Scientifically-Proven Herbal Remedies For Hormonal Acne

Scientifically-Proven Herbal Remedies For Hormonal Acne

Female hormonal acne is perhaps the most common form of adult acne. Doctors commonly prescribe birth control pills or anti-androgen drugs to help with hormonal acne.

Wary of side-effects or just want to avoid ‘messing up with hormones’, many women prefer to avoid prescription drugs and look for natural solutions. The net is of course full of ‘information’ and treatment options, but science shows that many of these touted solutions just don’t work.

In this post I’ll go over several herbs touted as solutions to female hormonal acne, and we’ll see if there’s any merit to the claims. I’ll show you one herbs that puts prescription drugs to shame (and I bet you haven’t heard of it before), a few that can work, and a long list that are better to be avoided.[am4show have=’p6;p7;’ guest_error=’guest’ user_error=’member’ ]

Insulin lowering herbs

Women with problems relating to excess male sex hormones (polycystic ovary syndrome (PCOS), hirsutism, acne) are often insulin resistant. Insulin resistant cells don’t respond to insulin well and the pancreas has to pump out extra insulin to compensate. Insulin stimulates the release of androgen hormones from the ovaries and increases their bioavailability, meaning high insulin level usually pumps up androgens to abnormally high levels.

Several studies have shown that treating these women with insulin lowering drugs improves hormonal profile and symptoms, including acne.

Studies have shown that berberine and cinnamon can be helpful in managing blood sugar and insulin levels.


Berberine is a substance found in Oregon grapes, Barberry and some Chinese plants. It’s used as treatment for diabetes in Traditional Chinese Medicine. Over the past decade scientific studies have shown that it can be as effective as prescription drugs in treating diabetes and blood sugar problems. It also has antibiotic and anti-fungal properties.

Earlier, I wrote about a study that showed almost 50% reduction in acne following Barberry supplementation.

In recent years two studies have tested the effect of berberine on PCOS patients, one in 2012 and another one in 2013. Why are we talking about PCOS studies? Because there are no studies with acne patients and, because both share similar hormonal disturbances, PCOS can serve as ‘proxy syndrome’ for hormonal acne – the things that help with PCOS are also likely to help with hormonal acne.

Yuan et al. gave 150 women with PCOS either berberine, metformin (a prescription drug for diabetes) or placebo.

I plotted the results into the graph below. The figures refer to improvements over baseline, i.e. beginning of the study.

Effect of berberry supplements on acne hormones

Fasting blood sugar and insulin readings refer to levels after 12-hour fast, more or less what you would have first thing in the morning. Free androgen index is an estimate of free (or bioavailable) testosterone level and total testosterone refers to, well, total amount of testosterone. Most testosterone is bound to sex hormone binding globulin (SHBG) and is thus not active (or bioavailable).

Both insulin and bioavailable testosterone levels dropped by 50% from their levels before the study. This should have a big impact on acne. The women in this study had BMI of 24, which falls to the upper range of normal.

Wei et al. did a similar study in 2012. There were some confounding factors in that study, so I won’t talk about it here. I’ll just say that berberine worked just as well as metformin.

Other studies have shown berberine can be just as effective as metformin in diabetic patients in reducing blood sugar and insulin levels.


The subjects in both of these studies were insulin resistant. Many women who struggle with hormonal acne also have some degree of insulin resistance but probably not everyone. Berberine is likely to reduce your acne if you are insulin resistant.

The picture is quite not so clear for women who are not insulin resistant. Studies on metformin on PCOS patients often show improvements in androgen levels even in women who are not insulin resistant. Tan et al. also showed that metformin reduced acne also in non-insulin resistant women with PCOS. Most studies have shown berberine to be equal to metformin, so I see no reason why treatment with berberine wouldn’t get similar results.

Drug interactions

According to WebMD, you should avoid berberine if you take cyclosporine (immunosuppressant), please see other warnings at WebMD.


Practitioners of alternative health methods often claim that cinnamon can help to regulate blood sugar levels and treat diabetes. There, indeed, is some evidence to suggest this could be true.

Wang et al. tested the effect of cinnamon on 15 women with PCOS. The participants received 1g of cinnamon for 8 weeks (or an equivalent amount of placebo capsules).

Results showed a significant reduction in insulin resistance in the cinnamon treated group, with no change in the placebo group. In fact, insulin sensitivity completely normalised in the cinnamon-group. Despite improvements in insulin levels, there were no changes in any of the other hormones linked to acne.

Several other studies have also showed that cinnamon can reduce blood sugar and insulin levels. A 2011 systematic review went over 16 studies on the effect of cinnamon on diabetes and concluded the following:

Although some studies with cinnamon did not show any effects, the majority of studies performed did consistently show beneficial effects of cinnamon on multiple parameters, especially decreasing fasting and postprandial glucose levels and improving insulin sensitivity.

Controversies surrounding the clinical potential of cinnamon for the management of diabetes.

So there seems to be reasonably good evidence to show cinnamon can be somewhat helpful in reducing blood sugar and insulin levels, and thus it could also be helpful in acne.

The positive studies used daily doses ranging from 3 to 10g of cinnamon.

Anti-androgenic herbs

Anti-androgens are substances that block or suppress the effect of male sex hormones in the body. Acne is an androgen-dependent skin problem, which explains why anti-androgens, such as birth control pills and spironolactone, work so well.

Research has shown that some herbs have anti-androgenic effects, but there’s very little research on this area and the studies we have are usually of poor quality. Meaning that it’s impossible to make reliable recommendations.

Anyhow, I’ll go over most of the herbs that have some degree of anti-androgenic effects and make brief recommendations concerning supplementation.


Out of all the anti-androgenic herbs I looked at, spearmint looks the most promising.

Grant assigned 42 women with hirsutism to spearmint and chamomile (placebo) tea groups. Both groups were asked to drink 2 cups of tea per day. Both total and bioavailable testosterone dropped in women drinking spearmint tea. The spearmint drinkers also reported that their hirsutism symptoms got better. There were no changes in the chamomile tea group.

Akdoğan et al. gave 12 women with PCOS and 9 with hirsutism a cup of spearmint tea for 5 days. Spearmint tea reduced the amount of bioavailable testosterone but had no effect on total testosterone levels.

While both of these studies show positive results, I would advice to take these result with a grain of salt. Both of these studies were too short and need to be replicated before we can really say whether these effects are real.

On the other hand, spearmint tea is quite delicious and there’s little downside to having a cup or two a day.



Licorice may have some anti-androgenic activity. The active ingredient in liquorice is called glycyrrhetinic acid.

I found 3 studies on the effect of liquorice supplementation on androgen levels in women. 1 study showed a nice reduction in testosterone through 2 menstrual cycles, but another study showed no changes. The last one treated PCOS patients either with spiro or spiro + liquorice. Addition of liquorice didn’t further improve androgen levels but it did reduce side-effects of spiro.

The best we can say is that liquorice may have some anti-androgenic effect, but it’s likely to be quite small and probably doesn’t warrant supplementation.

Green tea

In earlier posts I covered the antioxidant and insulin lowering effects of green tea. Green tea catechins can inhibit conversion of testosterone to DHT and thus suppress the effect of androgens, however the few studies we have show the effect is modest, at best.

Chan et al. tested the effect of green tea supplements on 34 obese women with PCOS. The supplement delivered 540mg of epigallocatechin gallate (EGCG). After 3 months of supplementation there was no change in androgen or insulin levels.

