anti-androgens

You wake up, roll out of bed, and find another hormonal acne pimple on your jawline. How can you treat this naturally without jumping straight to prescription medication? 

3 anti-androgens for acne may be just what you’re looking for: DIM, saw palmetto, and Vitex.

These natural anti-androgens can reduce or eliminate hormonal acne in many cases as they balance hormones and reduce acne vulgaris. Read on to understand their powerful effects.

What are anti-androgens?

To define an anti-androgen, let’s start with what an androgen is. 

An androgen is a sex hormone naturally produced in the human body. Androgen and testosterone are often referred to as “male” hormones, while estrogen and progesterone are “female” hormones. 

Nevertheless, all people have all of the androgens, just different ratios of them. 

How do androgens cause acne? Androgens can cause acne by triggering your sebaceous glands in the skin to overproduce oil, which clogs pores and hair follicles, inflames the skin, and feeds the Cutibacterium that cause acne.

Women tend to have lower androgen levels, but when the proportion of androgens to other hormones is imbalanced, symptoms such as acne can result. Heightened androgen production in women can come from a number of factors, including:

As a dermatologist, I have seen that balancing the androgen levels in female patients can cause a breakthrough in acne treatment. 

That’s where my favorite anti-androgens come into play, swooping in to save the day like the hero of a Hallmark romance! Anti-androgens balance out the overproduction of androgens.

anti-skin-androgen

What are anti-androgens used for?

Anti-androgens are used to block the effects of excess androgen in the body.

Scientifically, most anti-androgens that affect acne inhibit dihydrotestosterone (DHT) or alpha-reductase from binding to the androgen receptors in sebaceous glands. Do DHT blockers help acne? Yes, DHT blockers help acne by preventing androgens from locking onto their targets.

With the receptors blocked and no place to call home, androgens can’t wreak havoc on the skin. Many can also reduce inflammatory cytokine production, which means they can lower the inflammation that often comes with acne.

Heightened levels of androgens in women, or hyperandrogenism, can lead to hormonal acne vulgaris breakouts. Beyond hyperandrogenism can also cause:

  • Androgenetic alopecia (balding)
  • Seborrhea (inflamed skin) 
  • Hirsutism (irregular hair growth), and
  • High blood pressure (hypertension)

More seriously, long-term hormonal imbalances can cause serious issues like prostate cancer and breast cancer if not treated. Beyond your skin, it’s always in your best interest to balance your hormones.

While there are prescription hormonal therapy options like a low-dose contraceptive pill, spironolactone, Cyproterone acetate, or a topical antiandrogen cream like clascoterone, there are also more holistic ways to balance androgen production for the hormonal treatment of acne.

You may be wondering: how do I naturally balance androgens? To naturally balance androgens, sometimes adding in supplements such as DIM, saw palmetto, or Vitex can be helpful.

anti-androgensskin

DIM for Acne

Many patients at my dermatology practice have asked me, “How do you treat androgen acne?” To treat androgen acne, DIM can be a great natural starting point to curb sebum production. DIM occurs naturally in cruciferous vegetables like broccoli, but also comes in capsule form.

DIM is a natural anti-androgen, binding to the androgen receptors and blocking excess androgen from attaching to those proteins. Not only that, but an overproduction of testosterone can sometimes be converted to estrogen — causing even more hormone havoc.

Nevertheless, the benefits of DIM don’t stop there. DIM also assists your liver in breaking down excess estrogen and stops your body from converting surplus testosterone to estrogen. This further evens out hormonal levels in the body.

DIM can also reduce the production of inflammation-causing cytokines. Acne is an inflammatory condition, so this may also help with reducing breakouts.

In short, DIM can assist with both estrogen-related and androgenic issues, making it a star in the treatment of acne vulgaris, as I’ve written before. Looking to try it? My top recommendation is DIM-Evail from Designs for Health. I have also seen success with Accumax and Estroblock.

Saw Palmetto for Acne

Saw palmetto is often recommended by functional healthcare providers for acne because it helps decrease some testosterone from becoming DHT, its more potent form, which can worsen acne.

It can also decrease inflammation while supercharging the immune system to fight infection or other illness.

Saw palmetto also contains several fatty acids like laurate, palmitate, oleate, and linoleate that keep the skin hydrated and nourished while reducing irritation. The effects of this supplement can go beyond hormone regulation to skin rehabilitation.

This androgen inhibitor also works wonders in reducing hormonal hair loss. Saw palmetto can be taken as a supplement, applied topically with a carrier oil to the skin, eaten in its berry form, or used as an ingredient in topical creams.

Vitex for Acne

Vitex, also called chaste berry, is a long-used natural remedy for PMS pain and breast tenderness.

One study showed an improved hormone balance in women who took Vitex over those in the placebo group. While we are still researching the full effects of Vitex, preliminary research shows promise as an acne treatment.

The way Vitex works for acne is different from DIM or saw palmetto. In particular, Vitex limits the release of a hormone called prolactin. 

Prolactin is a “modulating” hormone, similar to cortisol. It’s released in response to stress, pregnancy, and even injury. But too much prolactin for too long can lead to a wide variety of skin problems, including acne breakouts.

But this isn’t just a hormone vs. skin issue. Prolactin impacts skin health by acting on the nervous system, creating a sort of “loop” between the endocrine system, nervous system, and skin.

That’s one way Vitex impacts acne, PMS, PMDD, and many more hormonal issues — it stimulates the release of dopamine (the “happy hormone”). When dopamine is released, your mood and mental health often improves and prolactin production is limited.

Finally, Vitex also seems to act on your acetylcholine and opioid receptors. That’s why it’s so useful for reducing inflammatory pain.

anti-androgens-skin

DIM vs. Saw Palmetto vs. Vitex

These 3 anti-androgens can all help reduce acne breakouts, but they work differently.

