TRANSKRIPTIO 🔗
WEBVTT
00:00:00.400 --> 00:00:06.400
Welcome to Naturopathic Beauty's Clear Skin Sessions, where we heal your acne from the inside out.
00:00:06.959 --> 00:00:10.480
Hello, beauties, and welcome to the Clear Skin Sessions.
00:00:10.560 --> 00:00:11.039
I'm Dr.
00:00:11.119 --> 00:00:18.079
Stacy Shillington, Naturopathic Doctor, and this podcast is here to help you on your clear skin journey.
00:00:18.239 --> 00:00:20.879
So today we're talking about hormonal acne.
00:00:21.039 --> 00:00:36.240
And I know so many of you may have been told that you have hormonal acne, maybe by your doctor, maybe by your dermatologist, maybe a friend, or maybe you just figured it out yourself because your acne shows up every single month like clockwork.
00:00:36.320 --> 00:00:38.079
And I want you to know I've been there.
00:00:38.320 --> 00:00:44.960
My own acne came on after I stopped the birth control pill, and it was hormonal acne in every sense of the word.
00:00:45.119 --> 00:00:48.799
Deep, painful breakouts along my jaw and chin.
00:00:49.039 --> 00:00:53.119
They kept coming back every month, and sometimes they never stopped.
00:00:53.359 --> 00:01:00.799
No matter what I did, I remember feeling like my hormones were working against me and there was nothing I could do about it.
00:01:01.039 --> 00:01:10.079
But after almost 20 years of working with acne patients, I've learned that hormonal acne is not a diagnosis, it's a description.
00:01:10.319 --> 00:01:14.480
It tells us where your acne is and when it shows up.
00:01:14.719 --> 00:01:17.680
It does not tell us why you have acne.
00:01:17.840 --> 00:01:21.680
And why is the most important question behind hormonal acne.
00:01:21.760 --> 00:01:25.519
It's the question I want you to walk away asking today.
00:01:25.760 --> 00:01:38.879
So I'm gonna share what hormonal acne actually is, why it's never just one hormone, why chasing hormone numbers so often does not work, and how to find out what's really driving your breakout.
00:01:38.959 --> 00:01:40.400
So let's get down to it.
00:01:40.480 --> 00:01:42.000
I'm gonna jump right in.
00:01:42.239 --> 00:01:46.079
So number one, what is hormonal acne?
00:01:46.239 --> 00:01:50.000
So hormonal acne follows a pattern with your cycle.
00:01:50.159 --> 00:01:55.840
Maybe you break out the week before your period, maybe it's during your period or right after.
00:01:56.000 --> 00:02:01.439
And for some women, it flares around ovulation right in the middle of your cycle.
00:02:01.680 --> 00:02:07.280
If your skin seems to know where you are on your cycle before you do, it's a big clue.
00:02:07.519 --> 00:02:09.599
The other clue is location.
00:02:09.759 --> 00:02:18.400
So hormonal acne usually shows up along the lower face, your jawline, your chin, and sometimes down onto your neck.
00:02:18.560 --> 00:02:29.199
In my practice, I sometimes call it the beard area because those are the same areas that are most sensitive to androgens, the male type hormones we're going to talk about in just a minute.
00:02:29.439 --> 00:02:35.680
And I want you to pay attention to what kind of breakouts you're getting because your skin is giving you information.
00:02:35.919 --> 00:02:47.680
If you're getting deep, painful cystic breakouts, the kind that sit under the skin for weeks and never really come to a head, that tells me there's a lot of inflammation happening deep down.
00:02:48.000 --> 00:02:57.120
Those are the breakouts that make me look harder at things like blood sugar, stress, the gut, infections, because those are the big drivers of inflammation.
00:02:57.280 --> 00:03:08.319
If your breakouts are more on the surface, like white heads, blackheads, small bumps, that tells me more about oil production and how quickly your skin cells are turning over and clogging the pore.
00:03:08.479 --> 00:03:11.120
Still important, but often a different story.
00:03:11.360 --> 00:03:13.280
So your skin is actually a messenger.
00:03:13.360 --> 00:03:14.879
It is not your enemy.
00:03:15.120 --> 00:03:19.520
Before we even run a test, it's already telling us a lot.
00:03:19.759 --> 00:03:27.199
So the second thing I want you to understand is that hormonal acne is never just about one hormone.
00:03:27.360 --> 00:03:34.479
So often women come to me and they say, My doctor said it's my testosterone, or I was told I have low progesterone.
00:03:34.639 --> 00:03:40.479
And it's like we're looking for that one bad guy, but your hormones do not work alone, they work as a team.