Wu et al. showed that green tea supplementation improved cholesterol and insulin levels in women with PCOS but had no effect on androgen levels.

Black cohosh

Black cohosh is another herb that’s claimed to have anti-androgenic properties, however I couldn’t find any studies that measured the effect of black cohosh on androgens.

Kamel showed that black cohosh supplementation worked just as well as a prescription drug in improving ovulation in women with PCOS. Unfortunately this study didn’t measure androgen levels.

Black cohosh can also improve menopausal symptoms.

Chaste tree (Vitex agnus-castus)

This herb is sometimes called as “the women’s herb” for it’s ability to improve premenstrual symptoms; one study showed it to be as effective as a prescription drug.

It hasn’t been tested on PCOS or hormonal acne, but the Wikipedia page says it could be helpful – whether it actually is, is another question and one we can’t answer yet.

Saw palmetto

I only mention saw palmetto because it’s hyped online as a powerful anti-androgen. I couldn’t find any research on how it affects sex hormones in women. It may have some effect in men, but more rigorous research is questioning these effects.

At the moment there’s no good human evidence to show saw palmetto has any anti-androgen activity. What we have is a big bunch of test tube and animal studies, but we cannot use those to say what happens in humans.

Conclusions and recommendations

The net is full of ‘information’ and treatments for female hormonal acne. Unfortunately science quite clearly shows that many herbs promoted for hormonal acne have little to no effect.

Evidence shows that berberine should be helpful in most women with hormonal acne.

If you are also insulin resistant (giveaways: abnormally high blood sugar levels after meals, you get acne from sugar, carbohydrates or dairy, you are above normal weight) then cinnamon could also be helpful. If you take berberine, then there’s probably no need to spend additional money on cinnamon supplements. I doubt that combining the two gives much, if any, additional benefit.

The data on anti-androgenic herbs is very limited. Based on currently available evidence, spearmint seems the most promising herb for hormonal acne, so you might consider having 2 to 3 cups of spearmint tea per day.

There are several anecdotal reports claiming chaste tree can reduce hormonal acne, but there’s no scientific data to support or refute these reports. However, both chaste tree and black cohosh have been shown to improve PMS symptoms and ovulation, so it’s plausible they could also help acne.

About Me

Hi, I am Acne Einstein(a.k.a. Seppo Puusa). I'm a bit of a science nerd who is also passionate about health. I enjoy digging through medical journals for acne treatment gems I can share here. You can read more about my journey through acne and how I eventually ended up creating this.


85 thoughts on “Scientifically-Proven Herbal Remedies For Hormonal Acne”

  1. I think more research is needed on side effects. I tried the spearmint tea and for the first time in my life I got an ovarian cyst that was really, really painful. I’m pretty sure it was because of the spearmint, I had never had any of these symptoms before. Just because it’s a herb doesn’t mean it’s harmless!!! And some of these herbs are also abortifacients so if a woman is trying to get pregnant she should avoid them. I think it’s crucial to have your hormones tested before you try anything that can possibly alter them.
    Also, for the first time in my life I had a low palates count. I was really scared what this might mean and then I discovered it was the ginger tea I used to drink every single day – it is known to thin the blood and lower palates. I thought I was doing a good thing for my body by drinking the tea every day but it turned out I was actually harming myself and creating a condition I didn’t have before. So be careful with any herbs.
    Actually, I don’t know if researchers also focus on side effects from herbs – if not, that’s a big problem.

    • Thanks for sharing your experience. Yes, I agree that herbs should not be taken lightly. They are basically drugs, just unregulated and in unpurified form so you don’t know how much of the active ingredient you get.

      I didn’t do any safety checks for spearmint as it’s commonly available and hence should be ‘generally recognised as safe’. Of course some people may react badly.

      The papers I read occasionally, but not always, also talk about safety. But there’s no safety data for all the herbs and supplements on the market – one reason this industry should be regulated more strictly.

      • I have never had any problems with spearmint used as a spice even in big amounts (I like it a lot). The problems started when I had two cups of spearmint tea per day. I know many herbs are safe when used in cooking but can be problematic when taken as an infusion. For instance, pregnant women can have rosemary in their meal but they shouldn’t drink rosemary tea because it might cause miscarriage. I’m pretty sure dosage is the key but unfortunately this rarely gets mentioned. Anyway, I’m not taking any more herbs without knowing how much is safe for me and how it will affect every single part of my body. I’m done with self experimentation.

        • I don’t doubt that spearmint can cause problems for you, but I don’t think it’s a common issue. Think of how many thousands cups are drunk every day. If it would cause more widespread problems, I’m sure there would be more about it in the medical literature. As it is, I could only find one case report of a woman trying to commit a suicide using peppermint oil.

          Anyway, I do agree with you that herbs should be seen as drugs, and just because they are ‘natural’ doesn’t mean they are safe.

          • This is a reply to Seppo November 10, 2013 at 5:53 am. When people have problems with herbs, prescription drugs, food, or other things, quite often it gets no attention in medical literature. Some people don’t share their experiences with their doctor. When they do share their experiences with their doctor, their doctor may tell them they are wrong. Even if their doctor believes them, then their doctor might not report the info. And sometimes when a person gets a problem from using an herb or other substance, the person doesn’t know the cause.

  2. Oh, I forgot to mention – spearmint tea causes constipation, maybe for some people that’s a desirable effect but not for those who already have a problem with bowel movements. And yes, it did clear my skin for the time I was drinking it but it caused much bigger problems and it took me months to get back to my normal cycle.

      • Yes, I’m aware that mint helps with digestion, but as far as I know it helps with diarrhea and can make constipation worse. The same way paprika is like a magic pill for my bowel movements but a person who struggles with diarrhea should not indulge in it.

        • You are probably right there. I only checked the abstract and didn’t see the details of the paper, but the abstract mentioned benefits in diarrhoea type IBS, can’t say about constipation types.

  3. So happy about this post.. thank you so much for all your research Seppo!!

    Here comes all my questions..

    SO basically it doesn’t make a difference weather we take Berberine or Metformin? Is there one you think would be better then the other… I feel like you are stressing berberine more then metformin .. why is that? Also what amount, mg of barberine should we take.. and anything we should look out when looking for brands.. ? Any specific one you recommend?

    Is the only way to take spearmint in tea? How about capsules… if so.. what dosage?
    What should we look out for when purchasing spearmint tea?

    So interesting that you are saying soy can help … All I have heard is that one should avoid soy when trying to clear acne..a little confused here.. what kind of soy are you referring to?

    For licorice study are you referring to spirolactone.. the drug? Do you have any information on that? I have been considering to take it..

    If the study for green tea should no effects in androgen levels.. then why is it being recommended so much.. in your web sight and in the book? more because of its antioxidant aspect?

    I am currently taking chastberry vitex.. don’t really know if its working.. its hard when you don’t have proven results in research.. really hope there will be more research done..

    • Glad to hear you liked the post. This took a bit longer than expected. The paper I originally planned to base this post on turned out to be almost completely useless, the vast majority of the references were animal and test tube studies. So I had to do most of the research from scratch and that always takes time.

      The point of this post was to highlight herbal options for female hormonal acne. Metformin is a prescription drug and thus not easily available. I only mentioned it to highlight the fact that berberine works just as well as a prescription drug.

