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Welcome to Naturopathic Beauty's Clear Skin Sessions, where we heal your acne from the inside out.
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Hello, beauties, and welcome to the Clear Skin Sessions.
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I'm Dr.
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Stacy Shillington, Naturopathic Doctor, and this podcast is here to help you on your clear skin journey.
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So today we're talking about hormonal acne.
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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.
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And I want you to know I've been there.
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My own acne came on after I stopped the birth control pill, and it was hormonal acne in every sense of the word.
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Deep, painful breakouts along my jaw and chin.
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They kept coming back every month, and sometimes they never stopped.
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No matter what I did, I remember feeling like my hormones were working against me and there was nothing I could do about it.
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But after almost 20 years of working with acne patients, I've learned that hormonal acne is not a diagnosis, it's a description.
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It tells us where your acne is and when it shows up.
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It does not tell us why you have acne.
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And why is the most important question behind hormonal acne.
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It's the question I want you to walk away asking today.
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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.
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So let's get down to it.
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I'm gonna jump right in.
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So number one, what is hormonal acne?
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So hormonal acne follows a pattern with your cycle.
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Maybe you break out the week before your period, maybe it's during your period or right after.
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And for some women, it flares around ovulation right in the middle of your cycle.
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If your skin seems to know where you are on your cycle before you do, it's a big clue.
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The other clue is location.
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So hormonal acne usually shows up along the lower face, your jawline, your chin, and sometimes down onto your neck.
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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.
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And I want you to pay attention to what kind of breakouts you're getting because your skin is giving you information.
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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.
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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.
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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.
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Still important, but often a different story.
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So your skin is actually a messenger.
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It is not your enemy.
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Before we even run a test, it's already telling us a lot.
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So the second thing I want you to understand is that hormonal acne is never just about one hormone.
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So often women come to me and they say, My doctor said it's my testosterone, or I was told I have low progesterone.
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And it's like we're looking for that one bad guy, but your hormones do not work alone, they work as a team.
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So let me walk you through the team really simply.
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So estrogen and progesterone are your main female hormones and they rise and fall through your cycle.
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When they shift, especially before your period, the balance can tip toward androgens, and that's often when breakouts show up.
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Androgens like testosterone and DHT are the hormones that tell your oil glands to make more oil.
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And we're going to come back to these.
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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.
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And insulin, this is the hormone we talked about in the breakfast episodes.
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When insulin is high, it pushes your ovaries to make more testosterone.
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It lowers a protein called sex hormone binding globulin, which is what normally holds testosterone in check.
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And when sex hormone binding globulin goes down, more testosterone is free to act on your skin.
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Insulin is one of the biggest things I look for when it comes to hormonal acne.
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And then there's cortisol, your main stress hormone.
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And beauties, if you've been listening to this
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podcast for a while, you know I'm obsessed with the nervous system.
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And here's why: cortisol and your nervous system affect every other hormone on this list.
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When you're stressed, your blood sugar goes up, which means insulin goes up, and your body may prioritize stress hormones over progesterone production.
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Your digestion slows down, and your adrenal glands make more of a hormone called DHEAS.
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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.
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So stress can act like testosterone on your skin.
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When you're living in survival mode, your skin is getting the message.
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That's why I always say if your body is in survival, if you are stuck in stress, it cannot heal.
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Your nervous system, that is the piece that sits underneath everything else.
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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.
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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.
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The link is in my show notes.
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Just click on the button, you can watch it for free.
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So let's talk about the third point.
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And this is the part that I think is going to surprise a lot of you.
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Most of my patients have normal testosterone.
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Yes, this is so true.
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They come in with their blood work and their testosterone is right in the normal range.
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They're confused because they were told they had hormonal acne.
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So how can that be?
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There's a few reasons.
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The first is DHT.
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So testosterone is converted into a much more potent androgen called DHT by an enzyme called 5 alpha reductase.
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DHT is the hormone that revs up your oil glands.
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When the enzyme is very active, you can have normal or even low testosterone on your blood work while DHT is busy fueling breakouts.
