involved, but the most common ones I see would be, we'll start with insulin, because that can drive things like hormonal acne in terms of PCOS. So with PCOS, if you have acne as an adult woman, then there is a big likelihood that you might have PCOS because that is a big driver, but that's not always the case. There are other things like poor gut health that can be involved or nutrient deficiencies, but with… What was the one that I was talking about?

Jennifer: Insulin.

Vivien: Insulin. With insulin, that can drive testosterone and other androgens to be produced from the ovaries. So we all have testosterone as women. We all have androgens like DHEA, but when you have high insulin levels that triggers a certain layer of the ovaries called the theca, the theca cells to produce excess androgens. But with PCOS as well, androgens don't just come from the ovaries, they can also come from the adrenals. That would be something like DHEAS. So first rule in our roulette insulin issues, and that could be based on lab work or that can be based off symptoms. So in terms of blood work, sometimes it's not showing too much until someone is pre-diabetic or full blown, has full blown diabetes. So you can't always just look up blood work, but things to look up would be high or elevated fasting insulin or HB A1C or glucose levels or some common ones.

Vivien: For some of my clients, I have them do finger prick, blood glucose testing. So postprandial testing, and you can get some kits off Amazon, or there's some ones that you can put into your arms. Some new devices that are a lot easier, but a little bit more expensive because some people it's not first thing in the morning that the blood sugar is over range. If they went to the doctor's office, it would probably show normal it's after they eat. That's the problem.

Jennifer: Well, how long do you, can you just walk someone through generally speaking, how do you do that? What's the timeframe that you're looking at the numbers after eating and….Yeah-

Vivien: How long for?.

Jennifer: Yeah.

Vivien: Yeah. So I would start with 15 minutes after eating. It depends cause some people, the glucose spike, the highest spike only happens an hour after eating for some people it's within 20 minutes, I always say start at the 15 minute mark. When you have the, the implant into your arm to do the glucose test, that's a lot easier. So the continuous glucose monitor CGMs, you can basically like scam a device or your phone over the area and it's going to tell you something, rather than pricking your finger every 15 minutes, it's going to be way easier. I do probably every 15 minutes for up to two hours. And I know that's pretty intense. You don't need to do this every single day.

Vivien: I recommend doing like two to three full days of testing and then put the kit away and just go up based off symptoms because otherwise it gets a little bit too stressful, but that can give you really good insight as to how high your glucose is spiking, how fast your body is clearing the glucose from your body because if it's staying elevated for a long period of time, that could be a sign of insulin resistance and that could be something that's driving your acne, but you could also go based off symptoms.

Jennifer: Okay. And I wanted to just ask you quickly about diet because we talked about this previously with Brie Wieselman some of you have probably heard her episode and in that episode, Brie had specifically mentioned that she doesn't like dairy for folks who are struggling with PCOS, acne issues. Some people notice their acne will clear up entirely just from removing dairy, but, you said something to me before we started talking about dairy and I think that the listeners would really appreciate hearing this. So what's your take on dairy?

Vivien: So it is a common food sensitivity and food allergy. A lot of people know that. So it can be a problem, especially when your body is out of balance, although sensitivities can develop, but it can be lifelong as well. So it's something like gluten and dairy. They can just be lifelong and you can't really change that. But for a lot of my clients, I've notice that they develop dairy sensitivities because the microbiome is messed up or they have low stomach acid levels or they're just chronically inflamed and once you address those things, you can introduce dairy back into the diet. In a lot of cases, it does depend on your ethnicity as well. I find that a lot of people from European descent tend to tolerate dairy a lot better than those nearer to the equator. So that could be a factor.

Vivien: But with acne, I always in PCOS, I say always do 30 day 60 day elimination just to let the body calm down any inflammation and just to see whether it is a factor or not because the thing is with a food sensitivity, you don't really know that you have long until you remove that food and do a challenge. So if you've drank milk every day of your life and then you don't really have any symptoms, if you remove that, your body will obviously tell you when you introduce it back, if it's not a good thing, cause you might get bloated, you might get diarrhea and your skin might flare up with a breakout. So I always do a short-term elimination whilst we work on the underlying root causes, reduce inflammation, then bring it back in. But for many people, dairy is fine. There can be an issue obviously with quality.

