Androgens

Androgens tend to decline more slowly with age than estrogen and progesterone do during menopause. Dihydrotestosterone (DHT) is a particularly potent androgen converted from testosterone that contributes to both acne and androgenic hair loss. High insulin is the primary driver of elevated androgens, directly stimulating androgen production. Excess androgens are the direct driver of sebaceous gland enlargement and acne formation. Elevated androgens stimulate the sebaceous glands to produce excess sebum, which directly fuels the scalp fungus responsible for dandruff. Polycystic ovary syndrome (PCOS) is the most common clinical manifestation of the insulin–androgen axis. High insulin levels drive elevated androgen production, which is the primary hormonal mechanism behind PCOS and its elevated dandruff rate. 5-alpha reductase converts testosterone into DHT, a far more potent androgen that directly triggers acne. Chronic psychological and physiological stress activates the adrenal glands, which produce additional androgens and worsen acne independently of diet. Menopause can produce relative androgen dominance compared with declining estrogen and progesterone. At normal androgen level…