I’ve lost count of how many times a client has come to me after spending months (sometimes years) treating their PCOS acne like it’s just regular acne. They’ve tried every topical treatment, switched skincare brands repeatedly, and still wake up to new breakouts along their jawline and chin. The frustration is real, and I get it.
Here’s what I tell them: PCOS acne isn’t a skin problem. It’s a hormone problem that shows up on your skin.
Until you address what’s happening inside your body, the breakouts will keep coming back. And while that might sound overwhelming, it’s actually good news. It means there are practical, evidence-based steps you can take that actually work.
In this article, I’m walking you through the hormone-skin connection, what I’ve seen make the biggest difference in my practice, and how to build a plan that addresses the root causes instead of just managing symptoms.
The Real Reason PCOS Acne Keeps Coming Back
The Androgen Connection
PCOS acne isn’t random. It’s directly linked to elevated androgens like testosterone and DHEA-S. These hormones trigger your sebaceous glands to produce excess oil, which clogs pores and creates the perfect environment for inflammation and bacterial overgrowth.
This is why PCOS acne typically shows up along the jawline, chin, and lower cheeks. These areas have more androgen receptors, making them particularly sensitive to hormonal fluctuations.
But it’s not just about clogged pores. The inflammation in PCOS is systemic, meaning it’s happening throughout your body, not just on your face. That’s why treating it topically alone doesn’t cut it.
What Most People Miss
There are a few key drivers that keep the acne cycle going, and most conventional approaches completely overlook them:
Insulin resistance is one of the biggest culprits. Even if you’re not overweight, insulin resistance can fuel androgen production. High insulin signals your ovaries to produce more testosterone, which leads directly to more oil production and inflammation.
The gut-skin axis is another piece that often gets ignored. I see digestive issues and skin flare-ups go hand-in-hand all the time. Gut inflammation, bacterial imbalances, and compromised gut lining can all contribute to systemic inflammation that shows up on your skin.
Stress and cortisol create a cascade effect. Chronic stress doesn’t just feel bad, it actively worsens insulin resistance, disrupts your cycle, and increases androgen production. When clients are stressed, their skin reflects it.
Key Insight
PCOS acne is driven by elevated androgens, insulin resistance, gut inflammation, and chronic stress. Addressing these internal factors is what actually moves the needle, not just treating the surface.
What I Actually See Working in Practice
Blood Sugar Balance (The Non-Negotiable)
If I could pick one thing that makes the biggest difference for PCOS acne, it’s stable blood sugar. This matters more than any supplement I could ever recommend.
When your blood sugar spikes and crashes throughout the day, your insulin levels follow. High insulin drives androgen production, which drives oil production and inflammation. It’s a direct line from what you eat to what shows up on your skin.
Here’s what stable blood sugar looks like in practice:
- Protein at every meal: This slows glucose absorption and keeps you fuller longer. I’m talking eggs, chicken, fish, tofu, legumes, Greek yogurt.
- Fiber with every meal: Vegetables, whole grains, legumes, and seeds all help slow the release of glucose into your bloodstream.
- Avoid eating carbs alone: Pairing carbohydrates with protein and fat prevents blood sugar spikes. Toast with avocado and eggs instead of toast alone.
- Consistent meal timing: Skipping meals or going too long between eating can cause blood sugar to crash, which triggers cravings and overeating later.
This isn’t about perfection. It’s about consistency. The clients who see the fastest improvement in their skin are the ones who prioritize balanced eating most of the time.
Supporting Your Liver and Detox Pathways
Your liver is responsible for breaking down and clearing excess hormones, including androgens. If your liver is sluggish or overwhelmed, those hormones recirculate instead of being eliminated, which keeps the acne cycle going.
I don’t jump straight to aggressive detox protocols. Instead, I focus on simple, sustainable shifts that support your liver’s natural detoxification processes:
- Cruciferous vegetables: Broccoli, cauliflower, Brussels sprouts, and kale contain compounds that support estrogen metabolism and liver detoxification.
- Adequate fiber: Fiber binds to excess hormones in the digestive tract and helps eliminate them through bowel movements. Aim for 25-30g per day.
- Hydration: Water supports kidney function and helps flush metabolic waste. It’s basic, but it matters.
- Regular bowel movements: If you’re not going daily, hormones aren’t being properly eliminated. Fiber, water, and sometimes magnesium can help.
If gut health or liver function is a concern, I often recommend targeted detoxification support to help the body clear hormones more efficiently.
Anti-Inflammatory Foods and Gut Support
Inflammation is a huge part of the PCOS acne picture. Reducing systemic inflammation helps calm the skin, support hormone balance, and improve insulin sensitivity.
Here’s where I start with clients:
- Omega-3 fatty acids: Salmon, sardines, flaxseeds, chia seeds, and walnuts all provide anti-inflammatory fats that help reduce skin inflammation.
- Antioxidant-rich foods: Berries, leafy greens, turmeric, and green tea help combat oxidative stress and inflammation.
- Probiotic-rich foods: Sauerkraut, kimchi, kefir, and yogurt support gut health. I usually start here before jumping to probiotic supplements.
- Reduce dairy and high-glycemic foods: Dairy can be inflammatory and may increase insulin-like growth factor (IGF-1), which stimulates oil production. High-glycemic foods spike blood sugar and insulin.
When I suspect gut issues are contributing to skin problems, I may recommend digestive health support or functional testing to identify imbalances like SIBO, dysbiosis, or leaky gut.
What I Tell Clients
Anti-inflammatory eating isn’t about restriction. It’s about adding in more of the foods that support your body and scaling back on the ones that trigger inflammation. Small, consistent changes add up.