      I don’t know which berberine supplement is good and which is not. I ordered Thorne Research from iHerb, but you can find cheaper options from Amazon. I had to order from iHerb since Amazon doesn’t ship to Thailand. If I were you, I would order something from Amazon. Please don’t ask me which since I don’t know any better than you do.

      As to how much to take. The studies on PCOS patients used 3x500mg per day. I’m planning to start with 1000mg per day and see if it helps. I’m mainly taking it to reduce insulin resistance and not so much for acne.

      I really don’t know what to look for in spearmint tea. The papers only mentioned that they used 1g of dried leaves per cup of tea, which is what you normally find in a tea bag. I would look over spearmint tea brands in supermarket and make sure the label say it’s actually spearmint – and not black tea mice with little bit of spearmint for example. That’s really all I can say.

      There’s a lot of conflicting information out there about soy. But looking at medical data, I’ve yet to see any good evidence indicating it would be bad. That said, it doesn’t do much good either, so I wouldn’t stress about not eating it.

      Yes, the in the liquorice study I mean spiro the drug. I know it can work for acne, but for more than that you have to talk to your doctor.

      While green tea may not reduce androgen levels, it can reduce insulin and it’s been shown to reduce inflammation in people with higher than normal levels of systemic inflammation, two very good reasons to drink it, but I wouldn’t say it’s necessary for getting clear.

  4. I’ve read your book and think it’s the best well written information I’ve seen. I also have been doing alot of research on acne and I found that you covered much more than others. I also agree with most of your information. I’m 49 years old and don’t have a huge history of severe acne until the past 10 years. It started as what I would call hormonal “chin”acne”, not pleasant but bearable. About 2 years ago I got a staff infection on my face (spread from picking), which got real bad. I had to take a powerful antibiotic and it took a long time to heal. Now for the past 2 years, I’ve been getting horrible cystic acne and where I have developed scars, they tend to come back even worse. I’ve tried countless approaches from mainstream to natural. I took your suggestion and am trying the exposed system, oral supplements ,green tea and fish oil. In your book I noticed you don’t talk about cystic acne or picking as being one of the contributing factors to acne. I love all of your information and thank you for all of the hours it must have taken to put everything together. I’d love to hear your thought on why someone develops cystic acne. I’ve been hearing alot about woman my age with huge acne problems. I do think hormones are a component and diet and toxins. Dermatologist not connecting food or stress doesn’t make sense to me, but most of western medicine seems to be in the dark on these issues with all diseases. They are more concerned about the mighty dollar, well,…don’t get me started on that one. Thanks again and I’d love to hear your thoughts, Jennifer

    • Glad to hear you liked the book, Jennifer. I’m not sure there’s anything that different about cystic acne. As far as I know, it’s just a worse form of acne but it’s still caused by the same things. From the papers I’ve read, it seems that people with severe/cystic acne have really low levels of antioxidants. In such a case antioxidant supplement could help a lot.

      Since the onset of your cystic acne was quite sudden, there should be something that triggered it. Perhaps it was the antibiotics making a mess of your gut flora or something else. Altered gut flora would be my first guess. I would 1) go to a doctor and get tested for small intestine bacterial overgrowth and other potential problems (GI specialist should be able to tell you what tests you need), or 2) use the self-diagnosis tools I talked about in the book and see if there are problems with your bowel function.

      Regardless, I wouldn’t recommend anything different to cystic acne than to milder versions.

      • Cystic acne occurs when there’s a deep break in the pore wall. A membrane than forms around the infection deep in the dermis. A nutritional deficiency or food allergy have nothing to do with this in the least. It is beyond the sufferers control.

        • Sorry but this is not correct. In many cases there is a lot you can do about it.

          Yes, cystic acne occurs because of a break in the wall of an enlarged skin pore. But it pays to ask why those pores got enlarged in the first place. Turns out, there’s a lot you can do to interfere with the acne formation process before it gets to the point of cystic acne. I wrote about how acne forms here.

          I do agree that to some degree acne is out of your control, it’s probably not possible to get rid of it completely, but it’s also not helpful to throw up your hands and say there’s nothing we can do about it.

          • It got enlarged because of excess sebum (duh!). How much sebum you produce is also genetic, people that are acne prone have a tendency to produce 5-20 times amount of extra sebum than needed.

            I have had severe acne for 17 years and I will tell you it is entirely beyond my control. I do NOT believe diet influences acne at all as my skin never improved on any diet. You are free to disagree with me (and I know you will) but this is just where I stand.

          • Actually, the pores got enlarge because they got blocked and there’s no way for the sebum to escape, thus they enlarge like waterballoons. And the reason they get stuck in the first place is because your skin produces too much protein called keratin that prevents skin cells from separating. Part of that is hormonal, but part of it is due to inflammatory damage to sebum.

            I don’t claim to know anything about your acne, but I can quite confidently say that most people with severe acne can do something about it. Perhaps they can’t get completely clear, but I’m willing to bet most can bring it down to mild/moderate levels.

  5. Re: soy. In theory, it’s supposed to boost estrogen levels, which sooths acne. Here’s the problem, however: there are two different kinds of estrogen receptors, beta and alpha. And you have more of one kind in the skin than you do on your ovaries and in your pituitary gland, such that soy increases estrogenic activity in ovarian and some other tissues, but then, as your pituitary downregulates estrogenic activity as it detects these guys on your estrogen receptors, your skin actually experiences LESS estrogen than it had before, resulting in acne for people who are sensitive to phytoestrogen intake.

    This is the best biochemical theory I can come up with having read as much as I could about estrogen receptors in bodily tissues, anyway.

    • Thanks for your comment, Stefani. After reading your book I got a bit confused with phytoestrogens. What you say in the book makes a lot of sense, but I’ve never found any evidence to support it, hence my confusion. But what you say here does clear things up a bit.

      Is there any evidence to support your statement that pituitary down-regulates estrogen in response to phytoestrogen intake? And would this happen also with flax seeds?

  6. Just bought your ebook-very helpful and thoughtful research. What do you think about evening primrose oil? It is not mentioned in the supplements you recommend but I’ve heard lots about it helping to regulate female hormones overall, which should help with hormonal acne..? What I’m concerned about is that it is a high level of omega 6 fats, not sure if that will tip the omega 3:6 balance that you mentioned.

    • Glad to hear that you like the book. I was under the impression that EPO could be helpful for eczema and other dry skin conditions, but a rigorous review of high quality studies shows it’s no better than placebo.

      Similarly, it seems to have no value in reducing PMS symptoms.

      I couldn’t find any research on how EPO affects acne-causing hormones. As far as I can tell, EPO doesn’t seem to do anything. It’s possible that it can be helpful when applied topically, though, but I doubt it has any effect on hormones.

  7. “Hormonal Acne”? All acne is hormonal. That does not mean imbalance though, the hormonal aspect in acne is having naturally androgen sensitive sebaceous glands that become easily stimulated. when hormones rise during the menstrual cycle ever so slightly, which is totally normal, there is usually an flare in an androgen born sensitive female

    It’s not an “imbalance” it’s an allergic reaction to your own hormonal chemistry which is 100% genetic. There are no special herbs, diet or remedies to change your sensitivity towards Androgens, sorry, this is something you just have to live with or opt for Spironolactone or Acctuane.

    Also I should say true hormonal imbalances are very rare. They also are not usually “acquired” through lifestyle but usually inborn. The symptoms associated with a true hormonal imbalance are rather severe and at times life threatening. Just because you have acne does NOT mean there is anything wrong with your hormones.

