By Erin Lukas
Updated Jan 29, 2017 @ 3:00 pm
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If you thought clear skin would be a given once you said goodbye to your teen years, your hormones still rage with your monthly cycle. The flux in testosterone around ovulation and progesterone right before the start of your period can result in those stubborn cystic pimples that fester on your cheeks, chin, and jawline. “Most women with hormonal acne have perfectly normal levels of hormones,” explains New York City-based board-certified dermatologist Dr. Cybele Fishman. “But blood measurement of hormones does not really explain what is going on at the level of the skin. I think with hormonal acne, either the skin level of the testosterone is too high (not measured by blood) or the skin is too sensitive to the testosterone.”

As if the actual breakouts aren’t annoying enough, because these blemishes are deeper in the skin, traditional topical remedies with common acne-fighting ingredients such as benzoyl peroxide, salicylic acid, and retinoids don’t penetrate deep enough to treat them. To make matters worse, some of these products can also be extremely irritating, which can exacerbate the whole situation.

Another reason why these medicine types don't always not work is because they’re not treating the larger problem at hand: a hormone imbalance. “Many acne medicines, including most topicals and oral antibiotics are really not treating the issue, which is too much testosterone activity in the skin,” says Dr. Fishman.

While taking an oral prescription like spironolactone can be an effective way to minimize hormonal acne, if you don’t want to risk the potential side effects that come with this treatment route, there are some natural alternatives you can try to help minimize hormonal breakouts. Here, Dr. Fishman helps us break them down.

Add a Supplement

Since many topical creams and spot treatments are treating skin on a surface level, they won't address an the internal issue of the hormone imbalance. Instead, Dr. Fishman recommends regularly taking a supplement such as diindoylymethane (DIM), which will help cut the excess testosterone that's affecting the skin.

Indole 3-Carbinol (I3C) is the precursor to DIM. It's a naturally-derived compound that comes from eating cruciferous vegetables like cauliflower, broccoli, and cabbage. On top of promoting gut and liver detoxification, it also regulates estrogen and androgen. Studies are increasingly showing that taking I3C supplements can prevent the development of estrogen-related cancers like breast, cervical, and endometrial cancers.

DIM is formed with I3C is metabolized in the gut. While there's no direct study on the relationship between taking I3C/DIM supplements and acne, the compound is proven to regulate estrogen, which according to studies, can effect sebum levels in the skin. Sebum plays a role in acne formation.

However, the plant-derived supplement isn't a foolproof solution. Dr. Fishman says it’s a matter of trial-and-error, and while DIM can help a lot of patients, it won't be a solution for everyone.

When taking DIM, don't expect to see improvement overnight. It can take a couple months to see results.

Cut Down Inflammation

Easier said than done, but Dr. Fishman says it’s important to be the most un-inflamed person you could be. This means to cut out high-glycemic foods like white bread, white rice, sugary drinks like soda, potato chips, and white potatoes. Why are these foods so bad? They cause a spike in blood sugar.

According to the American Academy of Dermatology, small studies have shown that following a low-glycemic diet can reduce the number of breakouts you experience. In the one US study, 87% of 2,258 patients placed on a low-glycemic diet for weight loss experienced less acne, and 91% said they needed less acne medication.

So, just how do you do this? In addition to adding low-glycemic foods like vegetables, beans, and steel-cut oats to your diet, clock in enough sleep and try acupuncture treatments.

Stop Drinking Low-Fat or Skim Milk

“Even if you get organic [cow milk], it has growth hormones in meant for the calf that can exacerbate hormonal acne,” says Dr. Fishman. “If you do drink cow milk, opt for full fat.”

A study published in the Journal of the Academy of American Dermatology has found a connection between drinking low-fat or skim milk and acne. The occurrence of acne in participants who drank low-fat or skim milk with acne was significantly higher than those with no acne.

Don’t worry your other beloved dairy products like cheese and yogurt are safe. “Cheese and yogurt are different because they’re fermented. I usually don’t tell people to cut those out,” she says. Like all delicious things in life, it’s best to indulge in moderation.

Minimize How Much Processed Sugar You Eat

Processed sugar is high-glycemic and it a domino effect on your body. One study conducted in Turkey found people who frequently consumed added sugars had a 30% greater risk of developing acne, while those who regularly ate pastries and cakes had a 20% greater risk. ​​​​​​​

“Too much leads to a cascade of events in your body,” explains Dr. Fishman. “First, there’s an increase in insulin, then an increase in an insulin-like growth factor that can exacerbate hormonal acne.”

What can you do? Cut back on processed sugars and add more low-glycemic foods into your regular diet.