Struggling with stubborn, deep, and painful cysts along your jawline, chin, and neck? You’re not alone. While many think of acne as just a teenage problem, for many adults in Kathmandu, it’s a frustrating, persistent issue. If your acne seems to follow a cyclical pattern or hasn’t responded to typical topical treatments, the culprit might be hiding deeper – in your hormones.
At Derma Clinic Kathmandu, we believe in treating the root cause, not just the symptoms. That’s why a comprehensive blood workup is often the first, most crucial step in our treatment plan for persistent acne. It’s like looking under the hood of a car; it tells us exactly what’s going on internally so we can create a personalized treatment plan that actually works.
Let’s break down the key tests we run and what they reveal about your skin. 🧐
What is Hormonal Acne?
Hormonal acne, often called “adult acne,” typically affects individuals between the ages of 20 and 50. While it starts in the hair follicles much like teenage acne, it is specifically driven by an overproduction of sebum (oil) caused by hormonal fluctuations.
- The “U-Zone” Pattern: Unlike standard breakouts, hormonal acne is most common on the lower third of the face, specifically the jawline, chin, neck, and around the mouth.
- The Appearance: It often takes the form of deep, painful cysts or nodules that linger for long periods and can leave behind significant scarring or pigmentation.
The Key Players: Hormones
Your hormones are chemical messengers that regulate everything from your mood to your metabolism—and yes, your skin’s oil production. When they’re out of balance, your skin is often the first place it shows. Here are the essential tests we perform.
1. Androgens: The “Male” Hormones
Androgens are often called “male” hormones, but they’re present and essential in both men and women. When it comes to acne, they are the primary instigators.
- Test: Total and Free Testosterone & DHEA-S (Dehydroepiandrosterone Sulfate)
- Why we test it: These androgens directly stimulate your sebaceous (oil) glands. Think of them as the “on” switch for oil production. When levels are high, your glands go into overdrive, producing excess sebum that clogs pores and feeds acne-causing bacteria. DHEA-S is an androgen produced by the adrenal glands, giving us a clue if stress might be a major factor.
- Normal Range (for adult females):
- Total Testosterone: 15-70 ng/dL
- Free Testosterone: 0.5-5.0 pg/mL
- DHEA-S: Varies by age, but generally 45-270 µg/dL
- What it means if it’s high: Elevated levels are a classic sign of hormonal acne and can be associated with conditions like Polycystic Ovary Syndrome (PCOS). This leads to increased oiliness, inflammation, and painful cystic acne.
2. Sex Hormone-Binding Globulin (SHBG)
- Test: SHBG
- Why we test it: Think of SHBG as a taxi service for your hormones. Its job is to bind to excess hormones, like testosterone, and keep them “inactive.” This is crucial because it’s the free, unbound testosterone that causes acne.
- Normal Range (for adult females): 25-125 nmol/L
- What it means if it’s low: Low SHBG means there aren’t enough “taxis” to go around. More testosterone is left “free” to roam and wreak havoc on your skin, even if your total testosterone level is normal. Low SHBG is often seen in cases of insulin resistance and PCOS.
3. Pituitary Hormones: The Master Regulators
Your pituitary gland in the brain is the command center, telling your ovaries and adrenal glands what to do.
- Test: LH (Luteinizing Hormone) & FSH (Follicle-Stimulating Hormone)
- Why we test it: The ratio of LH to FSH is a key diagnostic marker. These hormones regulate your menstrual cycle and influence ovarian hormone production.
- Normal Range: The levels fluctuate throughout the menstrual cycle. However, a key indicator we look for is the LH:FSH ratio. A normal ratio is typically close to 1:1.
- What it means if it’s high: An LH:FSH ratio of 2:1 or even 3:1 is a strong indicator of PCOS, a common cause of hormonal acne. This imbalance disrupts ovulation and leads to an increase in androgen production.
4. Insulin & Blood Sugar: The Energy Regulators
The link between your diet and your skin is very real, and it comes down to insulin.
- Test: Fasting Insulin & HbA1c (Glycated Hemoglobin)
- Why we test it: High consumption of sugar and refined carbs can lead to insulin resistance. This is when your body’s cells stop responding properly to insulin, forcing your pancreas to pump out even more. This excess insulin signals your ovaries to produce more testosterone, directly fueling your acne. HbA1c gives us a picture of your average blood sugar over the past 3 months.
- Normal Range:
- Fasting Insulin: < 10 µIU/mL (ideally < 5)
- HbA1c: < 5.7%
- What it means if it’s high: High fasting insulin is a tell-tale sign of insulin resistance. This condition not only drives hormonal acne by increasing androgens but also boosts overall inflammation in the body, making breakouts redder and more painful.
5. Cortisol: The Stress Hormone
Ever notice you break out during a stressful week? That’s cortisol at work.
- Test: Serum Cortisol (usually a morning test, AM Cortisol)
- Why we test it: Cortisol is your body’s primary stress hormone. While essential in small doses, chronic stress leads to consistently high cortisol levels. This can trigger your oil glands to produce more sebum and can disrupt the balance of your other sex hormones.
- Normal Range (AM Cortisol): 6-23 mcg/dL
- What it means if it’s high: Chronically elevated cortisol puts your body in a constant state of “fight or flight,” which can dysregulate your entire hormonal system. It can directly stimulate oil production and inflammation, leading to stress-induced acne.