    • You are of course correct. I’ve also said many times that all acne is hormonal, at least to some degree. In this post I just used the term ‘hormonal acne’ as it’s commonly understood, female acne that’s aggravated before menstruation.

      But I don’t agree with you that this is just something you have to live with. Yes, the sensitivity to androgen hormones comes partially, but not completely, down to genetics. Insulin, for example, aggravates ‘hormonal acne’ by increasing secretion of androgens from the ovaries and increasing sensitivity of your skin to those hormones. There’s a lot you can do about your insulin levels, using herbs, supplements or diet and lifestyle.

      There are also anti-androgenic herbs that can, to some degree, do what spironolactone does. I wrote about the more promising ones in this post.

      While I agree that in many acne cases there’s no real hormonal ‘imbalance’, I again use the word as its commonly used. But if your acne is linked PCOS or other such problem, then there could be a real imbalance behind it.

      • PCOS on it’s own does not cause acne, you first have to carry the “acne gene(s)” sor to speak. As here are plenty of women with PCOS that have never had issues with acne which suggests it’s more than just hormones. I think you should visit the website “Soul Cysters” and read the poll about symptoms PCOS women experience. Acne falls at a smaller percentage surprisingly enough.

        • Of course it does not by itself cause acne. Nobody claimed it does. Underlying PCOS is similar hormonal ‘imbalances’ that make it more likely that you get acne. But you don’t get acne unless your skin is somewhat sensitive to those hormones. There are plenty of studies on what kind of symptoms PCOS patients experience. If my memory serves me right, about 20% of PCOS patients also get acne.

          • I think it’s in the range of 20-30% yes you are correct. I have met more than a few PCOS women with porcelain skin so it’s just more substantiating evidence that hormones alone do not equate acne.

            Nobody really knows why some people get acne and some do not, it is not at this time entirely known. I know you have a lot of theories but some of your information is a little “off” – the “gut” plays little to no role in acne development. The leaky gut hypothesis is entirely medically unsound and has been scientifically debunked to not even exist


            . Also the immune system does not start in the gut, it starts with the lymphatic system which we do not have control of. And no you can not “bolster” your immune system with any particular diet or herbs, this is a fallacy.


          • You are of course correct that nobody really knows how acne happens. That said, science does provide us with enough clues to start taking action. There is good evidence to show oxidative damage to sebum initiates the acne formation process, and that antioxidant treatments (topical or oral) can be effective against acne.

            Similarly, it’s quite well established that high insulin level aggravates acne by 1) increasing the amount of bioavailable androgen hormones, 2) increasing sensitivity of skin to androgens, and 3) directly stimulating sebum production in the skin.

            While we don’t understand everything about acne, we know enough to start taking effective action.

            I do believe that what I have written on this blog and on my book fairly accurately represents current scientific understanding. Of course it’s possible, and probably even likely, that I’ve made mistakes. And I’ll be happy to correct any mistakes pointed out to me.

            I know you have a lot of theories but some of your information is a little “off” – the “gut” plays little to no role in acne development. The leaky gut hypothesis is entirely medically unsound and has been scientifically debunked to not even exist

            The QuackWatch article on dubious diagnoses is correct. But I’m not talking about ‘leaky gut syndrome’ as understood by the alt-med practitioners. The medical term is “intestinal permeability”, which means the tight joints between gut cells loose up a little bit, which allows toxins produced by the gut bacteria to ‘leak’ into circulation. Those ’toxins’ can trigger an immune response and cause inflammation.

            Intestinal permeability is a real medical issue. PubMed returns 989 studies with intestinal permeability in the title. So we aren’t talking about a fad issue invented by alt-med practitioners.

            The role of gut issues in acne is somewhat unclear. I’m the first to admit that the evidence we have is not very strong. Simply because only a handful of studies have looked into it, but all of those studies have shown gut does affect acne.

            Dr. Bowe did a good job of outlining the relationship in her 2011 paper: Acne vulgaris, probiotics and the gut-brain-skin axis – back to the future? I suggest you take a look at it. It’s free and fairly accessible to people without medical eduction.

            Indeed a 2013 review on the link between Accutane and inflammatory bowel disease concluded that Accutane doesn’t cause IBD, but it’s likely that acne itself is linked to IBD and that explains the correlation between Accutane use and IBD.

            Similar links have been found with other skin disease. A 2010 paper reviewed the association between psoriasis and gut problems, noting that gut issues (like Chron’s disease and Celiac disease) can be tens of times more prevalent in psoriasis patients than in general population.

            I’m not saying that acne, or other skin problems, are gut problems. But I do think it’s reasonable to conclude that gut problems can affect skin in some people, and that it’s something anyone with persistent acne should look into.

            Of course, if you have good information to suggest this is not the case, I’m happy to hear it.

            Also the immune system does not start in the gut, it starts with the lymphatic system which we do not have control of. And no you can not “bolster” your immune system with any particular diet or herbs, this is a fallacy.

            Correct, but I never claimed anything even resembling this. The possible gut-acne link is not due to ‘weakening of the immune system’ or anything like that.

            Neither did I claim that any of the herbs outlined here would boost the immune system. I did say that some herbs can reduce insulin level. It’s well-known that insulin stimulates androgen release from the ovaries. That’s why there are several studies testing diabetes drugs on PCOS – with rather good results. Similarly, some herbs have anti-androgenic properties, similar to spironolactone – though the research on anti-androgenic herbs is still very weak.

  8. @Seppo: Yes gut problems have been associated with other skin disorders, especially Rosacea, but not necessarily Acne. Don’t forget many skin problems can look like acne, it can sometimes hard to tell them apart.

    I really believe that many of these people that have claimed to have “cured” themselves of acne by cutting out a particular food actually have another skin disorder instead. Take “thelovevitamin” (Tracy) for example who claims to have cured her acne by eliminating her unknown food allergies ect. I don’t believe she actually had acne truthfully, I think she was suffering from Rosacea:

    (to me that doesn’t even look like acne)

    • Yes, it’s true that many cases thought to be acne are something else. Though I suspect it matters little to the affected person what you call them, most just want to get clear skin. So a debate that gut problems can cause rosacea but not acne is rather meaningless for most people.

      The fact remains that gut problems are associated with some skin problems, problems that look a lot like acne (at least to a layperson). And they are looking for solutions for acne. In that context, I think it’s more than reasonable to let them know of the possibility of gut affecting their skin. Especially since studies suggest that gut problems indeed affect acne – did you read Dr. Bowe’s paper? It’s by no means 100% certain that gut issues cause acne, but it’s a possibility we should take into account. Especially since a large portion of people who end up on this site are more or less at the end of the road where solutions are concerned.

  9. Seppo, I came across this research
    It looks like androgens are important for female fertility and you know, ovulation and all that stuff. So if a woman has normal or low levels of androgens taking any anti androgen herbs might be harmful (which might explain why I got a cyst). I think it’s reasonable not to take anything that alters hormone levels unless you know for sure what your hormone levels are. Also, I think the effect of the treatment depends on the cycle phase – maybe a certain herb is better to be taken prior to ovulation and another one after ovulation and so on.