Vivien: So I always recommend organic, especially in the U S the dairy quality is pretty bad in a lot of cases. For some people raw dairy is better as-well because it has the natural probiotics and enzymes that help you tolerate it even more. One thing that may not be great is whey protein, because that is very insulinogenic. So it, although it's low in carbs and it's low in sugar, it really promotes insulin release in the body and if you have PCOS or high insulin and high blood sugar levels, that's just going to be adding fuel to the fire. But something like cheese or an organic milk or butter or yogurt could actually be a good health food for some people and some people I've actually noticed that their skin gets better when they add some of those things in whether it's a coffea sometimes it's the fat-soluble nutrients that are in there, like the vitamin A, or the iodine, the minerals in there, that can actually support things like thyroid function and therefore improve the skin health.

Vivien: But it's always worth ruling it out as a factor first, but it's not a blanket statement. I see some people like no dairy at all. If you have acne and a lot of people with acne have food fear where they just, keep [inaudible 00:08:58] so with eczema and psoriasis, they just keep removing food after food and I've been there as well. So I want to get to the place where my body can tolerate as many foods as possible and that's by improving the microbiome immunity, all of that.

Jennifer: Yeah, and I just think it's interesting. The point you make, especially in regards to this conversation on insulin that wait, because whey protein is the most common protein I think, on the market and so for most people, when they hear me say, well, you should probably consider adding like a protein powder to your diet in order to increase the amount of protein you're getting.

Jennifer: The first thing that they can find on a store shelf is whey it's the most common one, and for some people it can be very problem, like whey would make me sick, probably not a concentration like that, but this, what would be, if someone does say, have a concern about acne and maybe they haven't doing whey protein, or they were told by someone to do whey and they have noticed that, you know, oh, now that I hear this, I'm thinking about it, I think my acne has actually gotten worse since I started using this protein, what would be a better option? And, we'll preface this with everyone is different. Yes. You can certainly have allergies to any one of these things. So this is just a general list and then you figure out what's best for you.

Vivien: Exactly. So there's the animal based ones, like the hydrolyzed beef protein, or collagen protein, and then there's the plant-based or vegan ones, which would be P or had that would have been my favorite, but always check the ingredients because a lot of them add 20 additional ingredients in there. So just make sure it's organic as possible. Just good quality, minimal ingredients, minimally sweetened if possible, but yeah, with the protein thing, it can, it's important to have that blood sugar balance, but the whey protein is why bodybuilders use it to gain, that muscle mass, but in some people it's just not a great thing.

Jennifer: Yeah, and so let's kind of like step to the next thing to cortisol because I think that cortisol is something most people are familiar with because they do have concerns that their adrenals may be taxed , or overwhelmed with all of the things going on a lot of people believe that they have something called adrenal fatigue, which is not really a thing. It's more the HPA axis dysfunction that's going on, but how is cortisol involved with acne?

Vivien: So both high cortisol and low cortisol can be a trigger, but I usually see high cortisol being the most problematic because when your body is pumping out cortisol from the adrenal glands, it's also coming out things like adrenaline and some of these androgens as well, like DHEAS and these things can increase sebum production in the skin. They can increase inflammation, they can increase blood sugar and insulin. So despite your diet, your stress levels can increase those as well. So it's a vicious cycle, but having low cortisol as well, or that quotes adrenal fatigue, which I agree, isn't really a technical term. The brain is telling the adrenals, stop producing so much because they've been stressed out for too long, but cortisol is anti-inflammatory. So when you have low levels of cortisol, your body doesn't regulate inflammation properly, and that can lead to skin issues as well, not just acne but eczema and psoriasis.

Jennifer: And so do you find something like the DUTCH test to be helpful in, because I know that they, I always like to see that cortisol response grid that they have. I think it's really helpful, especially in terms of, and this is an aside, but for people who've had a lot of steroid exposure because the steroid creams and things, I always find the whole cortisone cortisol chart to be really helpful. Is that also? So that's also helpful for acne folks as well.

