072: Sex Hormone-Skin Rash Connection w/ Dr. Carrie Jones

Hormones play a significant role in skin health. Imbalanced hormones can manifest on our skin in the form of cystic acne, eczema flares, psoriasis flares, and more. My guest today will explain how hormones (particularly sex hormones) impact skin conditions.

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My guest today is Dr. Carrie Jones, an internationally recognized speaker, consultant, and educator on the topic of women’s health and hormones.

Dr. Carrie graduated from the National University of Natural Medicine (NUNM), School of Naturopathic Medicine in Portland, Oregon where she also completed her 2-year residency in women’s health, hormones and endocrinology.

Later, she graduated from Grand Canyon University’s Master of Public Health program with a goal of doing more international education. She was adjunct faculty for many years teaching gynecology and advanced endocrinology/fertility and has been the Medical Director for 2 large integrative clinics in Portland.

Dr. Carrie is the Medical Director for Precision Analytical, Inc, creators of the DUTCH hormone test.

Join us as we talk about how imbalanced sex hormones can cause ongoing skin problems, such as cystic acne.

Have your skin conditions improved after optimizing your sex hormones? Tell me about it in the comments!

In this episode:

  • How do sex hormones play a role in skin issues?
  • What are androgens, and how do they play a role in acne?
  • Skin issues during perimenopause and menopause
  • Diet and skin
  • Supplement information
  • Why balanced estrogen is important (not too much, not too little)
  • The impact of cortisol on the skin
  • How a DUTCH test differs from a blood test


“Building lean muscle mass will actually help you reduce your insulin.” [10:35]

“There's a part of green tea called the EGCG. It's a pretty potent antioxidant but it's really helpful in shifting testosterone away from the acne pathway.” [10:51]

“That high estrogen rise is what triggers us to ovulate and help get us pregnant (if that's what you're trying to do). But for some women, that high rise in estrogen will trigger her skin stuff.” [12:54]

“Melatonin is an actual hormone. Vitamin D is a hormone. Progesterone is a hormone. DHEA is a hormone. And so even though it's over the counter, it's still a hormone and you can really mess yourself up if you just self-prescribe.” [21:43]


Find Dr. Carrie online

Use coupon healthyskin50 for $50 off a DUTCH Complete or DUTCH Plus test

Follow Dr. Carrie on Instagram

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Healthy Skin Show ep. 043: Candida and Skin Rashes: A Hidden Root Cause

Healthy Skin Show ep. 006: How To Tweak Your Diet To Combat Candida w/ Ricki Heller

072: Sex Hormone-Skin Rash Connection w/ Dr. Carrie Jones FULL TRANSCRIPT

Jennifer: Hi everyone. Welcome back to the Healthy Skin Show. Today I've got a guest whom I will acknowledge is another person that I stalk a little bit online because I just love what she does so much. It's so super interesting and she's just a total nerd. I'm like a fan girl for her nerdiness around hormones and I really believe that she has such incredible knowledge to be able to share with you that I invited her on the show today because a lot of us also because most of us are women, but yet guys, some of this may apply to you as well. You know, our hormones shift a lot and that can be a trigger for ongoing skin issues. So my guest today is Dr Carrie Jones. She's an internationally recognized speaker, consultant and educator on the topic of women's health and hormones. She graduated from the National University of Natural Medicine School of Naturopathic medicine in Portland, Oregon, where she completed her two year residency in women's health, hormones and endocrinology. Later. She graduated from Grand Canyon University's master's of public health program with a goal of doing more international education. She was adjunct faculty for many years teaching gynecology and advanced endocrinology and fertility and has been the medical director for two large integrative clinics in Portland, Oregon. She is the medical director for Precision Analytics, also known for being the creators of a test that you probably heard about. It's called the DUTCH hormone test. And I'm sure we'll drop a little bit of Info about that as well. Dr Carrie, thank you so much for joining me.

Dr. Carrie: Oh my gosh. Thank you so much for hosting. I love this. I love to talk about the skin. It's so exciting.

Jennifer: I know. And it's one of those things where, you know, we get frustrated because it's on the outside. It's something that everyone sees and we'd love to mask it, but it's not always that easy. And so why don't you talk to us a little bit about how hormones, so, and when I say this, I think we'll come from this as like how sex hormones specifically can impact skin conditions. Because I think a lot of times people don't necessarily see that as being the case. They only see like the steroid creams as their only option and they just need steroid creams. But we know for sure that that's not true. So how do hormones play a role here?