    • Thanks for the link. Yes, I’m sure androgens are important for female fertility, not to mention the other positive effects they have in the body. And I do agree that the less we ‘mess with hormones’ the better it is, the law of unintended consequences and all. That said, this is an acne blog and there’s fairly consistent evidence that women with acne have somewhat elevated levels of androgens, the exact hormone and degree of elevation varies from study to study. I consider female hormonal acne as ‘PCOS light’, if you will, and that’s why I often refer to PCOS research. I have yet to see any evidence that women with acne would have low levels of androgens, it’s usually the opposite. That’s why spironolactone and other anti-androgen drugs usually reduce acne.

        • I really wouldn’t say there’s consistent evidence that women with Acne have elevated Androgens, as I said before I have had acne for 17 years straight and all my hormones are perfectly normal as with my pattern of menstruation (sorry, yuck! I know).

          I’m sorry but this is wrong (the part about there not being consistent evidence that women with acne have elevated androgen levels). Most studies that compare androgen levels between women with acne and women without acne show that on average women with acne have higher androgen levels.

          Here are a few studies to the effect:

          Fifty-two percent of Group A [Acne], 60% of Group H [Hirsutism], and 63% of Group A + H patients had at least one abnormal hormone level. The most frequently elevated plasma androgens in all the women with acne were: free T 25%, free 17-beta 23%, and DS 19%. Total T was high in only 12%. Elevations of plasma androgens were present in some women who did not have hirsutism or irregular menses. Identification of endocrine abnormalities in women with acne may potentially offer an opportunity for hormonal therapy.

          Plasma androgens in women with acne vulgaris.

          RESULTS: The mean SHBG, free androgen index (FAI), and DHEA-S were significantly different between A + H and control subjects. The only significant difference between A – H and control subjects was observed for DHEA-S.

          Assessment of androgens in women with adult-onset acne.

          In the above study DHEA-S was the only statistically significant difference between women with acne (but without hirsutism) and women without acne (controls), but all the androgen measures were higher among acne patients, the difference just didn’t reach statistical significance due to small sample size. And androgen levels increased with severity of acne.

          Conclusion(s): Hyperandrogenemia was evident in a majority of nonhirsute acneic patients studied, regardless of age. These data suggest that androgen suppression may be useful in treating acne in many of these patients.

          Hyperandrogenemia in patients presenting with acne

          We retrospectively analyzed the outcome of 228 consecutive patients investigated over 6 years.Patients with hirsutism had higher levels of androstenedione, dehydroepiandrosterone sulfate (DHEAS), and salivary testosterone; lower levels of sex hormone-binding globulin (SHBG); and a higher prevalence of oligo-amenorrhea than patients with alopecia, while patients with acne showed intermediate values.

          Androgen dependence of hirsutism, acne, and alopecia in women: retrospective analysis of 228 patients investigated for hyperandrogenism.

          The following study measured the correlation between androgen (and other) hormones and acne severity. The results showed that women with acne have somewhat higher androgen levels than women without acne, but the difference didn’t quite reach statistical significance due to small sample size.

          Correlation between serum levels of insulin-like growth factor 1, dehydroepiandrosterone sulfate, and dihydrotestosterone and acne lesion counts in adult women.

          I’m not claiming that women with acne (excluding PCOS patients) have drastically higher androgen levels, but there is consistent evidence to show they are somewhat elevated. Add to that the fact that acne-prone skin is more sensitive to androgens. That’s why anti-androgen drugs are so effective in acne.

          • Well, since it didn’t reach statistical significance, we can’t say that there is evidence for that. Plus, I didn’t understand if the acne patients’ androgen levels were just higher but within the normal range or outside the normal range. This makes a big difference.

          • Well, yes and no. There is consistent evidence that women with acne have higher levels of androgens than women without acne. While those may still be in the normal range, it doesn’t mean levels at the high end of the normal range wouldn’t cause problems with the skin, especially when combined with the high sensitivity of acne-prone skin to the very same hormones.

          • Oh, and 228 subjects is in no way a small sample size, it’s not the biggest possible but it is still big enough to make conclusions.

  10. Maybe not low but normal or just slightly above average. Also, maybe the levels vary depending on the phase they are. Actually, I have very little acne before the ovulation and when I was taking the spearmint tea, my face was clear. My hormonal acne gets worse just before my period and that’s the case with many other women (I’m not sure that if a woman has regular period, she is qualified to be diagnosed with PCOS). Actually, as far as I’m aware researchers don’t know whether elevated androgens are a cause for PCOS or just a side effect. You get a cyst when something goes wrong with the folicule and many things can go wrong. For instance, it’s just my theory, if you don;t have enough androgens your folicule may not develop properly and the egg might not get released (your face is clear meanwhile). So you end up with a cyst and from there your hormones become a mess and androgens increase preventing you from having a normal ovulation or even mentruating. So a vicious cycle begins. If a woman has elevated androgens and cannot ovulate then anti androgens will be helpful (maybe if she hasn’t had her period in months). But if a normal ovulation was to take place, then anti androgens may get in the way and from there you get the cyst and your androgen level go up and of course your face pays for it.
    I am not sure I explained it well but I think it makes sense. Also, you said that acne sufferers’ skin is more sensitive to androgens even if their levels are normal so a woman can still get pimples and have normal levels of androgens. Or maybe her androgens get out of control just before her period or it’s just that estrogen levels go down. I know from you that estrogen is protective, that explains why my skin is perfect around my ovulation – estrogen levels are at their highest during that time. Well, almost perfect, gluten gets me any time

    • To be honest most women with acne have androgens within the normal range, they rarely find anything “off” in the blood test of women presenting with acne alone. It’s is mostly just a sensitivity issue (as you’re aware of) of how the skin reacts to androgens which overstimulates the oil glands and contributes to hyperkeritinazation which sets off the acne process.

      Also PCOS is a complex, age old endocrine disorder which is likely inborn/strongly genetic. It is not caused by “high androgens” are insulin resistance alone. I believe eventually we’ll find out the PCOS is primarily a genetic disease.

    • By the way, I didn’t mean that all adult women with acne have PCOS. When I said adult acne is ‘PCOS light’, I mean that women with acne show similar hormonal disturbances than women with PCOS (just to a much smaller degree).

  11. Yes, I don’t think lowering androgen levels can cure or help cure PCOS because it’s not been proven that high levels of androgens cause PCOS. So yes, it can help with acne in the short run but so can antibiotics and birth control pills. The long term effects are not well understood and you can end up with even more acne or a more serious problem. Also, as far as I know estrogen is made from testosterone (but I think that spearmint affects DHT). And from what I know from Stefani’s book you can have PCOS with low levels of all hormones or it can be a ratio problem. So all this makes me think that the logic – you are a woman, you break out before your period, so you must have PCOS and high androgens, so take these anti androgens, is wrong.
    Seppo, do you think it’s possible to have acne and not have cystic ovaries? Especially if the menstrual cycle is somewhat (or even very) regular? What about progesterone and acne? I found a study somewhere that progesterone makes the skin more oily, do you think this could explain acne before the period?
    Kelsey, actually, yes, acne is genetic but maybe you have heard about gene expression? Also, there was no report of acne in hunter-gatherers before they switched to “civilization”, so lifestyle does play a role. The same way not everyone is prone to gaining weight – I eat a lot and can eat junk food every day, not exercise and I will be slender at least until I get older. But to say that lifestyle has no effect on weight gain is ridiculous. Obviously, the way your body looks is determined by your genes but you can still change a lot and achieve normal weight (some people more easily than others). The same is true for acne and many other diseases.

