What 5-Alpha Reductase Has to Do with Acne (and How I Use DUTCH Testing to Decode It for My Clients)
So, What Is 5-Alpha Reductase?
5-alpha reductase is the enzyme that converts testosterone into dihydrotestosterone (DHT), a more potent androgen. DHT binds more strongly to androgen receptors in the skin, particularly in sebaceous (oil) glands, leading to increased oil production, clogged pores…aka more acne.
In other words, even if your total testosterone isn’t “high” on a standard blood test, you can still experience acne if you’re converting too much of it into DHT.
This is why some of the most frustrating cases of acne..where clients say "I was told my labs are normal, but my skin keeps breaking out" - start to make sense when we look at what's happening behind the numbers and how you’re actually metabolizing hormones.
It’s not just about how much hormone you have…
It’s about how you metabolize it.
And most importantly, what’s causing that hormone to be off in the first place (hormones are just chemical messengers responding to deeper imbalances in the body!).
Several factors can push your body toward increased 5-alpha activity, including:
Insulin resistance and blood sugar imbalances
High stress/cortisol
Inflammation (which can stem from many places, commonly things like your gut)
Low zinc status
Genetic predisposition
Even over-exercising or under-eating can shift your hormone metabolism toward this pathway
🧪 Why I Use DUTCH Testing to Detect It
The DUTCH Complete test is one of my favorite tools for a handful of my acne clients because it doesn’t just tell me what your hormone levels are..it shows me what your body is doing with them.
It helps me see:
✔️ How well you’re making hormones like estrogen, progesterone, and testosterone
✔️ If your body is pushing testosterone into the 5-alpha reductase pathway
✔️ What your cortisol curve looks like (because high stress = higher DHT)
✔️ How your liver is metabolizing estrogen (which also plays a role in acne!)
Spironolactone ISN’T Always the Answer
Spironolactone is commonly prescribed to block androgen and DHT, and it can help in some in the short term. But it doesn’t address the why..why your body is producing and converting hormones the way it is in the first place.
I’ve had countless clients come to me after spironolactone stopped working, or after years of feeling reliant on it just to keep breakouts at bay. My goal is to help you get to a place where your skin is stable without needing to micromanage it with medication.
That starts by identifying what’s happening inside.
So if no one’s ever talked to you about 5-alpha reductase before, you’re not alone! I didn’t even know it existed until naturopathic medical school. And unfortunately, most conventional approaches stop at surface-level lab work or symptom suppression. But that’s not enough when your skin is trying to tell you something deeper.
Whether your acne is persistent, cyclical, or feels completely unpredictable - there is a reason. You just need the right tools to uncover it. When we zoom in on your hormone pathways, stress response, and metabolism using functional testing like the DUTCH panel, we get a roadmap. Not just to clearer skin - but to a more balanced, resilient you!!
MEDICAL DISCLAIMER - All content on this website is provided for educational and informational purposes only. It is not intended as a substitute for advice and recommendations provided by your healthcare provider.
