Hormonal acne is a common condition I see in practice as a naturopathic physician. It is often characterized by deep, painful cysts on back, chest, neck and/or jawline of the face. Female patients may notice that their acne worsens around ovulation or their periods. Acne can be a condition that causes a great deal of social anxiety, insecurity and stress, especially when it presents on the face. One of our treatment goals is to support the body’s liver. A major function of the liver is to remove metabolic toxins and hormone metabolites from the body. According to Traditional Chinese Medicine, the liver is associated with the spring season; perhaps as a nod to its critical function of cleaning and detoxifying the body.
To better understand the cause of hormonal acne, we have to learn more about the anatomy of a hair follicle. Each hair follicle on our face has associated sebum (oil) glands. Normally, this oil helps lubricate the hair and provide some moisture to the skin. Attached to the surface of the oil glands are receptors for androgens. Androgens are sex hormones that both males and females have in their bodies. They are responsible for “male-like” features such as increased hair growth on the face and under the arms. When androgens connect with the receptors on oil glands of the face, it tells them to produce more oil. The oil can then trap bacteria in the hair shaft, creating acne.
Androgens (including testosterone and DHT) are created in biologically male bodies in the testes and in biologically female bodies in the ovaries. Testosterone can convert into estrogen in both males and females with the help of an enzyme called aromatase. Some people will have more estrogens in their body because they have very active aromatase enzymes (i.e. estrogen dominance).
One of the tools I use to treat hormonal acne is Diindolylmethane or DIM for short. Diindolylmethane (DIM) is a chemical formed from indol-3-carbinol (I3C), which is found in broccoli, kale, cauliflower and other members of the Brassica family3. DIM has potent antiandrogenic properties. It blocks androgens from connecting with the receptors on the oil glands of the face2. This decreases oil production and cystic acne. DIM also modulates estrogen metabolism by keeping estrogen levels relatively balanced4. DIM appears to be a unique, plant-derived bifunctional hormone disrupter.
Because of its ability to naturally disrupt hormones (especially estrogens and DHT) from reaching their target receptors, DIM is likely anti-cancer1. Animal studies have demonstrated promising results in gastrointestinal1, prostate2and breast cancer4. Estrogens and DHT are known as anabolic or growth hormones; their actions cause cell division and growth. By blocking these hormones, certain cancers cannot grow. It is important to note that while DIM can help detoxify estrogens in breast cancer, it also decreases the effect of Tamoxifen, one of the primary drugs used in the treatment of the disease5. It is thought that DIM increases the liver’s clearance of this drug so that it does not stay as long in the body.
DIM supports liver detoxification pathways3. Along with other critical components, DIM is used by the liver to help make it easier to excrete toxins such as metabolic end-products, microorganisms, pollutants, insecticides, pesticides, drugs and alcohol.
DIM is one of the supplements that naturopathic physicians use in practice to help treat acne through balancing hormones and supporting liver detoxification pathways. There is also some promising research for the use of DIM in estrogen and DHT-sensitive cancers.
- Kim, S. M. (2016). Cellular and Molecular Mechanisms of 3,3′-Diindolylmethane in Gastrointestinal Cancer. International journal of molecular sciences, 17(7): 1155.
- Le, H.T., Schaldach, C.M., Firestone, G.L., Bjeldanes, L.F. (2003). Plant-derived 3,3′-Diindolylmethane is a strong androgen antagonist in human prostate cancer cells. J Biol Chem6: 278(23):21136-45.
- Patel, K. (2018). Diindolylmethane: Proven Health Benefits, Dosage, and more. Examine.com. Retrieved from https://examine.com/supplements/diindolylmethane/#interactions-with-hormones. Accessed April 9, 2019.
- Rajoria, S., Suriano, R., Parmar, P.S., Wilson, Y.L., Megwalu, U., Moscatello, A., Bradlo, H.L., Sepkovic, D.W., Geliebter, J., Schantz, S.P., Tiwari, R.K. (2011). 3,3′-diindolylmethane modulates estrogen metabolism in patients with thyroid proliferative disease: a pilot study. Thyroid21(3):299-304.
- Thomson, C.A., Chow, S.H.H., Roe, D., Wertheim, B. Chalasani, P., Altbach, M., Thompson, P., Stopek, A. and Maskaranic, D. (2017). Effect of diindolylmethane on estrogen-related hormones, metabolites and tamoxifen metabolism: Results of a randomized, placebo-controlled trial. Cancer Epidemiology, Biomarkers and Prevention, ASPO 41stAnnual Meeting Abstracts.