    • Yes, you are correct that it’s a ratio problem. In both PCOS and acne the levels of androgens are high compared to estrogen levels. No matter which way you look at it there are too many androgens in the system, so taking anti-androgens makes sense (assuming you aren’t suppressing them too much).

      Where did you get the idea that women with acne have cystic ovaries? Because I don’t think that’s the case, at least I’ve never seen anything to indicate that.

      • Well, PCOS stands for polycystic ovaries syndrome so if all women with acne have some kind of PCOS, then this means they have cystic ovaries. If their ovaries are not cystic, they don’t have PCOS. Also, even if taking anti androgens makes sense, it doesn’t mean that it’s the right thing to do to get rid of acne and cure PCOS. Many things make sense but we need evidence first. How are anti androgens supposed to help? They help you ovulate when you can’t? They clear acne while you are taking them? What happens when you stop taking them? Or you need them forever? Do you need them to maintain normal cycle or just to help you regain your normal cycle? What happens if you already have a normal cycle? And, most importantly, what happens to other hormones? Estrogen is made from testosterone, so will we have a problem here? I’m not going to ask about pregnancy, that’s too complex and research is not possible for ethical reasons anyway. But these are just questions we don’t have answers to and I would still warn any girl with a normal cycle against taking antiandrogens unless blood tests show that she has too high levels of androgens. But the insulin resistant herbs make sense

        • I never said that women with acne have PCOS. When I said that I consider female adult acne as PCOS light is because they both show similar underlying hormonal disturbances, as I mentioned in an earlier comment.

          What makes you think that PCOS can be cured? That we can do something other than to keep it under control with drugs?

          There is evidence that anti-androgens are effective in PCOS and adult acne. To the point where they are often considered as the first-line therapy in those conditions, especially in PCOS. In PCOS they help to normalize ovulation and relieve most other PCOS symptoms. Like all medical interventions they carry risk and benefits. They seem to be safe for most women, given how widely they are prescribed, but I’m sure there are cases where they cause other hormonal disturbances.

          We actually have answers to most questions you posted, and in most of them anti-androgens show positive effects, and yes, you probably have to keep taking them continuously. They are far from perfect medical intervention, but they are one of the few options available for women with hormonal acne that’s resistant to diet changes.

          Here’s a 2012 review on the use of Spironolactone on acne. It specifically mentioned that spiro can be useful even for women without overt hormonal disturbances. While some side-effects exists, they seem mostly mild. I didn’t see anything about estrogens getting worse or disturbances in the cycle.

          The fact remains that adult can be difficult to get rid of. Most people aren’t exactly spoilt for choice. Anti-androgens, to me, seem like a fairly sensible option. Of course they have potential downsides, like all medical interventions do, but then, so does living with acne. So I’m putting it out there as an option for people to consider. Of course, if someone doesn’t think that the potential benefits justify the risks, then they shouldn’t take them.

    • I’ve had acne for over 17 years and all my androgens are normal, no cysts on my ovaries ect. – so yes it’s possible to have persistent acne without “cystic “ovaries. All acne is genetic, it can not necessarily be “calmed” down or triggered by lifestyle either. I’ve been eating “special acne diets” since I was twelve years old and my skin never responded to anything. If acne was manageable by lifestyle my skin would be clear now. We do not have total control of our genetics as we think we do (Unfortunately) since my Cancer diagnosis at age 22 I became increasingly aware that genetics sometimes “hold our fate” after all and lifestyle often falls short despite our best expectations.

      • Sorry to hear you’ve had to go through all that, I can only imagine what it must feel like. I do agree with you that genes, to a large degree, determine our faith and most of the alt-med and natural healing talk about epigenetics and changing your gene expression is pure bunk.

        That said, there’s no gene that codes for amino acids that ‘create acne’. Genes affect the degree you are sensitive to acne risk factors (hormones, inflammation, bacteria, etc.). There’s still a lot one can do to mitigate those risks, for example by reducing or suppressing the levels of androgenic hormones or by using topical treatments to interfere with the inflammatory process that kicks off acne.

        I’m sure there are individuals for who are not helped by such treatments. Perhaps they have an extraordinary degree or sensitivity or something else. But everything I’ve seen in research suggests these people are the minority. On this site alone I have reviewed 100+ studies showing various natural ways to make a positive difference to your skin.

        I’m really sorry that you are in a situation where these things haven’t helped you. I hope you understand that your situation is quite unique and that by actively discouraging people from taking action on their skin you may do a disservice for them. Given that there is real, solid, scientific evidence to show most people can make a difference to their skin.

        • I’m not trying to discourage people in any shape or form, I’m trying to make them aware that sometimes there’s really only so much you can do to allay chronic conditions with a strong genetic basis and not to blame themselves. I’m sure you’re aware there are many people with chronic acne that spend thousands of dollars on “quack medicine” and futile treatments and procedures and when it all doesn’t work they end up blaming themselves. There are lots of women and men that develop eating disorders because of acne because of the fear of “unknown food triggers” (as I’m sure you’re aware of) which is really becoming a problem.

          There is a vicious cycle of self blame that leads to destruction, I have been there, I have suffered immeasurably. I became anorexic eating nothing but spinach for more than a year, I wanted to die, I attempted suicide more than twice and had a long term hospital admission. Then at 22 upon finding a lump behind my ear close to my jawline and having a subsequent biopsy I was diagnosed with a cancerous Parotid tumor called an Acinic cell Carcinoma and underwent a parotidectomy and subsequent radiation treatments. I fought hard and developed a stronger will to live at the time, no longer experiencing suicidal ideation for the time being. Now at 26 I am having a second recurrence of my cancer and the prognosis is not looking good but I am still continuing on. I have no self blame anymore, I know that neither Cancer or years of chronic severe acne were not my fault. I have done nothing wrong and I now accept what I can’t control instead of engaging in self blame.

          Healthy eating and living is a superb idea that everyone should engage in, but it is still no magic bullet as life is terribly uncertain. Things do not always make sense. All we can do is try our best.

          • Again, I’m sorry to hear how much pain and suffering acne has put you through. While I haven’t gone through anything like that, nor have I had an eating disorder, I do know that acne can make you do pretty desperate (and stupid) things. It’s directly responsible my me falling into the black hole dense stupidity known as alternative medicine – and wasting 8 years of my life there.

            That’s one reason I started this website. To share science-based and rational advice to people who are in the same crossroad I was 8 to 9 years ago. To show that it’s possible to combine ‘natural’ treatments with reason and evidence. And that you don’t have to fall into the hands of quacks in order to get clear.

            And I understand that to some degree acne is out of your control, that’s why I wrote about the genetics behind it. And I often mention it’s unrealistic for acne-prone person to expect perfect skin, and one shouldn’t use excessively restrictive diets to try to achieve ‘perfect skin’. That’s why I occasionally write about psychological things and working to accept yourself as you are.

  12. Kelsey, if you had an eating disorder and even attempted a suicide, I would say that maybe emotions are the problem. Many people with an eating disorder have OCD, anxiety and other mental health problems. I am in no way a mental health care professional but I am not exactly “normal” so I am interested in that. I have OCD tendencies myself and very high levels of anxiety which interfere with my sleep as well. You might also have some neurological condition that has not been recognised by doctors (like ADHD) and it might be the main reason for all your emotional problems. I don’t think you can benefit too much from changing your diet because the underlying problem might be something else. To me, even with a perfect diet and exercise routine (and you can be sure a person with OCD tendencies like me insists everything to be perfect) I get acne from the lack of sleep and emotional problems and my difficulties in falling asleep have a lot to do with neurological issues I was born with. However, when I know what the real problem is I can find solutions.