Targeted Herbal and Nutritional Support
Once the foundation is in place (blood sugar, gut health, liver support), I layer in targeted supplements and herbs based on the individual. This is where personalization really matters, because what works for one person doesn’t necessarily work for another.
Here’s what I commonly use for PCOS acne:
Spearmint tea is one of my favorite evidence-based options. Research shows that drinking two cups of spearmint tea daily can lower androgens, specifically free testosterone. It’s simple, affordable, and effective.
Zinc is essential for skin healing, immune function, and reducing inflammation. It also helps regulate oil production. I typically recommend 30-40mg daily, especially if someone has a history of frequent infections or poor wound healing.
Vitamin A supports skin cell turnover and reduces oil production. I use it cautiously and always consider liver function before recommending higher doses.
Omega-3 supplements (EPA and DHA from fish oil or algae) provide concentrated anti-inflammatory support, especially if someone doesn’t eat fatty fish regularly.
Adaptogenic herbs like ashwagandha, rhodiola, and holy basil help modulate cortisol and support the body’s stress response. Chronic stress is a major driver of PCOS symptoms, so managing cortisol is part of the bigger picture.
I personalize supplement protocols because everyone’s presentation is different. Some clients need more androgen-lowering support, others need blood sugar management, and some need gut healing first. That’s where herbal medicine comes in.
When to Consider Functional Testing
I don’t test everything on everyone, but functional testing can be incredibly helpful when you want a clear picture of what’s actually happening instead of guessing.
Here’s what I commonly recommend for PCOS acne:
- Hormone panels: Testosterone (free and total), DHEA-S, LH/FSH ratios, and sometimes estrogen and progesterone to assess your hormonal picture.
- Insulin and glucose markers: Fasting insulin, fasting glucose, and HbA1c help identify insulin resistance, which is often the biggest driver.
- Comprehensive stool testing: If gut issues are part of the picture (bloating, irregular bowel movements, food sensitivities), a stool test can identify bacterial imbalances, inflammation, and digestive function.
Testing helps me create a targeted plan instead of throwing spaghetti at the wall. If you’re interested in exploring what might be useful for your situation, you can learn more about functional testing options here.
What Doesn’t Work (And Why I Don’t Recommend It)
Let’s talk about what I don’t recommend, because I see clients waste time and money on approaches that don’t address the root cause.
Aggressive topical treatments alone might reduce surface-level symptoms temporarily, but they won’t stop the cycle if hormones, blood sugar, and inflammation aren’t addressed. I’m not saying topical treatments are useless, but they’re not the solution on their own.
Generic “PCOS supplements” that promise to fix everything rarely deliver. PCOS presents differently in different people. Some have high androgens, others have insulin resistance, some have both. A one-size-fits-all supplement protocol doesn’t make sense.
Restrictive diets that aren’t sustainable often backfire. Cutting out entire food groups or following extreme protocols can spike stress hormones and make insulin resistance worse. I focus on adding in supportive foods rather than restricting everything.
Quick fixes and 30-day cleanses don’t address the underlying drivers of PCOS acne. Sustainable change takes time, and shortcuts usually lead to frustration.
How I Work With Clients on PCOS Acne
When someone comes to me with PCOS acne, we don’t just jump straight to supplements. Here’s how I approach it:
Initial assessment: I look at your symptoms, cycle patterns, diet, stress levels, digestion, and any previous testing you’ve had done. This gives me a full picture of what’s contributing to your acne.
Building a foundation: We start with blood sugar balance, gut health, and stress management. These are the non-negotiables that make everything else more effective.
Layering in targeted support: Based on your specific presentation, I’ll recommend herbs, nutrients, or functional testing that address your drivers, not a generic PCOS protocol.
Realistic timelines: Skin takes time to shift. The skin cells you see today were formed weeks ago. I tell clients to expect 8-12 weeks minimum before seeing significant improvement. Some see changes sooner, but patience is key.
Adjusting as we go: We check in regularly and adjust the plan based on what’s actually working. If something isn’t helping, we pivot.
If you’re dealing with PCOS and want personalized support, you can learn more about how I work with PCOS clients here.
My Honest Take on Expectations
I’m going to be straight with you: PCOS acne doesn’t disappear overnight. I wish I could promise faster results, but I’ve seen too many clients get discouraged when they expect immediate changes.
Progress is rarely linear. You might see improvement for a few weeks, then have a flare-up around your cycle or during a stressful period. That’s normal. It doesn’t mean the plan isn’t working.
This isn’t a “fix it and forget it” situation. PCOS is a chronic condition, which means maintenance matters. The habits you build now are what keep your skin clear long-term.
You don’t need perfection. Consistency beats perfection every time. If you eat balanced meals most of the time, manage stress most of the time, and support your body with targeted nutrition, you’ll see results.
Reality Check
Managing PCOS acne is about building sustainable habits, not achieving perfection. Small, consistent changes compound over time.
When to Get Support
You don’t have to figure this out alone. Here’s when I recommend getting professional support:
- You’ve tried multiple approaches and nothing’s shifting
- You’re overwhelmed by conflicting information online
- You want testing and a personalized plan instead of trial and error
- You need accountability and consistent guidance through the process
I work with clients across Australia via online consultations, which means you don’t need to be local to get support. We can meet virtually, go through your history, create a tailored plan, and adjust it as we go.
If that sounds like something you need, you can book a consultation here.
Final Thoughts
PCOS acne is frustrating. I see it every day in practice, and I know how much it affects confidence and quality of life. But it does respond when you address the underlying drivers.
The combination of blood sugar balance, gut support, stress management, liver function, and targeted nutrition is what I see work consistently. It’s not flashy, and it takes time, but it’s effective.
You don’t need to do this alone. If you’re ready for a clear plan and consistent support, I’m here to help.