Dr. Carrie: Absolutely. So, and this applies a lot to women, but men when we get to the testosterone part, that definitely applies to you too. We as women have estrogen and progesterone and it cycles up and down through our month. This is assuming, you know, as a woman, you still have your menstrual cycle and you get a period roughly every month. And a lot of women will tell me, Carrie, as I get close to ovulation or is I get close to pms, my skin goes crazy. Whether my Eczema gets worse, even things like psoriasis, autoimmune can be very effected by hormones. My acne breaks out. I get jaw line acne, I get, you know, neck, acne, back, acne and then I get my period and it gets better. Or maybe it even goes away. And then poof, it comes back. And because not a lot of practitioners and people really kind of correlate your pms can also include skin changes that I think practitioners often forget like, oh, I should probably check her hormones. I should probably see what her estrogen and progesterone are doing at different points in the cycle and see if that's what the problem is. Just like with testosterone. And this applies to men as well. We know when you have a lot of testosterone in the body or if your testosterone is going down a particular pathway, you, we make testosterone and that has to go somewhere. So one of the pathways that goes down, we call it the Alpha pathway, but I think it's a for acne because if you predominantly go down that Alpha pathway, then you predominantly get that cystic chin, jawline, neck type acne. And the great thing is in both cases, estrogen, progesterone, testosterone, there's a lot we can do to help it.

Jennifer: And so when you say the testosterone piece where the neck and the chin line area breaks out, this is the same for men and women. So that's a good visual diagnosis. Good symptom. So let's talk a little bit about those androgens that are involved in acne. Cause I think that a) what is an androgen, in case no one has heard of that before and b) how exactly are they playing a role in acne?

Dr. Carrie: Definitely. So androgens are basically the hormones like testosterone and DHEA (DHEA is primarily made in your adrenal glands). It's one of your stress hormones, but it also has a lot to do with things like energy. Your muscle mass making, building lean muscle mass, but too much of it, and you may experience breakouts, you may experience cystic acne just like testosterone, too much of it. Or if you're headed down the wrong pathway, you kind of feel like a teenage boy in puberty, your acne kind of resembles that. And so when men and women head down that direction, that testosterone binds really I would say aggressively to the receptor in your skin and the receptor goes, oh my gosh, testosterone. Or you know, that that Alpha pathway and Poof, you break out, poof, you get cystic acne and you feel like you're in puberty again and it's not fair.

Jennifer: And so it's interesting you say this, I actually have a lot of readers who have emailed me saying, you know, all of a sudden I turned, you know, 45. And now all of a sudden I have this horrific cystic acne. Some of them have been on birth control pills for quite a while to help manage other symptoms elsewhere. So I assume that that can also play a role in this.

Dr. Carrie: It can. And it can for a couple of reasons. For example, when women get closer into perimenopause, you have a layer of cells in your ovaries that make testosterone. They're called the theca. So starts with a t cause they make testosterone. So as you get closer and closer to perimenopause, your brain is telling your ovaries to make hormone like, Hey, you're not responding as well as you used to because we're hitting our forties and maybe or fifties so it's now the brain is now yelling at the ovaries. Now when it yells at the ovaries, these layer of cells get thicker and when they get thicker they will kind of temporarily put out more testosterone than us women are used to. So I'll have women hit their forties tell me they're having some hot flashes, some night sweats, some joint pains and brain fog and their skin is breaking out. I'm like, okay, you're getting closer to menopause. And I bet that layer in your ovaries is getting thick because it's getting yelled at. So it's getting bigger and, and as a result it's making testosterone. It does go away. It does go away, but it does cause a lot of women in their forties that say to me, what the heck? I did this in puberty and now I'm going through it again. Now, another big trigger though for that layer is insulin. So if women have blood sugar, insulin dysregulation, if they have too much blood sugar, they too much glucose in their blood. Maybe they're eating very eratically. So they have what we call hypoglycemia or hyperglycemia. They get hangry, you know, if they don't eat for while they're mad and then their insulin will affect those cells. And then you make testosterone. So insulin is a very big driver of that layer of cells in the ovaries. And so we kind of get it as women two fold.

Jennifer: So what I'm hearing is that we can have an impact on some of this, the hormone balance and the testosterone balance per se. If we are mindful of the amount of like say, processed carbs and sugar that we're taking in to our diet.