    • I had severe acne since age nine onward! I didn’t attempt suicide until I was 19. Emotional problems do not cause acne at all, genetics do. My sleep cycle was totally normal.

  13. To me it’s very strange that when it comes to health problems related to lifestyle and diet (and there are many), there are always people who want to throw their hands up in the air and say “it’s just genetics, I can’t do anything about it” even if there’s clear evidence that making lifestyle changes can have a positive effect on the condition, maybe even cure it completely. And i think there’s a lot of guilt and anger behind that way of thinking. And I see a lot of it in this comment section. But i think it’s unnecessary and harmful to feel guilty for not having known better. And seeing yourself as a helpless victim doesn’t help either, I’ve never seen anybody who thinks that way solve their problems and overcome obstacles. The people who solve problems and get better are those who have the courage to be honest with themselves.

    • Thanks for the comment Maria. While I do agree with you, I can also understand where the people who “throw their hands up and say it’s genetics” come from. As Kelsey mentioned above, acne can make you desperate and push you to doing stupid things.

      Most of those of course don’t work, so going through the endless string of disappointments is hard emotionally. There’s only so much emotional beating one can take before giving up hope.

      I blame the rampant alt-med industry for this problem. As you must know, there’s no shortage of people selling dubious therapies and false hope to desperate patients. And once you get sucked into that mentality it’s easy to start blaming yourself. Then, aside from desperate, you also get to feel guilty and ashamed for not getting over this ‘simple problem’.

      • It’s not that I don’t sympathize with everybody who suffers from acne, I do, and I’m also one of those people, but personally whenever I have a health problem that has been proven to improve with lifestyle choices or any safe and pain free remedies I feel quite lucky and hopeful. In my childhood I was severely ill, it was an illness that caused internal bleeding and swelling of the organs and all that could be done were painful treatments time after time (sadly the effects would only last for a day or two and then I would start to bleed internally again and vomit all the blood) and in the end surgery, but the risks were unknown since the surgery was brand new. Of course hypothetically it’s possible that one day they will discover a link between lifestyle choices and the illness that I had, but currently there is nothing that suggests a connection. I tell you this because I want to offer this perspective; there are some health problems that you yourself can truly do very little about, so why not be glad whenever your health problem is such that has been shown to improve with safe, painless choices, things that you can have an impact on? I’m not saying it’s easy to change your lifestyle choices, it can be very demanding emotionally, but many of the things in life that are worthwhile are very hard, that’s how life is. When you have the least strength that’s when you must endure the most, and try harder than ever. Of course it’s not fair, but it’s what must be done in order to overcome obstacles and it makes all the difference, in my experience. And guilt is no good for nothing, and neither are denial and dishonesty with the self.

  14. Hi Seppo,
    Thank you for great posts!!! Very informative.
    Just wanted to know your opinion on my issue. I been battling with black heads and white heads well and occasional cystic acne (rarely) for 5years I maintain pretty healthy lifestyle, jogging 4 times a week, no sugar ( not even fruits), raw and cooked vegetables (have all year access here in hawaii) , good protein, small size of meals, probiotics, green tee ( can’t drink too much I have low blood pressure and seems like it lowers it even more) u name it… I did a gut cleanse while ago ( some detox tea for 3 days and light eating ). Noticed huge improvement in my skin condition: less oily, less black heads, even skin tone. I don’t want to detox again coz my guts get really out of control. would u recommend something less stressful for the body and mind to take that would have same effect? Its so annoying to see how all these nasty black and white spots invading my skin, they started spreading to my cheeks and jaw line. Thank you so much!

    • Hard to say anything based on this. You have to figure out what your acne is linked to. Gut problems, stress, hormones, diet, or just genetics in which case the best you can do is to manage it with topicals.

  15. Hey Seppo,

    Just wondering: I started taking vitex a couple of months ago. Finished one jar of 60 capsules and one bottle of drops. (I experienced stomach cramps, but those went a away) Since 6 weeks I have very dry eyes and for now I can’t wear my contact lenses. This sucks of course and I started to think what has changed in the past couple of months to see if there is a direct cause of my dry eyes. I stopped taking my birth control pills in January, but that should improve the condition of my eyes not worsen them. Have you ever read anything about a relation between vitex and dry eyes? Thank you!

    • Sorry but I’m not an expert on these herbs. I’m generally quite wary of herbs since they are essentially dirty drugs. They work like drugs in the body, because they have drug-like substances in them. The problem is you never know how much of the active ingredient you are taking and what other contaminants you take with it. That’s why I would use herbs only as the last resort.

      That said, a quick Google search showed that apparently in some cases vitex can cause dry eyes and other such side-effects.

      • Hey! Thank you for your response. I decided to stop taking Vitex, just in case. Yesterday my eye doctor told me that the dryness could be due to hormonal imbalance, although he thinks it is a permanent change of the quality of my tear film. After taking the pill for ten years I have been off it for six months now. Hopefully I will have my hormones balanced soon, because my skin is still a mess as well. Your book is helping me. I am exercising on a regular basis, doing meditation practices at least 3 times a week, I cleaned up my diet and have a pretty nice skin routine going on. Also I am drinking green tea and taking probiotics every day. If you have any other tips for me, please let me know, because it is taking so long for me to clear out my skin. Thanks!

        • I outlined most of the important points in the Quick Start Guide, with more details found in Clear for Life. That said, your acne seems hormonal in nature, so you could benefit from sugar and carbohydrate restriction. I would limit carbs to 20 to 30% of total calories and focus on healthy fats and protein. And in general, paleo-style diet could be a good option.

          I would also try some of the blood sugar controlling supplements I talked in this post. Spearmint tea may be helpful but I’m hesitant to recommend it because it’s probably better to mess with hormones as little as possible. So I’ll leave the decision of whether to try it or not up to you.

  16. Should people be wary about the antibiotic part of berberine? How strong is it compared to antiobitics that doctors prescribe to patients etc etc?
    I ordered a relative cheap one off amazon ( I got one for 16 dollars!) and I dunno. I’ve been thinking that the last thing I can do for my acne is try and pay more attention to the hormonal side of it. It’s been going great with the other parts though!

    • In that case people should also worry about green tea, which also has fairly substantial antimicrobial activity. Turmeric is even more potent – turmeric extract is 10 times more potent antibacterial than benzoyl peroxide (against acne-causing bacteria).

        • My point is that most natural substances also have some antibiotic activity and that it’s nothing to worry about. They are certainly not strong enough to wipe out the entire gut microflora.

  17. Right got it, I wanted to ask you this, what does bioactive/Bioavailable/Free Testosterone mean?? I bought berberine but it sounds like that this product is going to lower my testosterone? It’s the same with the big breakfast and small dinner, with the 105% higher SHBG, it just sounds like all of this is going to make me become a female (not literally but you get the idea).

    • It means exactly what I said in the earlier comment. Bioactive, or free, testosterone is what your body can use immediately. Bound testosterone is like ‘quick reserve’. It’s circulating in the blood but cannot be used until it’s cleaved free from the sex hormone binding globulin.

      I doubt that any of these things will lower testosterone below normal levels. They work for women because they remove the testosterone increasing effect of insulin and blood sugar.