Vivien: Definitely the stress isn't one that I jumped to right away with acne, because just based off clinical experience and certain symptoms, I can tell usually what the driver is, whether it is progesterone, lack of progesterone or high androgens, which we can get in. So, but if someone is still struggling and they're also having other symptoms like fatigue or anxiety or menstrual problems, then the DUTCH test can be good. It's like a one-stop shop for all of those things. Some people might have heard about the salivary of the saliva cortisol tests. I'm not a huge fan of those because that's just looking at free cortisol levels. So how much is available at the tissue level, which is important, but the Dutch test, doesn't just show you that it shows you how much your adrenals are actually making, because sometimes people get diagnosed with adrenal fatigue because the free cortisol is really low.

Vivien: But when you look at the DUTCH test, the body is actually producing a ton of cortisol and they just, we can get the wrong thing. So if there were given treatments of booster cortisol even more, thinking that they had adrenal fatigue, they're just going to make the issue worse.

Jennifer: Oh wow.

Vivien: The gut really shows comprehensive a look at how much your body is making, how it's getting rid of it, how it is throughout the day. So is it high at the wrong times? Like at night when it should be pretty low? So, yeah, it's a really good test.

Jennifer: Okay and actually let's talk about androgens because I think that seems to be a good segue. So for people who don't know what androgens are, what are they?

Vivien: So it's a class of male hormones and men obviously have, I think men have 10 times as much testosterone as women, but women have some elements of testosterone and androgens, which are these male hormones. Men have small amounts of oestrogen or estrogen within their system they're basically just masculinizing hormones. So they can in excess lead to things like excessive hair growth or hirsutism, which is also common in PCOS. So if you have acne and you're also dealing with excess hair growth on the beard area. So I think when men would grow hair and sometimes on the nipples, sometimes underneath the belly button or, in other parts of the body they can have issues that could be a sign of high androgen levels, or if your skin is excessively oily, if your hair is oily, if you're losing hair on your head and getting it on your body in excessive levels then, the places that you don't want it basically, and that could be a sign that your androgens are too high, but having low androgens, isn't great either. So we want a nice balance.

Jennifer: It's sounds a lot like the Goldilocks principle, like we don't want too much, we don't want too little. We want just the right amount for you.

Vivien: Sometimes that's easier said than done in some of these cases, but with PCOS a big driver is that insulin, high insulin levels and insulin resistance.

Jennifer: And in some instances I have a family member in her twenties who was actually given spironolactone for her acne because they told her that she had high testosterone. So how does high testosterone levels in a woman, aside from the hair growth and such, how does that actually contribute to acne?

Vivien: So that increases your sebum levels mainly and then that can obviously clogged the pore, the pore gets a localized infection and that's where the redness and the puss comes in as well. So it mainly is just increase in that sebum production in the skin and increase in inflammation as well. But there's a, another androgen called DHT that testosterone can convert into and that one is very potent. So I have some clients who have normal, even normal to low levels of testosterone and that's all they get. They told everything's fine, but the way that the body converts that testosterone, it turns it into this super potent version called dihydrotestosterone and that's the one that is really problematic for skin issues.

Jennifer: So in this instance, is the medication the only option or are there other routes to rebalance the testosterone and also not just the testosterone per se, but to maybe shift it away from that more potent acne prone.

Vivien: Yeah. It's an enzyme. Yeah. It's an enzyme that does that called 5-alpha reductase. You can slow that down. Using things like socometal, zinc, nettle, reishi mushroom, and things that upper regulate that enzymes so speed up that DHT production would be inflammation that high insulin and stress they're the main things as well. So I'm always trying to figure out the cause of the problem, not just throwing like reishi mushroom as a supplement because that's not really going to fix the problem. It can help, but it is a bit of a bandaid solution. So I'm trying to figure out, does this person have insulin resistance? And if so, how can we address that through increasing muscle mass, balancing the blood sugar, more protein, less refined carbohydrates, better sleep, they all help,

Vivien: does this person have chronic inflammation stemming from infections in the gut or environmental toxicity removing those things. So it really is just about getting the person healthy and balanced overall and a lot of the time these hormone imbalances, they just fix themselves. Not always, but hormone imbalances don't happen randomly. They happen as a result. They usually like the tip of the iceberg, the things that people focus on, but you need to look under the surface, but all of these other things and address those first, rather than jumping to medication.

Jennifer: And so for someone who is on, say, they're on spironolactone now, or some other medication and I know sometimes people are also put on birth control pills to try and deal with their acne as well. Do you see in your practice where people are able to eventually stop taking these medications? So it's not a lifelong, like you're stuck on them.

