Priming the pump with hormones

Hormones play a central role in the acne drama. Hormones are the
body’s chemical messengers. Without hormones, you wouldn’t
have acne, but you’d be in pretty bad shape, because hormones
control just about every bodily function, from regulating your
metabolism to ensuring that you can mature and have children.
In both males and females, a particular group of hormones, called
androgens, are primarily associated with the formation of acne. The
term androgen is a general term for hormones that have more mas-
culinizing features. Androgens are responsible for the development
of secondary sex characteristics in males (facial hair, increased
muscle mass, the ability to reproduce, and so on). The androgen
testosterone is the main male hormone. However, if you’re female,
you have androgens too, but they’re produced in smaller quantities
and are much weaker than in your male counterparts.
Estrogen and progesterone are the primary female hormones that
control menstrual cycles and regulate pregnancy. Both of these
hormones can have an affect on acne as well — albeit less than
androgens — by their periodic monthly fluctuations. (I talk more
about these hormones in Chapter 5.)
The androgenic hormones help us regulate how much sebum (the
healthy oil I describe in the preceding section) our sebaceous
glands produce. People who get acne aren’t producing any more of
these androgens than anyone else; it’s just that their sebaceous
glands are very sensitive to the hormone’s message to increase
production. The glands respond by pumping out excessive
amounts of sebum. Your face, chest, and back contain the highest
concentrations of sebaceous glands; that’s why you’re more likely
to have acne on these areas.
Adolescence is generally the worst time for acne because androgens
are increasing steadily during the teen years, and they signal your
sebaceous glands to get larger and to generate more sebum, as
shown in Figure 3-2. As adolescence ends, the amount of androgen
secretion diminishes and acne tends to disappear for most teens by
age 18 or 19. But for various reasons that I discuss in Chapter 5,
some women (and much less commonly, men) retain a heightened
sensitivity to their androgens and continue to have acne beyond
adolescence. Some women even get acne for the first time as adults.