      • Sorry, I didn’t see your comment in the last post before now, anyways.

        That’s interesting, do you think it’ll have an effect on bodybuilding?

        • Bodybuilding, or any form of exercise for that matter, would have similar effect on blood sugar and insulin levels. So most likely this would have no negative effects on results at the gym. Bodybuilding anyway has only minor and very transient effect on male sex hormones (see my article about bodybuilding for more on this).

          • Hmm I see, it’s just that, every time you search for SHBG and bodybuilding, you’ll see ton of bodybuilding threads where people ask for advice to lower their SHBG, that’s why I’m debating why I should try this or not since this and the big breakfast and little meal will increase my SHBG by more than 100% (or so it states by the studies)

  18. Actually after doing some research, I found these articles which may have answered my question:

    Apparently.. strength training increases SHBG, and a decrease of SHBG seems to correspond with an increase in insulin resistance. How interesting. I may follow the big breakfast and low dinner recomendation + take berberine now.

  19. Hi Seppo,
    I’m going to try and post this again as I tried earlier and it doesn’t appear to have gone through. I bought your book two days ago and really liked it ! Thanks for all of the information your provided 🙂

    Anyway, I’m 20 and have had mild to moderate acne for the past 8 years. It’s always been concentrated on my chin, and usually of the cystic kind. I began noticing that this was mainly centered around right before my period, which led me to believe my acne is hormonal.

    I have given up dairy for the past month, and after reading your book I bought the NAC supplement and zinc supplement that you reccomended. I also have been using epiduo as my bp, and the madre green tea cream afterwards. I am also going to work on meditation and eating a low GI diet ( Low carb alone would be too hard for me, but I will focus on more whole grains/ fruits/ soluble fiber veggies). Should I wait to see the effect of these changes before I buy the berberine supplement? Or do you think I might as well add berberine in to the mix too?

    My skin was doing better until I made the mistake of trying oil cleansing for a week. Blocked pores and cysts galore! I thought the high linoleic acid in grapeseed oil would be beneficial, but I guess not for me.

    • Glad to hear that you liked the book. I presume you’ve read my post on acne types? If not, please read it here:

      For hormonal type acne antioxidants and zinc may not be that helpful. When I was writing the book I didn’t think of separating acne to different types. So some of the recommendations are slightly out of date.

      So if you have hormonal acne, the best thing would be to limit your carbohydrate intake. No need to go low carb, but I would keep carbs at 20 to 40% of total calories and focus on eating more fat and protein. That seems to be the most effective dietary strategy for hormonal issues.

      Should you wait until taking berberine? Well, that depends on what you want. Academically speaking, it’s good to give every action you take some time to take effect. That way you’ll know what actually worked. That said, I don’t think that’s very high on your priorities. If you just want to get clear as soon as possible, then I would start taking it as soon as possible.

      Sorry to hear you had a bad experience with the oil cleansing method. Frankly speaking, I’ve never seen the point of it. But perhaps that’s just me. I’m more interested of data and facts than trying to be ‘all natural’.

  20. Hi seppo,
    Thanks for getting back to me so quickly! I’ll definitely look into getting the berberry supplement. Messing with hormones scares me slightly, but I am really sick of my acne… I may try cinnamon first as it seems a little less potent…do you think that would be an okay option to start with? Also, is it worth taking the NAC and zinc? Or do you think it won’t be helpful for me?
    Thanks again!

    • Sorry about late reply. I had to take some break from all this acne stuff for a while.

      Yes, cinnamon would probably be a good option to start with. Many women also say that DIM supplements help with hormonal acne. There’s some test tube data to show this is plausible, but no real human data. Unfortunately the whole DIM/EstroBlock thing is mired in alt med BS and the company is known to solicit positive reviews from their customers by basically bribing them. So it’s hard to know what to make of all the positive stories.

      As to NAC and zinc, it’s difficult to say. They might help people with hormonal-type acne, but I suspect that the effect is fairly limited. Would they help if you already eat healthy diet with plenty of fruits and veggies? That I can’t say. Still, they are cheap, so might be worth a try for a few months.

  21. Hi Seppo,
    Don’t worry I totally understand. I would need a break from all of the research that you do too.

    I actually ended up ordering the Berberine, and I have been taking that twice a day for the past week. I also am going to continue the NAC and zinc since I already ordered them and I don’t feel like they can hurt (plus maybe they will help a bit with my oily skin). I am also trying to focus more on my fruits and veggies, my green tea, and stressing less in general.

    I know that you say it takes time to see change, so I plan to stay the course for now for an entire month so that I can really see if what I am doing is taking an effect. I’ll check back with you then to let you know how things are progressing!

  22. Hi Seppo,

    I have chronic Lyme disease and other autoimmune diseases (and a weakened immune system). After years of treatment with herbs, antibiotics that RUINED my gut and left me with leaky gut, I am struggling to regain my health. I WON’T go into that part of my life, it’s just back story to say that I know I’ve had an unhealthy gut for years and yet somehow I’ve had clear skin until recently, when I started seeing a new doctor. This guy does “detox” IV treatments with lots of amino acids, B vitamins, glutathione, and other things. I saw your article on B12, so I’m concerned about that. This clinic says that acne is “toxins” coming out of your skin any way they can. They also say my liver is over taxed and that is why I’m breaking out.

    However, I have NOT BEEN BREAKING OUT CONSISTENTLY the whole time I’ve been at this clinic (4 months). I believe that a huge turning point was when they mandated that I get a testosterone shot. Since then, I’ve had cystic acne on my chin and a few other pimples here and there. The cysts on my chin WILL NOT GO AWAY no matter what I do. This seems to indicate hormonal acne, but I’m incredibly thin, have low estrogen levels and struggle to keep weight on. When the cysts appeared, hair growth on my chin and jawline did as well.

    Would you suggest DIM or saw palmetto or another herb? Does this seem like an androgen problem? Would boosting estrogen typically help?

    Thank you!

    • Sorry to hear you have had to go thought all that. It sounds like your new doctor practices some serious quackery.

      There’s no evidence that acne is caused by “toxins”, and there’s really even no good reason to think that. It’s a common alt-med/natural health myth. Similarly, there’s no evidence (or reason to think) that acne is caused by liver congestion. I wrote about these here.

      It does sound like you have hormonal-type acne, perhaps with inflammatory-type mixed in. Try taking inositol, about 1000mg/day. There’s a lot of evidence it’s helpful for women who struggle with androgen/estrogen imbalance.

      As to DIM and saw palmetto. They might work. The problem is there’s very little evidence to support them, so it’s a hit or miss situation.

  23. What is your perspective on spirolactone? I am currently taking it at 100mg and plan on reducing my dosage once I’ve been clear for a few months. I saw that you think antibiotics are not a good idea for long-term treatment since they affect the prebiotics in the gut…do you have any opinion on whether spiro is a bad ‘band-aid’ for acne & whether it will end up making things overall worse in the future? Thanks so much!

    • Spiro is not at all like antibiotics. As far as I know, taking is long-term doesn’t cause any issues. In some studies (writing from memory, and don’t have the papers in front of me now), they have followed women taking spiro for years, and those studies haven’t given any reasons to be concerned about the long-term safety of spiro.

      That being said, I’m not that familiar with prescription drugs, and this is something you should talk to your doctor about.

      As to being a band-aid, yes, it won’t fix the root cause of acne. Whether the underlying cause can be fixed in all women with acne, is a completely different matter.

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