Is Your Acne Hormonal? (And Why the Answer Might Surprise You)
A familiar story, and one that I’ve experienced first hand is being told my acne is hormonal and being sent off with a prescription for a ‘skin-friendly’ version of the oral contraception pill. However, the research shows that the hormones driving your breakouts might not be the ones anyone has talked to you about.
"It's Hormonal" But Which Hormones and What Does This Really Mean?
If you've ever seen a doctor about your acne, there's a good chance you were told it was hormonal. Perhaps you walked away with a prescription for the contraceptive pill or a topical treatment but did anyone talk to you about which hormones, simply blame testosterone or share what you could do about your breakouts from the inside?
When most people say acne is hormonal, they're thinking about oestrogen, progesterone and testosterone. And yes, these sex hormones can play a role, especially in polycistic ovary syndrome (PCOS). But for a significant number of people with persistent acne — particularly adult women — the more important hormonal drivers are ones that don’t seem to be mentioned as often despite appearing in the research.
They are insulin and IGF-1. And understanding them could make a real impact on how you understand and support your skin.
What Is IGF-1 and Why Does It Matter for Acne?
IGF-1 stands for Insulin-like Growth Factor 1. It's a growth hormone produced primarily by the liver in response to signals from the pituitary gland, but crucially, its production is also stimulated by insulin and by certain foods, particularly dairy (which is why dairy is often mentioned when it comes to acne).
IGF-1 plays an important role in puberty, driving the growth and development of bones, muscles, and organs. But it also has a profound effect on the skin, which is why acne affects approximately 95% of adolescents to some extent (British Journal of Dermatology, 2020).
Here's what elevated IGF-1 does in the skin:
Stimulates sebaceous glands to produce more sebum (oil).
Increases keratinocyte proliferation — causing skin cells to multiply rapidly, which can block pores leading to an increase in blackheads and whiteheads.
Promotes androgen activity in the skin — amplifying the effect of testosterone and other androgens locally, even when blood levels appear normal (this is important as it is why testosterone gets a bad reputation when it comes to acne, but it’s actually acting in a very localised level in the skin, not throughout the body, hence why it often doesn’t show up in blood tests).
Drives inflammation — worsening the severity of existing breakouts.
This last point is particularly important. Many women with hormonal acne have their sex hormones tested, find them within normal range, and are told nothing is wrong. But IGF-1 can be driving androgen activity at tissue level, even when circulating hormone levels look perfectly fine on paper. The test didn't capture the real problem.
The Insulin Connection
Insulin is the hormone your body releases in response to rising blood sugar. Every time you eat, your blood glucose rises and insulin is secreted to bring it back down. Insulin has to work particularly hard when it comes to foods high in sugar, alcohol and refined carbohydrate, such as white bread and processed snacks.
This is entirely normal. The problem arises when blood sugar spikes are frequent, large and sustained, a pattern driven by a modern diet high in refined carbohydrates and low in fibre, protein and healthy fats. A pattern I’ve noticed in clinic with clients with acne is that they can be more sensitive to blood sugar fluctuations, which can show by easily getting hangry or having fluctuations in energy.
Chronically elevated insulin affects acne in several ways:
Directly stimulates IGF-1 production — the two hormones are deeply interconnected, high insulin drives high IGF-1, and together they create the perfect internal environment for acne to flourish.
Increases androgen production — insulin stimulates the ovaries and adrenal glands to produce more androgens, including testosterone, which increase sebum production and drive breakouts. This is one of the reasons acne is so prevalent in polycystic ovary syndrome (PCOS), a condition characterised by insulin resistance.
Suppresses sex hormone binding globulin (SHBG) — SHBG is a protein that binds to testosterone in the bloodstream, keeping it inactive. High insulin lowers SHBG levels, meaning more testosterone is left free and active in the body — with direct consequences for the skin.
Drives inflammation — like IGF-1, chronically high insulin is pro-inflammatory, worsening the severity and healing time of breakouts.
So Where Do Sex Hormones Fit In?
Sex hormones, oestrogen, progesterone, and testosterone, can have an influence on acne. The cyclical breakouts many women experience before their period — the jawline flares, the deeper cystic spots — these are real and sex hormones can play a role.
