Skin & Hair Changes: Signals of Hormonal Health

We’re all sold the ideal of flawless skin and perfect hair, but sometimes the cause of persistent breakouts or unexplained thinning is more than skin deep. Your complexion and scalp are often the first, most visible external indicators of your internal hormone balance.

When hormones that regulate your sebaceous glands and hair follicles shift out of their optimal range, the results – from cystic acne to a widening hair parting – can be frustratingly visible.

Quick Facts:

• Hormonal acne and hair thinning are primarily caused by fluctuations or imbalances in androgen hormones (like testosterone) and thyroid hormones.
• Oestradiol supports skin health and increases a key protein that controls active androgen levels.
• These symptoms are common in conditions like PCOS and during hormonal transitions like perimenopause.

💡 Find out what your hormones are telling you

Don’t guess what’s causing your skin and hair changes. Take our Advanced At-Home Hormone and Fertility Test to uncover the root causes and get a personalised care plan.

What are Hormonal Skin and Hair Changes?

These symptoms are related to the pilosebaceous unit – the complex structure comprising the hair follicle and the sebaceous (oil) gland.

• Hormonal Acne: Breakouts related to hormonal imbalance or fluctuation, typically found on the lower face, cheeks, jawline, chest, neck, and back.
• Hormonal Hair Changes: This includes both hair thinning or loss on the scalp (androgenic alopecia) and excessive dark, thick hair growth on the face or body (hirsutism).

The Hormonal Culprits Behind Your Skin and Hair

Your sebaceous glands and hair follicles have receptors for several key hormones. Imbalances in these messengers directly influence how much oil is produced and how the hair growth cycle progresses.

1. Androgens: The Oil and Hair Drivers

Androgens, such as testosterone and DHEAS, are the most significant modulators of your skin and hair health.

• Acne and Oily Skin: When your body produces excess androgens, there is more of the hormone binding to the sebaceous gland receptors. This stimulates excessive oil (sebum) production, resulting in oily skin hormones and clogged pores, which can cause inflammatory, cystic acne.
• Hirsutism: High androgen levels convert fine hair into thick, dark hair in androgen-sensitive areas (face, chest, back).
• Hair Thinning: Conversely, in scalp follicles, testosterone can be converted into dihydrotestosterone (DHT) which causes hair follicles to shrink, shorten the growth phase, and ultimately lead to hair thinning and female pattern hair loss (Glaser et al., 2012).

A key marker for assessing true androgen activity is sex hormone-binding globulin (SHBG). SHBG is a protein that binds to and deactivates sex hormones. If your SHBG levels are low, more testosterone is left “free” and biologically active in your system, intensifying its impact on your skin and hair, even if your total testosterone level is within range.

• Clinical Link: High androgens, measured as testosterone or DHEA-S, are a defining feature of Polycystic Ovary Syndrome (PCOS) symptoms (Teede et al., 2018). This is why people with PCOS are significantly more likely to experience persistent hormonal acne and hair issues.

2. Thyroid Hormones: The Metabolic Regulators

The thyroid gland acts as the body’s metabolic regulator, and its hormones (thyroid stimulating hormone (TSH) and free thyroxine) are essential for the natural cycle of the hair follicle (Schmidt et al., 1991).

• Hypothyroidism (underactive): When the thyroid is underactive (often seen with high TSH and low FT4), cell regeneration slows down. This commonly results in diffuse hair thinning across the entire scalp, hair that is dry and brittle, and dry, scaly skin.
• Hyperthyroidism (overactive): An overactive thyroid accelerates the hair cycle, causing hair to shed prematurely. This can also lead to noticeable thinning and frequently causes the skin to be warm and moist.

Hair and skin changes can be some of the first signs of underlying thyroid dysfunction and require testing to confirm if the condition is metabolic or hormonal in origin.

3. Oestradiol, LH, FSH, and Prolactin: The Modulators

These hormones work together to modulate androgen activity and support tissue health:

• Oestradiol (Oestrogen): Oestradiol supports the anagen (growth) phase of hair and promotes healthy skin by increasing collagen production, hydration, and wound healing. Critically, high oestradiol levels increase the production of SHBG in the liver, lowering the amount of active, acne-causing free testosterone. Conversely, low oestrogen (e.g. in perimenopause) can cause skin thinning, dryness, and sometimes acne.
• LH and FSH: As the pituitary signals that regulate the ovaries, an altered LH:FSH ratio combined with other markers (like high AMH and testosterone) helps diagnose conditions like PCOS, which are the source of most severe hormonal skin and hair symptoms.
• Prolactin: Elevated prolactin (hyperprolactinemia) can sometimes signal hormonal disruption that indirectly affects the balance of sex hormones, potentially contributing to symptoms like hirsutism (Tirgar-Tabari et al., 2016).

When to Get Tested

If you are treating your skin and hair symptoms with topical creams or cosmetics and seeing minimal, temporary, or no improvement, it’s a strong indication that the issue is systemic and hormonal. 

Consider testing your hormones if your symptoms include:

• Acne that is cystic, deep, or confined to the lower face and jawline.
• Noticeable, persistent thinning of the scalp hair, especially if your part line is widening.
• The new or increased growth of coarse body or facial hair (hirsutism).
• Skin or hair changes coupled with other systemic symptoms, such as irregular periods, chronic fatigue, or unexplained weight changes.

What Your Personalised Results Can Tell You

Hertility’s panel of personalised hormones provides the essential diagnostic data needed to find the root cause. This panel is tailored to your symptoms and what you are looking to achieve from your test.

1. Pinpoint Androgen Activity: Your personalised results will clarify if the issue is high total androgens, high free testosterone (due to low SHBG), or high adrenal output (DHEAS), which directs the most effective therapeutic strategy (e.g. lifestyle, targeted supplements, or medication).
2. Uncover Thyroid Issues: We can rule out or suggest thyroid dysfunction by measuring TSH and free T4, ensuring hair loss isn’t misdiagnosed as purely androgenic.
3. Identify Underlying Conditions: The results provide the crucial diagnostic criteria for complex conditions like PCOS or thyroid disease, allowing you to treat the root cause and not just the visible symptoms.

💡 Find out what your hormones are telling you

Don’t guess what’s causing your skin and hair changes. Take our Advanced At-Home Hormone and Fertility Test to uncover the root causes and get a personalised care plan.

References

• Glaser, R. L., Dimitrakakis, C., & Messenger, A. G. (2012). Improvement in scalp hair growth in androgen-deficient women treated with testosterone: a questionnaire study. The British journal of dermatology, 166(2), 274–278. https://doi.org/10.1111/j.1365-2133.2011.10655.x 
• J.B. Schmidt, A. Lindmaier, A. Trenz, B. Schurz, J. Spona; Hormone Studies in Females with Androgenic Hairloss. Gynecol Obstet Invest 1 April 1991; 31 (4): 235–239. https://doi.org/10.1159/000293166 
• Teede, H. J., Misso, M. L., Costello, M. F., Dokras, A., Laven, J., Moran, L., Piltonen, T., Norman, R. J., & International PCOS Network (2018). Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertility and sterility, 110(3), 364–379. https://doi.org/10.1016/j.fertnstert.2018.05.004 
• Tirgar-Tabari, Soudabeh; Sharbatdaran, Majid1; Manafi-Afkham, Sara2,; Montazeri, Mohammad3. Hyperprolactinemia and Hirsutism in Patients Without Polycystic Ovary Syndrome. International Journal of Trichology 8(3):p 130-134, Jul–Sep 2016. https://doi.org/10.4103/0974-7753.188998