Vivien: Definitely, yeah. I usually have people come to me first, which is kind of the ideal thing. Try and address the problem first and there is a tiny place for medication. So there is, if someone is really struggling with their skin, like mental health wise, the birth control pill might be a good thing just to get the skin a little bit clearer if they're struggling with depression. But if you don't address the root cause of the acne now, and you just go on the spironolactone, then you're not really addressing the problem and sometimes the internal imbalances that are dragging your acne, they just get worse and then your body will tell you in another way that it's struggling. So it may not be acne anymore. It may be chronic fatigue or hair loss they can spiral.

Jennifer: Yeah and actually, so speaking of chronic fatigue, a lot of times people who have thyroid issues have also have chronic fatigue and the thyroid can also, I find if someone is dealt with long long-term stressors, a lot of times their thyroid can really take a hit. So how is the thyroid also related to this whole acne piece?

Vivien: This is one that's commonly overlooked and I never heard about thyroid issues contributing to acne when I had it and sometimes it's a direct connection because thyroid is the metabolism of the body and it's involved in things like skin, cell turnover. So if that's happening at a slower rates, then you're going to have skin cell buildup and that's just, that's going to predispose you to developing clogged poles and then breakouts. Some people get chronically dry skin with thyroid issues. So it really does affect the skin, but it can also affect things like progesterone production. So if your thyroid is sluggish, then your body is going to have issues with producing progesterone, which is very beneficial for the skin. So progesterone helps to keep things like DHT and androgens in chat and it also helps to give us that nice glow. That's why a lot of pregnant women, they get the pregnancy glow. A lot of the times it's due to progesterone levels. So if there's one hormone that's amazing for skin and healthy acne, it's progesterone.

Jennifer: We're not suggesting that you supplement,

Vivien: Oh no, no. We want our body to produce its own natural progesterone. That's the goal. So no bio-identical sometimes bioidenticals can actually make acne worse. That's an important point. So the goal is to have your body and do it on its own. So a healthy thyroid, it works both ways. You can't really produce progesterone until your thyroid's healthy, but then in order to have a healthy thyroid unit healthy progesterone, so they all are interconnected.

Jennifer: And can I ask one other question that you, now that you bring this up about the progesterone is this one potential scenario or explanation of why a woman who say pre pregnancy might have awful skin, get pregnant, acne could clear up, and then post-pregnancy, it comes back.

Vivien: Definitely. Yeah. That's another reason that people get breakouts before their period as well because if you have low progesterone levels leading up to your period, you're going to be naturally estrogen dominant. So the goal is to be more estrogen dominant in the first half of the cycle, leading up to ovulation, but then we should be progesterone dominant between ovulation and before our period. So it's the ones breakouts off cyclical and they notice a direct correlation between where they are in the menstrual cycle and how many breakouts they have. Then it's usually low progesterone levels to blame.

Jennifer: Interesting. This is so complicated. This is why I'm like, acne is not my wheelhouse sometimes it's one of the complaints that someone has, but usually, they're like, no, I have psoriasis. Right? I'm like, okay.

Vivien: Yeah. There's a lot of things, a lot of crossover with diet and nutrition with all of these skin conditions, but acne is more specific in certain areas. Yeah. With the whey protein, it can be used for eczema with increasing [inaudible 00:23:08] levels and that's why it's usually recommended for liver support because of the high sulfur. But whereas acne, it can be a problem. So there's a few things like that that they don't cross over.

Jennifer: Exactly. Oh my gosh. It's so interesting. I have one last question for you because I think this would benefit everybody listening. You talked, you actually mentioned stress a number of times on this podcast because stress does play a role in our hormone balance in general. Do you have like one favorite tip that you like to share with clients of how to start de- oh gosh, I hate the term de-stressing or managing your stress. It sounds like, nobody wants to manage their stress, but do you have one suggestion for people listening that where they could maybe initiate this one little thing tomorrow and do that one little thing every day and you know, at least it's a start and then once they sort of learn to ride that bike, they could begin adding on to that. But I think I be curious to hear what you're, what a stress tip, stress relieving tip you have, [crosstalk 00:24:15]

Vivien: Because sometimes people, they get more stressed when you tell them to stress less. They're like, oh my God, I shouldn't be stressing. My skin's going to be my god. So the goal is to, relax more. We'll use that. We'll use that term. And then one of the best ways to do that is through the breath. I know people have probably heard this before, so I'll give you the breath law. So the breath is one of the best ways to put the body into the parasympathetic nervous system, which is the rest and digest and heal state of the nervous system. So if you, if your life was actually in danger and the body doesn't know the difference between real or perceived danger, you could be sat on your couch on your cell phone, worrying and worrying about 2020, COVID or all of these other things, and still have that same physiological response as if you were being chased by saber tooth tiger.

