Is my skin breaking out because of hormones or something else?

Adult acne — particularly along the jawline, chin, or back — is most commonly driven by androgen excess, insulin resistance, or gut dysbiosis, not poor skincare. The most common biological drivers include:

• Androgen excess — elevated testosterone or DHEA-S directly stimulates sebaceous glands to produce more sebum; this is the most common hormonal driver of adult acne, particularly in women with PCOS or adrenal dysfunction
• Insulin resistance — high insulin levels amplify androgen activity and stimulate IGF-1, which further increases sebum production and skin cell turnover; this is why high-glycemic diets consistently worsen acne
• Gut dysbiosis — an imbalanced gut microbiome drives systemic inflammation that manifests in the skin; the gut-skin axis is well-documented and explains why gut health protocols often resolve skin conditions that topical treatments cannot
• Estrogen-progesterone imbalance — low progesterone relative to estrogen (estrogen dominance) can worsen androgen-driven acne and cause cyclical breakouts
• Chronic inflammation — systemic inflammatory signals increase skin cell turnover and pore-clogging, independent of androgen levels

Topical treatments address the surface. Functional medicine addresses the biology driving it. The same internal pattern that causes acne often also drives fatigue, hair thinning, and irregular cycles — which is why treating the skin in isolation rarely produces lasting results.

A functional medicine evaluation identifies which of these patterns is active through targeted lab testing, then builds a protocol that resolves the skin symptoms by addressing the underlying biology.