THE ACNE & ECZEMA CLINIC

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What Tests Can I Do For Acne?

There’s a million ways to start this blog, but I guess I should stick to the point.

There is absolutely no standalone cause of acne

That’s why tests are so important.

I treat many, many women who have acne, and all of them have a different story, a different medical history, a different set of genes, different stressors in their life, different lifestyle and habits, different genetics, different gut function… the only thing they all have in common is they’re on a sliding scale from heartbroken to frustrated about their skin. Oh, and they want my help! That’s always an important part of the equation!

It’s so important to me that I help these women actually understand what’s driving their skin problems, and help them to change whatever needs to be changed so that there can be long lasting resolution of their acne.

For me to understand the cause of their acne, I need to do a little investigation.

This is where 90 minutes in consultation goes like the blink of an eye.

It’s often in this time that I discover they’ve had a number of things that can correlate to the onset of acne:

  • irregular periods

  • have been on the pill for many years because of incredible period pain

  • experience spotting throughout their cycle

  • have a history past or current of PMS

  • have used antibiotics frequently, even before getting acne

  • have recurring infections

  • are sensitive and reactive to foods

  • have a history of gut problems like bloating and pain

  • irregular bowel motions, either looser and more frequent or a history of constipation

  • high stress in their life for many years

  • overachiever in school and/or as an adult

  • emotional or physical trauma

  • … just to name a few common ones!

Everyone obviously has a unique presentation, but there’s always a red flag that leads to the onset of acne problems.

It’s important to me as a Naturopath that I do these three things for you:

  1. Find the cause (though often there’s several occurring at once, feeding each other)

  2. Educate you about how the problem developed, why it’s still occurring, and how it can be helped

  3. Ensure you have the support, knowledge and guidance to bring about the changes required to resolve the cause of the problem and to be able to maintain those factors in the long-term

In my years of experience, the only way to be 100% sure of something is to test, and this is especially true when it comes to hormones and acne.

Because, guess what? Not all acne is hormonal.

Acne can be due to

  • sluggish detoxification

  • years on the pill leading to post-pill acne

  • hormonal imbalance (yes, very common, but not the only cause)

  • dysbiosis and poor gut health

  • small intestinal bacterial overgrowth (SIBO)

  • stress (high cortisol)

  • diet

  • infection

  • poor skin function

There’s so many factors - and we need to take them all into account by either ruling them out or treating them!

Obviously after 90 minutes of 1:1 consultation I have a pretty thorough idea of what the cause of your acne is.

I still refer for screening testing, and often we will then do deeper testing into whatever seems to be the most relevant cause in your unique case.

Screening tests that I like to see include:

  • iron studies

  • liver function tests

  • B12 (to assess gut function)

  • zinc (very important nutrient for the skin and often suboptimal or deficient)

These are usually done via blood test through a referral from us to a doctor.

Then there’s the in-depth tests… these are used more so where there’s hormone drivers that we want to identify.

I usually use salivary testing for these hormone tests for acne because salivary testing gives us a better idea of the bioavailable hormone.

These are the most common ones that I address:

  • E2 (estradiol - this is the estrogen that is highest in reproductive women)

  • progesterone (to see it in ratio to estrogen, and to assess likelihood that you are ovulating)

  • testosterone (an androgen, high levels of which can cause acne)

  • dihydrotestosterone (the much more potent form of testosterone)

  • androstenedione (an androgen as well, acting similarly to testosterone, but produced by the adrenals and worsened by stress)

  • DHEA (the master sex hormone)

  • cortisol (stress hormone)

These tests are less common to have done by a GP, and salivary testing is almost never done. Unfortunately, without salivary testing, we aren’t seeing the true picture of the hormones. Salivary testing allows us to get an idea of the bioactive hormone, whereas blood tests just show us the bound hormone in the blood.

The other thing to mention here is that our hormones change quite dramatically throughout our menstrual cycle.

It’s important to have your hormone testing done on specific days of the cycle so that the results can be put into context.

For example, having estrogen of 700 is normal if you are near ovulation, but having this level when you have just started your period is abnormal.

Often doctors don’t give you any guidance on when to get your hormone tests done, and this can dramatically change the interpretation of the results.

Estrogen is important to be tested in the first 2-3 days of your cycle (so, the second or third day that you are bleeding).

Whereas progesterone is important to be tested 7 days prior to your next period coming. This can sometimes be difficult to do if you have an irregular cycle.

And, if you are currently on the pill or you have not been off the pill for longer than 3 months then it is entirely a waste of time to have your hormones tested, because I can tell you exactly what it will show (high estrogen, low progesterone).

You must wait three months after coming off the pill for the ovaries to wake up and start doing their job. Your hormones will be all over the shop (most likely for longer than those initial three months!) so don’t go straight in for hormone testing in this situation! (Here’s a blog about what to expect when you come off the pill, by the way).

I always recommend having the guidance of someone who is highly trained in their field if you are needing help with your acne, and are looking for natural solutions.

Tests save a lot of time, which in my opinion is essential when it comes to treating acne!

It’s also important to be able to retest the things which were abnormal to ensure that they have regained balance, and to know when treatment can safely stop without symptoms returning.

If you or a girlfriend of yours needs help, reach out.

There’s nothing I love more than helping women love the skin they’re in.

And, don’t forget our amazing skin health quiz that can help to identify what’s driving your acne!

Much love,

Emily (Directing Naturopath, Herbalist & Lover of Skin)