Speaker 2: Yup. 100%. 100% it's the first thing I do when I'm sure, which of course you talk about all the time is diet and skin. There's how, how closely related your intestinal health, what you put in your body, what shows up on your skin. But in particular, this layer of the ovaries, these theca cells that make testosterone are very impacted by it. And so for those women and even it men, but just for a different reason, if your testosterone is really affected, then you may notice like more cystic acne and now you know, like, oh, okay, I can probably affect this by the foods that I eat, the foods that I choose not to eat.

Jennifer: And out of curiosity is you're talking about cystic acne. What about back acne? Which is not pleasant either.

Dr. Carrie: It definitely can play a role. It definitely, you know, unfortunately back acne is definitely a harder one to pinpoint. It can be a lot of different reasons, whether it's, you know, intestinal health or its nutrient deficiencies or food triggers that you're eating or environmental. You know, like some women forget the shampoo and our conditioner and then it runs down our back, you know, and then we hair spray her hair and then it, you know, goes down and we have long hair and it touches our back. It may be something like that and have nothing to do with testosterone or it may have everything to do with testosterone. We address our insulin, we get our hormones better under control, we take supplements to help mitigate this. And then our back acne goes away. So it could be one the other or both.

Jennifer: And so actually a question that just popped into my head right now. So you're saying that if you do have elevated testosterone, the way to address that though might not be then to add more estrogen in, would it?

Dr. Carrie: Right, correct. Not necessarily, no. In fact, most of the time now I'm very careful with testosterone and women because I don't want her to lose energy and I don't want to lose her lean muscle mass. And I don't want her to lose like her sex drive. But I do want her to have clear skin. So usually what I'll do is I'll work to affect the way the body processes testosterone. So what I'll do is I'll use diet, like we talked about careful of processed foods, working on limiting sugar, you know, sodas. And things like that. Exercise. Because building lean muscle mass will actually help you reduce your insulin. But I'll also use supplements. Now this supplements are not cures, but they are just helpful. So things in which you've definitely talked about things like zinc is a really big one for helping testosterone process better. Believe it or not, there's a part of green tea called the EGCG. It's a pretty potent antioxidant but it's really helpful in shifting testosterone away from the acne pathway. A particular type of mushroom, Reishi mushroom, you know, I'm sure people have seen mushrooms. I'm not talking about the like crazy psychedelic kind I'm talking about like the kind you eat and cook with and things like that. So reishi mushroom, you're commonly seen it now and teas and you're seeing at the grocery store and you're seeing it whole foods, but Reishi mushroom is a good one. And then there's two other herbs that funny enough are common in prostate formulas. And I have to tell women, I know it says prostate. I know you don't have a prostate, but what it does is it affects that pathway. So one is called saw Palmetto and the other is called stinging nettle root. Not the leaf, but the root. And so often I'll use one or a combination of these to try to help the woman's testosterone process down the a different pathway so she's not so alpha, she's not so acne and it can be really helpful.

Jennifer: And would these also be helpful for men who are experiencing this?

Dr. Carrie: 100%. All of them. 100%. Yep. They're definitely not male or female derived herbs. Either men or women can take them.

Jennifer: Okay. Now here's another good question. You know, estrogen seems to be the one driving hormone that as women we focus on a lot. But I think sometimes people think, oh, well I want a lot of it, but there could be problems with having a lot, just as much as there could be problems not having enough. So we can talk a little bit about that.

Dr. Carrie: Absolutely. And I definitely say estrogen's like Goldilocks, right? Like, it can't be too small, can't be too big, can't be too hot, can't be too cold. Cause we need estrogen at high amounts, certain points of our cycle and then lower amounts at other points. So right before we ovulate in the middle of our cycles, so right before we release an egg, believe it or not, we make an abundance of estrogen. That high estrogen rise is what triggers us to ovulate and help get us pregnant if that's what you're trying to do. But for some women that high rise in estrogen will trigger her skin stuff. So some women, that high rise in estrogen maybe is a little higher than it should be. Or maybe you have the high rise in estrogen, but your liver doesn't clear it out quite as fast as it should. And so it hangs around longer. And now she says, you know, at ovulation or in the middle of my cycle, my eczema comes back, my psoriasis flares worse, my skin looks terrible. Or she says, as I get close to my period, her estrogen is maybe going up when it should be going down or she doesn't have enough progesterone, which is the other hormone to counterbalance it. Same thing she says, you know what pms, I feel moody, I crave chocolate, I feel bloated and my skin breaks out, my eczema comes back, my psoriasis flares worse. And again, it's that balance with estrogen, estrogen being able to properly get cleared out of the body. Progesterone that makes it the perfect Goldilocks and it makes it right where it should be.