00:03:40.719 --> 00:03:44.479
So let me walk you through the team really simply.
00:03:44.800 --> 00:03:51.280
So estrogen and progesterone are your main female hormones and they rise and fall through your cycle.
00:03:51.439 --> 00:03:59.599
When they shift, especially before your period, the balance can tip toward androgens, and that's often when breakouts show up.
00:03:59.840 --> 00:04:06.319
Androgens like testosterone and DHT are the hormones that tell your oil glands to make more oil.
00:04:06.479 --> 00:04:08.000
And we're going to come back to these.
00:04:08.319 --> 00:04:18.079
Prolactin is the hormone that's best known for breastfeeding, but when it's elevated, it can push your adrenal glands to make more androgens.
00:04:18.399 --> 00:04:22.079
And insulin, this is the hormone we talked about in the breakfast episodes.
00:04:22.240 --> 00:04:27.920
When insulin is high, it pushes your ovaries to make more testosterone.
00:04:28.079 --> 00:04:35.279
It lowers a protein called sex hormone binding globulin, which is what normally holds testosterone in check.
00:04:35.439 --> 00:04:42.240
And when sex hormone binding globulin goes down, more testosterone is free to act on your skin.
00:04:42.560 --> 00:04:48.319
Insulin is one of the biggest things I look for when it comes to hormonal acne.
00:04:48.639 --> 00:04:51.839
And then there's cortisol, your main stress hormone.
00:04:51.920 --> 00:04:58.240
And beauties, if you've been listening to this
Load full transcript
podcast for a while, you know I'm obsessed with the nervous system.
00:04:58.319 --> 00:05:04.959
And here's why: cortisol and your nervous system affect every other hormone on this list.
00:05:05.199 --> 00:05:14.879
When you're stressed, your blood sugar goes up, which means insulin goes up, and your body may prioritize stress hormones over progesterone production.
00:05:15.040 --> 00:05:21.519
Your digestion slows down, and your adrenal glands make more of a hormone called DHEAS.
00:05:22.000 --> 00:05:35.920
And here's what most people don't know: your skin can actually take that DHEAS and turn it into testosterone and DHT right inside the oil gland, right inside your skin.
00:05:36.079 --> 00:05:40.160
So stress can act like testosterone on your skin.
00:05:40.319 --> 00:05:44.399
When you're living in survival mode, your skin is getting the message.
00:05:44.639 --> 00:05:51.279
That's why I always say if your body is in survival, if you are stuck in stress, it cannot heal.
00:05:51.600 --> 00:05:57.360
Your nervous system, that is the piece that sits underneath everything else.
00:05:57.680 --> 00:06:06.879
So if any of what I'm talking about is resonating with you and you want to understand what's really driving your acne, I've prepared a free clear skin masterclass for you.
00:06:06.959 --> 00:06:15.519
So in it, I share a lot of my method and what's really going on underneath your acne, including how your hormones, blood sugar, and your gut all connect.
00:06:15.600 --> 00:06:17.279
The link is in my show notes.
00:06:17.439 --> 00:06:20.240
Just click on the button, you can watch it for free.
00:06:20.480 --> 00:06:22.639
So let's talk about the third point.
00:06:22.800 --> 00:06:26.000
And this is the part that I think is going to surprise a lot of you.
00:06:26.240 --> 00:06:29.279
Most of my patients have normal testosterone.
00:06:29.439 --> 00:06:31.040
Yes, this is so true.
00:06:31.199 --> 00:06:36.319
They come in with their blood work and their testosterone is right in the normal range.
00:06:36.480 --> 00:06:40.160
They're confused because they were told they had hormonal acne.
00:06:40.240 --> 00:06:41.279
So how can that be?
00:06:41.439 --> 00:06:42.720
There's a few reasons.
00:06:42.959 --> 00:06:44.639
The first is DHT.
00:06:44.720 --> 00:06:54.079
So testosterone is converted into a much more potent androgen called DHT by an enzyme called 5 alpha reductase.
00:06:54.800 --> 00:06:58.240
DHT is the hormone that revs up your oil glands.
00:06:58.480 --> 00:07:07.839
When the enzyme is very active, you can have normal or even low testosterone on your blood work while DHT is busy fueling breakouts.
00:07:08.319 --> 00:07:12.319
The second reason is that your skin makes its own androgens.
00:07:12.399 --> 00:07:19.759
So remember, your oil glands can turn DHEAS into testosterone and DHT right in the skin.
00:07:19.920 --> 00:07:24.560
Your blood work is not able to see or report on that activity.