Other tests that can do done:
Prolactin: Elevated levels can mimic or contribute to menstrual irregularities and skin issues.
TSH (Thyroid-Stimulating Hormone): Thyroid dysfunction can contribute to acne and is often ruled out.
17-Hydroxyprogesterone: Helps exclude non-classical congenital adrenal hyperplasia—a differential diagnosis.
Anti-Müllerian Hormone (AMH): May serve as an adjunct for PCOS diagnosis.
Lipid Profile & Oral Glucose Tolerance Test (OGTT): Useful for evaluating metabolic risks associated with PCOS
Beyond the Blood Test: The Role of an Ultrasound
Sometimes, blood tests tell only part of the story. If your results and symptoms (like irregular periods and cystic acne) point towards Polycystic Ovary Syndrome (PCOS), an ultrasound is the next essential diagnostic step.
- What is it? We recommend a pelvic ultrasound for a direct look at the ovaries.
- Its Use and Findings: The primary purpose is to see the structure of your ovaries. In PCOS, the ultrasound often reveals multiple small follicles (sometimes called cysts) arranged along the outer edge of the ovaries, often described as a “string of pearls” appearance.
- The Benefit: This visual confirmation is incredibly powerful. When combined with your blood work and clinical symptoms, an ultrasound can provide a definitive diagnosis of PCOS. This allows us to create a highly specific and effective long-term management plan that addresses not just the acne, but the underlying metabolic and hormonal condition.
Comprehensive Treatment Protocol (2026 Updates)
Treatment in 2026 has shifted toward personalized, multifactorial management that combines topicals, oral medications, and new technology.
A. Topical & Oral Foundations
- Topical Retinoids: The cornerstone for unclogging pores and promoting cell turnover.
- Spironolactone: A highly effective anti-androgen for women that blocks hormone receptors in the skin to reduce oiliness.
- Combined Oral Contraceptives: Used to regulate the cycle and lower androgen production.
B. Latest 2026 Medical Updates
- Clascoterone (Winlevi): A breakthrough topical anti-androgen that blocks hormones directly at the skin level, making it a safe drug-free alternative for both men and women.
- 1726 nm Lasers (AviClear/Accure): These lasers specifically target and shrink the sebaceous glands (the source of the oil) without damaging surrounding tissue.
- Denifanstat: A new mechanism of action currently in Phase 3 trials that reduces the skin’s ability to produce fatty acids (lipids), directly lowering oil levels.
- Microbiome & Postbiotics: Modern routines now include ingredients that support “good” skin bacteria to reduce inflammation and strengthen the skin barrier.
Lifestyle & Dietary Management
Your skin’s health is closely tied to your metabolic health. At Derma Clinic, we emphasize the following adjustments:
- Low-Glycemic Diet: Swap refined carbs (white bread/rice) for whole grains and legumes to prevent insulin spikes that trigger hormone production.
- Dairy Limitation: Evidence suggests that skim and low-fat milk can worsen hormonal acne due to bioactive molecules and proteins that increase inflammation.
- Omega-3 Intake: Fatty fish, flaxseeds, and walnuts have anti-inflammatory properties that can calm redness and swelling.
Frequently Asked Questions (FAQ)
1. Which blood tests are needed for hormonal acne?
The core panel includes Total & Free Testosterone, DHEA-S, LH/FSH Ratio, Fasting Insulin, and SHBG.
2. What is the cost of hormonal acne blood tests in Kathmandu?
In 2026, basic panels start around NPR 8,000, while comprehensive PCOS panels range from NPR 15,000 to 30,000 at Kathmandu labs.
3. When is the best time in my cycle to do the test?
Draw blood on day 2 or 3 of your period for the most accurate reproductive hormone readings.
4. Do I need to fast?
Yes. A 10-12 hour fast is required if we are testing Fasting Insulin or Glucose.
5. Can acne be hormonal if my periods are regular?
Yes. You can have a “local” hormone sensitivity in your skin even if your blood levels appear normal.
6. Does stress worsen hormonal acne?
Yes. Stress triggers Cortisol, which stimulates oil glands to produce more sebum, leading to flares.
7. Is Spironolactone safe?
It is highly effective for women. While it can cause minor cycle irregularities, it is generally safer for long-term use than antibiotics.
8. Can I get tested while on birth control?
No. You must be off hormonal birth control for at least 3 months for accurate diagnostic results.
9. How long until I see results?
Hormonal treatments usually take 8 to 12 weeks to show significant clearance.
10. Why did my acne come back after antibiotics?
Antibiotics kill bacteria but don’t fix the hormonal “oil switch.” Once you stop the pills, the oil returns and the acne restarts.
Your Path to Clear Skin Starts Here
Understanding your blood work and other diagnostics is the difference between guessing and knowing. It allows us at Derma Clinic Kathmandu at Basundhara Chowki to move beyond generic creams and create a targeted plan that may include lifestyle adjustments, specific dietary advice, and medications that address the hormonal imbalance directly.
Don’t let hormonal acne control your life. Schedule a consultation with us today by calling or sending message at Whatsapp at 9801358600 Let’s get the full picture and start your journey toward clear, healthy skin from the inside out. ✨