Jennifer: Interesting. Yeah. And Wow. And you know it's funny cause Collagen for it for as one I think is very helpful for skin issues and chronic skin issues. It's so, so helpful. So if you are in this situation where your estrogen is just all over the place or not in a healthy state, that could be working against you as far as having a healthy amount of Collagen in the skin. That's really interesting. And so the last piece of this, and I have to bring it up because stress is such a huge factor and, it's not just like the Oh, you're stressed, legit stress that people have. And especially when you have these skin issues, it's visible. You are walking through life with almost a scarlet letter on you and sometimes people treat you differently depending on the way that your skin manifests. Right? And that can cause a tremendous amount of cortisol in your system because you are constantly afraid to go out. You're ashamed, you have a, there's a lot of stuff going on. So can we talk a little bit about how cortisol could also have an impact on your skin?

Dr. Carrie: You know, and it's multifold now we need cortisol much like we need estrogen. Cortisol is very important for things like fighting inflammation to a point, helping us get, you know, out of bed in the morning, helping us make blood sugar. Cortisol is a big trigger. So if you skip a meal, it's cortisol that helps you not feel hungry and not want to, you know, kill your coworker. Cause you haven't eaten. But cortisol does a couple of things. So one, if you have way too much cortisol, then you will make a whole lot of blood sugar. You'll have a whole lot of excess glucose in your system because cortisol is your fight or flight hormone. And so if your body thinks you're in fight or flight, it thinks it needs sugar so you can run from the tiger. Now you might not actually be running, it's maybe more a mental stress. So now you have all this sugar in your system. So what has to come out to deal with your sugar? Insulin. And now your insulin comes out to deal with all your sugar. But it pushes on those cells in the ovaries to make testosterone. So they do. And now you make excess testosterone and it goes back to cortisol. Another big thing is when you're in fight or flight, even if you're not running from a tiger. Maybe your day was stressful, your job is stressful, your kids are stressful and you're just like over it. Your brain says, oh, you know what, I'm not going ovulate this month or I'm not going to do it very well because I don't think in this fight or flight situation, you should get pregnant now. You may not want to get pregnant. And you might be like that's okay. I don't want more kids, I'm good. But when you don't ovulate you don't make progesterone. You have to release an egg to make progesterone, whether you want to get pregnant or not. And if you don't release progesterone now you have way too much estrogen, than you want in relation to progesterone, your ratio is off. So now you head into your, you know, pms time and it's bad. You're moody, you want chocolate, everything hurts, you're bloated, your cycles are heavy, nothing fits. Your skin is bad. And it's when you dial it back, you're like, oh, I did have a really stressful month. It stops my ovulation. I don't make progesterone. And that makes me have a bad pms. And as a result, my skin issues are badagain, and the dominoes continue. And that's just, that's just two ways that stress affects you.

Jennifer: And I just want to also to, I want to make sure to hold space for the women that are listening who are in menopause, who are, you know, not getting your period anymore. Do we still see this similar pattern for them with the elevation in testosterone and the shift in hormones may come regardless of whether you're going to menstruate or not?

Dr. Carrie: To a much smaller degree. Because when women go into menopause, for example, their estrogen production drops down to like less than 5% of what they were when they were premenopausal when they, you know, were cycling, hopefully cycling regularly. But the ability to make hormones, you know, the ability for your body to hopefully eke out more hormones can be reduced when you're in this fight or flight state. So no matter what, you know, hormones are a luxury. You don't necessarily need hormones to survive. You need cortisol. You, you know, you need thyroid, but you don't need estrogen per se, to survive and to live. And so if you, even a menopausal woman who was in a very stressed out state, her body might say the little tiny amount that we do make, like we're not going to do it very well because the fight or flight is more important. We need to help her with that right now so it can absolutely affect her. And, and on top of it, you know, high cortisol affects lots of other stuff, right? It affects our gut, it increases leaky gut. It affects our memory and it affects the cells that help us with memory. It affects our thyroid. And our gut is important for skin health. Our thyroid is important for skin health. And so there's just multiple aspects that all that cortisol, well, that excess cortisol can affect.

Jennifer: Absolutely. So I think one final question people would have, and I think you're probably the best person to answer that. So you guys have the DUTCH test, which I have run on myself. It took a lot of practice to do the one that was like a whole month long. That was a lot of work. And I've had some clients that are always asking me about it where it's not really my wheelhouse in dealing with hormones per se, but why a urine test versus blood? Like you go to the doctor and they just want to test your plasma levels. So what would be the difference between the two? Because the DUTCH test relies on urine instead, right?