00:07:24.879 --> 00:07:27.199
And the third reason is free testosterone.
00:07:27.279 --> 00:07:38.720
So your total testosterone can look completely normal, but if your sex hormone binding globulin is low, which happens when insulin is high, more of this testosterone is free and active.
00:07:39.040 --> 00:07:41.759
And the fourth reason is sensitivity.
00:07:42.000 --> 00:07:46.240
Some women simply have oil glands that are more sensitive to androgen.
00:07:46.480 --> 00:07:50.000
So even perfectly normal levels can trigger breakouts.
00:07:50.480 --> 00:08:01.600
And we can even get into how high estrogen or low progesterone can also allow androgens to work freely because they kind of act as breaks.
00:08:01.680 --> 00:08:08.639
And when estrogen and progesterone are out of range, the break that keeps androgens in check is no longer there.
00:08:08.959 --> 00:08:20.480
So, and for a long time, especially in my early career, I relied a lot on hormone testings and hormone testing and hormone treatments to fix the numbers.
00:08:20.720 --> 00:08:27.439
If androgens were high, I'd use herbs to block them, or or things that inhibit 5 alpha reductase.
00:08:27.519 --> 00:08:31.600
And if progesterone was low, I might use bioidentical progesterone.
00:08:31.759 --> 00:08:38.080
Sometimes these treatments help for a while, but I kept seeing the same thing over and over again.
00:08:38.240 --> 00:08:45.679
The acne would improve, then it would come back, or the numbers would look better on the paper, but the skin would not have changed.
00:08:46.000 --> 00:08:51.440
And eventually I realized that blocking hormones was not the answer.
00:08:52.000 --> 00:08:56.639
And it was not helping me understand why it was out of balance in the first place.
00:08:56.799 --> 00:09:00.879
It's like turning off the smoke alarm without checking for the fire.
00:09:01.200 --> 00:09:07.200
So now I use hormone testing much more carefully as only one piece of the picture.
00:09:07.360 --> 00:09:18.399
And I rarely, rarely rely on bioidentical hormones for acne because when we're fixing what's driving the hormones, the hormones very often start to balance on their own.
00:09:18.559 --> 00:09:26.000
And I want to be clear: if you're using an herb or a medication for your acne right now, you do not want to stop it suddenly.
00:09:26.080 --> 00:09:28.480
You want to work with your practitioner first.
00:09:28.879 --> 00:09:36.960
And I want you to know that it's okay to ask for testing and to get help to manage the numbers that you're seeing.
00:09:37.279 --> 00:09:45.519
Okay, so the fourth most important thing that I want to talk about is that you always want to ask why.
00:09:45.759 --> 00:09:49.600
Why is my very favorite word in the English language?
00:09:50.000 --> 00:09:55.360
If a practitioner tells you your progesterone is low, ask why.
00:09:55.679 --> 00:09:56.799
Is it stress?
00:09:56.960 --> 00:09:59.279
Is it that you're not ovulating regularly?
00:09:59.440 --> 00:10:01.600
Is it nutrient deficiency?
00:10:01.919 --> 00:10:05.679
Is it something called pregnenolone steel?
00:10:05.919 --> 00:10:12.879
This is when your body is actually prioritizing the production of cortisol over the production of progesterone.
00:10:13.039 --> 00:10:14.879
I see this all the time.
00:10:15.440 --> 00:10:18.240
If you're told that your androgens are high, ask why.
00:10:18.399 --> 00:10:19.440
Is it insulin?
00:10:19.600 --> 00:10:22.480
Is it stress pushing up the DHEAS?
00:10:22.720 --> 00:10:26.879
Is it your liver having a hard time clearing used up hormones?
00:10:27.120 --> 00:10:29.519
Is there something going on in your gut?
00:10:30.000 --> 00:10:32.399
Because there's always a reason.
00:10:32.559 --> 00:10:35.759
Your hormones, they are not randomly misbehaving.
00:10:35.919 --> 00:10:39.519
They're responding to what's happening in the rest of your body.
00:10:39.759 --> 00:10:42.639
So, how do I find that why?
00:10:42.960 --> 00:10:45.919
I have to do functional medicine testing.
00:10:46.080 --> 00:10:53.279
At this point in my career, I do not see patients without testing because I'm guessing otherwise.
00:10:53.360 --> 00:10:57.919
And I do not want to waste my patients' time and money on my guesses.
00:10:58.080 --> 00:11:02.320
I want to know exactly how we need to heal their bodies.
