Acne is a complex condition in the skin resulting from hormonal and bacterial shifts that set the skin up for inflammation, immune system recruitment and acne development. Adults with acne are likely experiencing their symptoms for different reasons than pre-pubertal patients, and deserve a more comprehensive work up to determine the actual root cause.
DHT (or Dihydroxytestosterone) is a testosterone-based hormone that is elevated in the skin of acne sufferers, and contributes to adult facial acne, male pattern hair loss, body acne, unwanted hair growth in females and prostate enlargement in men(1–4). DHT is produced in the skin of susceptible patients at a rate faster than their clear-skinned peers, which triggers excess sebum production and encourages bacterial overgrowth. DHT has 10x the affinity for androgen receptors than regular testosterone(5), so any disturbance in DHT production exerts “excessive” testosterone response in many tissues, including the skin.
Measuring DHT is the first step towards understanding adult acne, and in our experience, most sufferers have never been properly assessed by their doctor.
The process by which some patients produce more DHT than others is complex, but understanding your DHT numbers (as well as a few other hormones such as SHBG, insulin and cortisol) we can encourage your body to produce less of this hormone, or eliminate the dietary triggers that worsen your body’s response to elevated DHT. Many nutrients are involved in the DHT-Acne pathway, and healing time, lesion count and inflammation levels can all be affected by simple diet changes or nutritional supplementation with nutrients such as green tea(6), zinc(7) and fiber.
All patients presenting with acne at our office also have an in depth evaluation of their current supplements. Commonly self-prescribed supplements such as vitamin B12 and branched chain amino acids (BCAAs) worsen adult acne, and should likely be discontinued to get the best results.
- Förström L. The influence of sex hormones on acne. Acta Derm Venereol Suppl (Stockh). 1980;Suppl 89:27–31.
- Scholl GM, Wu CH, Leyden J. Androgen excess in women with acne. Obstet Gynecol. 1984 Nov;64(5):683–8.
- Aizawa H, Niimura M. Adrenal androgen abnormalities in women with late onset and persistent acne. Arch Dermatol Res. 1993;284(8):451–5.
- Urysiak-Czubatka I, Kmieć ML, Broniarczyk-Dyła G. Assessment of the usefulness of dihydrotestosterone in the diagnostics of patients with androgenetic alopecia. Adv Dermatol Allergol Dermatol Alergol. 2014 Aug;31(4):207–15.
- Melnik BC. Linking diet to acne metabolomics, inflammation, and comedogenesis: an update. Clin Cosmet Investig Dermatol. 2015 Jul 15;8:371–88.
- Grant P, Ramasamy S. An Update on Plant Derived Anti-Androgens. Int J Endocrinol Metab. 2012;10(2):497–502.
- Stamatiadis D, Bulteau-Portois MC, Mowszowicz I. Inhibition of 5 alpha-reductase activity in human skin by zinc and azelaic acid. Br J Dermatol. 1988 Nov;119(5):627–32.