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The second reason is that your skin makes its own androgens.
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So remember, your oil glands can turn DHEAS into testosterone and DHT right in the skin.
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Your blood work is not able to see or report on that activity.
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And the third reason is free testosterone.
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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.
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And the fourth reason is sensitivity.
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Some women simply have oil glands that are more sensitive to androgen.
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So even perfectly normal levels can trigger breakouts.
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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.
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And when estrogen and progesterone are out of range, the break that keeps androgens in check is no longer there.
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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.
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If androgens were high, I'd use herbs to block them, or or things that inhibit 5 alpha reductase.
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And if progesterone was low, I might use bioidentical progesterone.
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Sometimes these treatments help for a while, but I kept seeing the same thing over and over again.
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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.
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And eventually I realized that blocking hormones was not the answer.
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And it was not helping me understand why it was out of balance in the first place.
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It's like turning off the smoke alarm without checking for the fire.
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So now I use hormone testing much more carefully as only one piece of the picture.
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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.
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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.
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You want to work with your practitioner first.
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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.
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Okay, so the fourth most important thing that I want to talk about is that you always want to ask why.
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Why is my very favorite word in the English language?
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If a practitioner tells you your progesterone is low, ask why.
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Is it stress?
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Is it that you're not ovulating regularly?
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Is it nutrient deficiency?
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Is it something called pregnenolone steel?
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This is when your body is actually prioritizing the production of cortisol over the production of progesterone.
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I see this all the time.
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If you're told that your androgens are high, ask why.
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Is it insulin?
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Is it stress pushing up the DHEAS?
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Is it your liver having a hard time clearing used up hormones?
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Is there something going on in your gut?
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Because there's always a reason.
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Your hormones, they are not randomly misbehaving.
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They're responding to what's happening in the rest of your body.
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So, how do I find that why?
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I have to do functional medicine testing.
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At this point in my career, I do not see patients without testing because I'm guessing otherwise.
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And I do not want to waste my patients' time and money on my guesses.
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I want to know exactly how we need to heal their bodies.
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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.
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And your gut is so important for hormones because that's where used up hormones like estrogen leave the body.
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If your gut is not working well, those hormones can be reabsorbed into circulation.
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Number two, an organic acid test or an oat test.
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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.
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And then I always do blood work.
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And I look at blood work through a lens of acne.
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I look at your fasting insulin and blood sugar, your sex hormone binding globulin, DHEAS, ferritin, thyroid, and so much more.
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And I always look at it through functional medicine ranges.
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I'm looking for optimal health.
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And when I do hormone testing, timing matters.
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So testosterone shifts across your cycle and throughout the day.
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So I like to test in the morning and I like to test at the right time during your cycle.
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So we're getting the information that we need in relation to your estrogen and your progesterone levels.
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And I have to tell you, after almost 20 years and thousands and thousands of lab tests, these tests still surprise me.
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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.
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That's exactly why I test instead of guessing.
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Every woman is different.
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So let's bring it all together.
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Hormonal acne follows a pattern with your cycle and usually shows up along your jaw, chin, and neck.
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Deep cystic breakouts tell us there's more inflammation underneath.
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It's never just one hormone.
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Estrogen, progesterone, androgens, prolactin, insulin, and cortisol all work together as a team and your nervous system sits underneath it all.
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Chasing a hormone number or blocking a hormone does not fix why it was out of balance in the first place.
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And the most important question you can ask is why?
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And beauties, I want you to hear this.
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If you've been told your hormones are normal, but you're still breaking out every month, it's not in your head.
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It just means no one has found your why yet.
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Listen to your body because this is what it's all about.
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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.
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The links are in my show notes.
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This is the work I've been doing for 20 years.
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I've read thousands and thousands of functional lab tests.
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So I really deeply understand the patterns behind acne.
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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.
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So I hope this has really helped you.
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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.
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So I hope this has helped you to take one more step toward clear skin.
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Be sure to check out the free Clear Skin Masterclass in the show notes.
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Thank you so much and have a beautiful, beautiful day.