00:11:02.480 --> 00:11:15.600
So the tests that I use, first of all, a GI mapping test, this shows me what's happening in the gut, the good bacterial, any bacterial or fungal overgrowths, how well you're digesting and absorbing your food.
00:11:15.840 --> 00:11:21.919
And your gut is so important for hormones because that's where used up hormones like estrogen leave the body.
00:11:22.080 --> 00:11:28.000
If your gut is not working well, those hormones can be reabsorbed into circulation.
00:11:28.399 --> 00:11:31.440
Number two, an organic acid test or an oat test.
00:11:31.679 --> 00:11:43.279
This shows me what's going on on a cellular level, your nutrient status, your mitochondria, your detox pathways, and markers of yeast and bacterial and mold.
00:11:43.840 --> 00:11:46.000
And then I always do blood work.
00:11:46.080 --> 00:11:49.600
And I look at blood work through a lens of acne.
00:11:49.679 --> 00:11:57.600
I look at your fasting insulin and blood sugar, your sex hormone binding globulin, DHEAS, ferritin, thyroid, and so much more.
00:11:57.759 --> 00:12:01.519
And I always look at it through functional medicine ranges.
00:12:01.679 --> 00:12:04.000
I'm looking for optimal health.
00:12:04.320 --> 00:12:07.679
And when I do hormone testing, timing matters.
00:12:07.840 --> 00:12:11.120
So testosterone shifts across your cycle and throughout the day.
00:12:11.200 --> 00:12:17.759
So I like to test in the morning and I like to test at the right time during your cycle.
00:12:17.919 --> 00:12:23.840
So we're getting the information that we need in relation to your estrogen and your progesterone levels.
00:12:24.080 --> 00:12:32.000
And I have to tell you, after almost 20 years and thousands and thousands of lab tests, these tests still surprise me.
00:12:32.159 --> 00:12:42.799
I'll have a patient I'm sure is going to be a blood sugar case, and her test shows a big gut infection, or someone I was sure was stress-driven, and her ferritin is barely there.
00:12:42.960 --> 00:12:46.080
That's exactly why I test instead of guessing.
00:12:46.320 --> 00:12:48.559
Every woman is different.
00:12:48.960 --> 00:12:51.279
So let's bring it all together.
00:12:51.600 --> 00:12:58.480
Hormonal acne follows a pattern with your cycle and usually shows up along your jaw, chin, and neck.
00:12:58.799 --> 00:13:03.279
Deep cystic breakouts tell us there's more inflammation underneath.
00:13:03.440 --> 00:13:05.279
It's never just one hormone.
00:13:05.519 --> 00:13:15.919
Estrogen, progesterone, androgens, prolactin, insulin, and cortisol all work together as a team and your nervous system sits underneath it all.
00:13:16.240 --> 00:13:23.039
Chasing a hormone number or blocking a hormone does not fix why it was out of balance in the first place.
00:13:23.519 --> 00:13:27.519
And the most important question you can ask is why?
00:13:27.840 --> 00:13:29.919
And beauties, I want you to hear this.
00:13:30.159 --> 00:13:36.240
If you've been told your hormones are normal, but you're still breaking out every month, it's not in your head.
00:13:36.399 --> 00:13:39.600
It just means no one has found your why yet.
00:13:39.840 --> 00:13:43.759
Listen to your body because this is what it's all about.
00:13:44.000 --> 00:13:50.720
And if you want to learn more about how to heal your acne and what's really causing it, check out my free Clear Skin Masterclass.
00:13:50.799 --> 00:13:52.240
The links are in my show notes.
00:13:52.480 --> 00:13:54.960
This is the work I've been doing for 20 years.
00:13:55.120 --> 00:13:58.159
I've read thousands and thousands of functional lab tests.
00:13:58.240 --> 00:14:01.679
So I really deeply understand the patterns behind acne.
00:14:02.000 --> 00:14:09.279
And if you have a friend who's been told she has hormonal acne and is still searching for answers, please send this episode to her.
00:14:09.519 --> 00:14:12.159
So I hope this has really helped you.
00:14:12.320 --> 00:14:28.320
I hope it wasn't too much information, but I really want you to understand what hormonal acne is, what's behind it, and why we have to continually ask why, because there's so many different players when it comes to hormonal acne.
00:14:28.639 --> 00:14:33.039
So I hope this has helped you to take one more step toward clear skin.
00:14:33.200 --> 00:14:37.600
Be sure to check out the free Clear Skin Masterclass in the show notes.
00:14:37.840 --> 00:14:42.240
Thank you so much and have a beautiful, beautiful day.