Dr. Carrie: Absolutely. So it's much more comprehensive. So the great thing about blood is you can get an in the moment, I need to know my progesterone right now. I need to know my testosterone right now. But what it doesn't tell you is what it converts into. Again, those pathways. So you make testosterone, but where does it go? You make estrogen. How do you detoxify it out of your body? The way to find out those pathways is through urine. And that's why urine is so great because I can tell you what your estrogen level is as you get close to pms. And then I can tell you how your liver detoxifies it. I can tell you if you do it well, I can tell you if you're a little too slow, I can tell you if maybe you're headed down a pathway that's been linked to be more carcinogenic, more cancer causing. And so by knowing these pathways, I can give you more information and we can really pinpoint what we need to do on our treatment versus just, you know, kind of blindly trying supplements and nutrients and what have you. And hoping for the best. So that's why it's a really nice test cause you just get more information about what your hormone is doing in your body. We're not guessing.

Jennifer: It's a lot of information. I will admit, when I looked at it I was like, oh my goodness, there is so many things here to consider. And, and it is, I want to say this and this is a little bit of a warning for everyone listening. Hormones are complicated and you really shouldn't screw around with them yourself. I just don't personally think that's a good idea. And every practitioner that I've spoken to, like it's not a good idea to just go out and like get some DHEA drops or some progesterone cream on your own. Do you feel the same way to just be careful?

Dr. Carrie: That United States is one of the only countries that actually allows some hormones over the counter. So believe it or not, in a lot of other countries you can't even get Melatonin. Like we sell it at the airport. There's water companies that put Melatonin in the water and sell it at the airport so you can drink it and fall asleep on the plane. That's unheard of in other countries. Melatonin is an actual hormone. Vitamin D is a hormone. Progesterone is a hormone. DHEA is a hormone. And so even though it's over the counter, it's still a hormone and you can really mess yourself up if you just self-prescribe.

Jennifer: So the best way, if you were me I would say I would go get testing done to get a baseline to understand what's going on and then find a practitioner that really understands how to translate those results into actionable steps that include things like some supplementation, dietary and lifestyle shifts. But it's very much tailored to your system, not just like, oh, well if you have a high estrogen, then you have this because there's a, there's a lot that goes into this.

Dr. Carrie: Oh, 100%. Yeah, absolutely. And definitely men, it doesn't really apply to you, although men, when you get your blood drawn or you do your hormone check you should do it first thing in the morning. Testosterone is made at night, so you want to go as soon as the lab is open in the morning. Women make sure if you're still cycling women, you want to do it after ovulation. So when women will bring me their lab results, they'll say, here I have these results. What does this mean? And I'll say, where were you in your cycle when you got this drawn? And they'll go, I don't know. My appointment was on Monday at noon. I think that's very helpful because your hormones go up and down. So I need to know. So women, the ideal time for you if you're cycling is to do it about five to seven days after you ovulate. So for most women, that translates into about day 19, 20, 21 of her cycle if day one is her first day of her period. Menopausal women, it doesn't matter when you test, you can test anytime you want. Thankfully. and men, same thing. Men, you can test any day you want, but make sure you go first thing in the morning because your testosterone is made at night.

Jennifer: Perfect. I love this. I feel like we've covered the whole gamut in a very short period of time. Although, yes, this was very much like scratch the surface. There is a lot more that we could dive into, but we are always a little limited on time here at the Healthy Skin Show. So Dr. Carrie, I just, first of all wanna thank you so much for being here. Everybody can follow you over on Instagram. Like I love your Instagram by the way. So that's a really great account. We'll link to that. And you also have a really nice gift for everybody listening. If they're interested in getting a DUTCH test run, they can use the code healthyskin50 and get $50 off a Dutch complete or a Dutch plus test. So how can they get in touch and connect with that coupon code.

Dr. Carrie: Thankfully the website is easy. It is Dutchtest.com. So if they go to Dutchtest.com, everything on there is free to look at. You can look, watch all the videos, the webinars, really educate yourself, and then you can choose on the purchase page a DUTCH complete or a DUTCH plus, and then enter in that coupon code where it prompts you for a coupon.

Jennifer: Perfect. Thank you so much and I really appreciate you being here and I hope that we can have you come back some time.

Dr. Carrie: I would be honored. Thank you.

There's a part of green tea called the EGCG. It's a pretty potent antioxidant but it's really helpful in shifting testosterone away from the acne pathway.