DIM, saw palmetto, and Vitex all:

  • Suppress androgen hormone activity
  • Reduce inflammation

But here’s where each of them stands out:

  • DIM may curb sebum production and controls excess estrogen production for powerful hormone-balancing and acne-fighting benefits.
  • Saw palmetto blocks testosterone-to-DHT conversion, which means it protects from acne and hormonal hair loss (in both men and women). It also has skin-hydrating properties.
  • Vitex limits the production of prolactin, which is released in large amounts when you experience stress, become pregnant, or start lactating. It creates a healthier connection between the skin, nervous system, and endocrine system. It may also improve your mood and reduce pain responses.

Precautions for Using DIM, Saw Palmetto, and Vitex for Acne

Before you rush out to buy these three recommendations, sit down and have a real conversation with your dermatologist about the cause of your acne. Not all pimples are hormonally related, and some have unexpected causes. 

Anti-androgens are also known to cause side effects like:

  • Lowered sex drive
  • Raised liver enzyme levels
  • Hair loss on the face and body
  • Hepatitis
  • Breast tenderness
  • Diarrhea 

A few other considerations:

  • Be sure to tell your dermatologist about any other medication you’re on, including combined oral contraceptives or other prescriptions.
  • It’s not advisable to take any anti-androgens if you are pregnant or breastfeeding.
  • If you’re thinking of taking DIM, be sure to start with the lowest dose possible and only increase after you have taken it for 2-3 months. It has the potential to negatively affect your menstrual cycle.
  • Saw palmetto, DIM, and Vitex may not be suitable for people under 18.
  • When Vitex stimulates dopamine release, you may produce lower levels of TSH (thyroid-stimulating hormone) as a result. If you have thyroid problems, talk to your doctor before taking Vitex.

When I work with hormonal acne patients, I take the time to review their individual case, the root issues of their acne breakouts, and what treatments have worked or not worked for them in the past. Only then do I make a recommendation as to which of these anti-androgens may help reduce their breakouts.

Should you try DIM, Saw Palmetto, or Vitex?

If you’re a female patient who is at their wit’s end with systemic over-the-counter options or recommendations from friends as a treatment option for your severe acne, it may be time to ask your dermatologist about your options for androgen inhibition, both prescription and natural.

However, it’s not possible to tell any individual patient what’s right for them without a proper medical consultation. If you think these anti-androgens for acne options could help you, chat with your dermatologist today!

Sources

  1. Bhatia, A., Maisonneuve, J. F., & Persing, D. H. (2004, June). Propionibacterium acnes and chronic diseases. In The Infectious Etiology of Chronic Diseases: Defining the Relationship, Enhancing the Research, and Mitigating the Effects: Workshop Summary., Knobler, SL et al.(eds.) (pp. 74-80). Full text: https://www.ncbi.nlm.nih.gov/books/NBK83685/ 
  2. Azziz, R., Carmina, E., Dewailly, D., Diamanti-Kandarakis, E., Escobar-Morreale, H. F., Futterweit, W., … & Witchel, S. F. (2006). Criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an androgen excess society guideline. The Journal of Clinical Endocrinology & Metabolism, 91(11), 4237-4245. Abstract: https://pubmed.ncbi.nlm.nih.gov/16940456/ 
  3. El-Maouche, D., Arlt, W., & Merke, D. P. (2017). Congenital adrenal hyperplasia. The Lancet, 390(10108), 2194-2210. Abstract: https://pubmed.ncbi.nlm.nih.gov/28576284/ 
  4. Lause, M., Kamboj, A., & Faith, E. F. (2017). Dermatologic manifestations of endocrine disorders. Translational pediatrics, 6(4), 300. Abstract: https://pubmed.ncbi.nlm.nih.gov/29184811/ 
  5. Thomson, C. A., Chow, H. S., Wertheim, B. C., Roe, D. J., Stopeck, A., Maskarinec, G., … & Galons, J. P. (2017). A randomized, placebo-controlled trial of diindolylmethane for breast cancer biomarker modulation in patients taking tamoxifen. Breast cancer research and treatment, 165(1), 97-107. Abstract: https://pubmed.ncbi.nlm.nih.gov/28560655/ 
  6. Tesch, B. J. (2003). Herbs commonly used by women: an evidence-based review. American journal of obstetrics and gynecology, 188(5), S44-S55. Abstract: https://pubmed.ncbi.nlm.nih.gov/12748451/ 
  7. Verkaik, S., Kamperman, A. M., van Westrhenen, R., & Schulte, P. F. (2017). The treatment of premenstrual syndrome with preparations of Vitex agnus castus: a systematic review and meta-analysis. American Journal of Obstetrics and Gynecology, 217(2), 150-166. Abstract: https://pubmed.ncbi.nlm.nih.gov/28237870/ 
  8. Westphal, L. M., Polan, M. L., & Trant, A. S. (2006). Double-blind, placebo-controlled study of Fertilityblend: a nutritional supplement for improving fertility in women. Clinical and experimental obstetrics & gynecology, 33(4), 205-208. Abstract: https://pubmed.ncbi.nlm.nih.gov/17211965/ 
  9. Yarnell, E., & Abascal, K. (2006). Herbal medicine for acne vulgaris. Alternative & Complementary Therapies, 12(6), 303-309. Abstract: https://www.liebertpub.com/doi/abs/10.1089/act.2006.12.303?journalCode=act 
  10. Foitzik, K., Langan, E. A., & Paus, R. (2009). Prolactin and the skin: a dermatological perspective on an ancient pleiotropic peptide hormone. Journal of Investigative Dermatology, 129(5), 1071-1087. Full text.