Vivien: So your, your mind and your brain is very, very powerful. But when I say stress as well, it also includes things like infections in the body, deficiencies, thyroid issues, low progesterone levels that also stresses on the body. So obviously some of those things and environmental toxins or pollution, we can't control those types of stress, but we can control what, how much we delegate tasks and who we surround ourselves with. So breath, when you breathe through the nose in particular, it really comes the body. And if you were really in the same room as a saber tooth tiger you would not be able to breathe that deep and slow so it tricks the brain a little bit. So you can do it. It's free. It's easier. Particularly before meals it's really powerful to get you into that rest and digest mode so that you can actually break down your food properly.

Vivien: But there's a few different breathing techniques. There's the alternate nostril breathing there's box breathing. So you can go on Google or YouTube, a few of these, but another tip I'll give you an extra one is the mindset shift around stress because I was that person who knew that stress was a trigger for my PCOS and my acne, but someone telling me that was actually making it worse. So there's a really good book called the ‘Upside Of Stress', I think it's by Dr. Kelly, something, called the ‘Upside Of Stress'.

Jennifer: We'll find it, we'll link to it in the show.

Vivien: It was a very useful, but that talks all about how to reframe your thoughts and your perceptions of stress to make it less harmful to your body. So in the morning, if you have a big to-do list, you change that to, ‘I get to do' these things instead, or if there's a project or an interview at work that you have, instead of thinking how scared and nervous you are for it, think of that feeling inside as excitement instead, because they really do feel similar that racing heart, the sweaty palms, that tension, you can easily trick your brain into thinking that you're excited rather than thinking that you're scared.

Vivien: And that's going to have way less detriment to your health, where less cortisol, being released with that same scenario.

Jennifer: I love that. We'll, we'll definitely put all of those, everything you shared in the show notes. And also too, just to remind you guys, I did actually do an episode on three different breathing exercises. I'll link to that in the show notes as well. That way you guys can easily find that. And if you want, I have YouTube videos and just walk you through how to do those. So they might be helpful.

Jennifer: So I just, Vivien, I want to thank you so much for sharing all of this. This has been a great conversation and really enlightening and, I love too, that you took this in so many different directions to show that, you know, someone may not have all of these different things going on. You might just have one or two pieces of this hormone imbalance, but why it's so important to take a step back and not just say, ‘oh, it must be my sex hormones, it must just be my progesterone or my insulin', because it could, there could be other pieces to this, that complicate one's particular acne picture, especially when they're really frustrated and it's a chronic stubborn problem they can't get rid of. So I just want to thank you so much for sharing so much great information and I look forward to the feedback that we'll get and the questions, and then hopefully we can have you come back sometime.

Vivien: Amazing. I would love that. I feel like I love acne so much because of how complex it is. Like a detective trying to figure it out and for someone it could be as simple as removing dairy and that could be like the cure for the acne. Whereas someone else like me, there was like a ton of different things driving it, and it really needs to be a holistic approach.

Jennifer: Very, very much I do. I agree with you. Yes. I love this. I love this. That's why I'm so glad that we met and remember everyone. I was actually on the hormones in harmony podcast. It's Vivien's podcast. So if you're looking for more information on this, check out her show and share that with people who are really struggling with this, because I have a feeling they're going to learn a lot and then if you want to get in touch with Vivien, you can find her @vivanaturalhealth.co.uk. I will link to all of her social media in the show notes and gosh, Vivien, thank you so much for joining us.

Vivien: You're welcome, thank you so much, Jen.

“When people think hormones, they think estrogen, progesterone and testosterone, and they really do influence the skin, but there are other hormones like cortisol and insulin that can also be involved.”