But here's the important nuance: insulin and IGF-1 significantly amplify the impact of sex hormones on the skin.
Think of it this way. If your insulin and IGF-1 levels are chronically elevated, your skin is primed and sensitised, more oil, more blocked pores, more inflammation, greater sensitivity to androgens. In that environment, even normal fluctuations in oestrogen and progesterone around your cycle can trigger significant breakouts.
I find that when you address the insulin and IGF-1 picture many clients find their hormonal acne becomes dramatically less severe — even before doing anything specifically targeted at sex hormones.
Why This Matters for You
This distinction has profound practical implications. The contraceptive pill works for acne partly by increasing SHBG, binding up more testosterone and reducing its activity. For some women it improves their skin. For others the improvement is partial or temporary. And for many, coming off the pill triggers a significant rebound flare, because the underlying insulin and IGF-1 picture was never addressed.
Similarly, Spironolactone and other anti-androgen medications target sex hormone activity but do nothing to address the metabolic drivers that are amplifying that activity in the first place.
This is not a criticism of those treatments, they have their place. But they work downstream of the real problem for many women. When I’m working with clients, I’m always aiming to work upstream to really join the dots of what is causing the breakouts. The other benefits of working this way are the ongoing benefits it brings to that person’s future health and energy.
What Drives High Insulin and IGF-1?
The good news is that both insulin and IGF-1 are highly responsive to diet and lifestyle. The main drivers include:
A high glycaemic diet — refined carbohydrates, sugary foods and drinks, processed snacks.
Dairy consumption — particularly skimmed and semi-skimmed milk, which stimulates IGF-1 production directly regardless of its sugar content.
Infrequent meals and blood sugar instability — skipping meals, under-eating, and then overcorrecting all disrupt insulin regulation.
Chronic stress — cortisol raises blood glucose, which raises insulin.
Poor sleep — even one night of poor sleep measurably impairs insulin sensitivity.
Sedentary behaviour — movement is one of the most powerful regulators of insulin sensitivity.
Signs That Insulin and IGF-1 May Be Driving Your Acne
Common signs include:
Acne that worsens after high sugar or high carbohydrate meals.
Breakouts that flare during stressful periods.
Skin that worsens significantly when you started consuming more dairy.
Acne alongside energy crashes, afternoon slumps, or sugar cravings.
A diagnosis of PCOS or suspected insulin resistance.
Acne that partially improved on the pill but never fully resolved.
Breakouts that persist despite good skincare and topical treatments.
What Can You Do About It?
Addressing insulin and IGF-1 through nutrition and lifestyle is one of the most powerful levers available for clearing acne, and it's largely within your control.
Shift to a lower glycaemic way of eating
This doesn't mean eliminating carbohydrates. It means prioritising complex carbohydrates (such as brown rice, oat cakes, root vegetables, beans, lentils, quinoa, buckwheat) and eating them alongside protein, fat and fibre to slow glucose release, and making friends with your kitchen again to reduce refined and processed foods.
Reconsider dairy
The evidence linking dairy, particularly cow’s milk, to acne via IGF-1 is among the strongest in the nutritional dermatology literature. A structured elimination trial is worth doing for most people with persistent acne. However, this is something I always personalise to the individual.
Balance your meals
Every meal should contain a quality protein source, healthy fat and fibre. This simple shift stabilises blood sugar and reduces insulin demand throughout the day.
Prioritise sleep and stress management
Both have a direct and measurable impact on insulin sensitivity. They are not optional extras.
Move your body regularly
Exercise improves insulin sensitivity significantly — even a short walk after meals has been shown to reduce post-meal glucose spikes.
What Next?
Hormones do play a key role in acne. But the hormones most responsible may not be the ones you've been told about. Insulin and IGF-1 sit at the centre of the acne picture for a huge number of people — driving sebum production, blocking pores, amplifying androgen activity and fuelling inflammation.
The empowering news is that these are hormones you can meaningfully influence through the way you eat and live. No prescription required.
Understanding your unique hormonal and metabolic picture is central to everything I do. If you're ready to find out what's really driving your breakouts, you can book a complementary clarity call here.