The question of why obese people have less acne has been asked for hundreds if not thousands of years.
Almost every teenager has wondered why their fat friend or classmate is completely free from acne. After all, obesity is the definition of bad health; people can’t comprehend why somebody so far away from the peak of fitness would have such clear skin. In all likelihood, medieval teenagers, Roman teenagers and even Ancient Greek teenagers were wondering the same thing.
Perhaps you used to be overweight or obese and are delighted with your new-found fitness, but disappointed that your skin has started breaking out again. Other attributes people notice in the obese are smooth skin, younger looking skin, and even a healthier skin tone in general.
Is the connection real? It certainly is, and the reasons aren’t complicated at all.
Despite the centuries of confusion, it’s all down to overweight people having less testosterone than everyone else.
Higher body fat equals less clogged pores
As science pushes ahead, quite possible to our destruction, it’s becoming more and more obvious that fat tissue is a biologically active substance. It’s active in many different ways to muscle tissue, and importantly for us, multiple studies have demonstrated that excess body fat leads to decreased testosterone. 20 pounds can make all the difference:
ONE – scientists gathered the medical records of over 3000 men who had previously been treated for testosterone deficiency (2015 study). On average, obese men showed significantly lower blood testosterone concentrations compared with healthy men.
TWO – this 1990 study spelled it out clearly. Levels of both total and free testosterone were “negatively correlated with waist/hip circumference ratio and visceral fat area”.
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The fatter the 23 men aged 25-50 were, the less testosterone they had in their bloodstream. Interestingly, this effect wasn’t observed in women, but obviously, men and women differ massively in their hormonal networks.
THREE – this study on 110 Japanese-Americans showed a correlation between obesity and low testosterone levels, and in particular, intra-abdominal visceral fat and low testosterone. Subcutaneous fat is your normal skin surface fat, while visceral fat is the fat found underneath muscles such as the abdominals. One example is a massively round beer belly which still seems hard somehow, or the pregnant look that pro bodybuilders get.
FOUR – finally, this big review from 2000 stated that low testosterone levels are commonly encountered in obese men, including ones with no separate issues with hormone production.
Moderate obesity decreased total testosterone, whereas severe obesity decreased free testosterone (the biologically active form) as well. Furthermore, the scientists claimed that low testosterone in obese men was non-permanent and reversible, but only through substantial weight loss.
How do testosterone levels affect acne? It’s extremely simple.
Testosterone and DHT, the secondary androgen which is derived from testosterone, bind to androgen receptors in your sebaceous glands. This stimulates them to pump out more oil, and your pores get clogged. The stage is set for an outbreak of pimples.
So we have our answer. The more weight you gain, the less stimulated your skin’s oil production will be.
If you have an overweight friend who laughs about how great his skin is, saying that he’s glad to be fat, then testosterone is almost certainly why he has the advantage.
It isn’t guaranteed of course; he or she could have great skin genetics, with an example being naturally tighter skin pores which are less prone to clogging. Alternatively, they could live in a village, where the pristine rural air is nourishing to the skin and free from pollution.
You also never know exactly why a person is fat. For example, if your friend is obsessed with eating omelettes, steaks, and cheese then they’ll be ingesting a ton of acne-clearing nutrients. An obese person who loves burgers and fries, meanwhile, will be pumping their body with pure inflammation.
However, in the vast majority of cases that have you questioning the very nature of reality, the testosterone factor will be responsible.
Another reason – obese people have less DHT
Then there’s another twist in the hormonal saga, as body fat can also lower DHT, the second most abundant androgen in the body.
Dihydrotestosterone (DHT) increases sebum production even more strongly than testosterone does. Both bind to androgen receptors, but DHT specialises in those in the skin.
This study found that enzymes produced in adipose tissue (body fat) can completely destroy DHT molecules. It began as a general study into testosterone and obesity like the ones above. Canadian scientists gathered 21 morbidly obese men and 11 lean to obese men and took an extract of their fat tissue.
They found that an enzyme called 3α/β-HSD, churned out by fat cells, deactivated DHT and turned it into a harmless by-product called 5alpha-androstane 3alpha,17beta-diol which had little androgenic effect.
The more obese the patients, the more of this enzyme they churned out, and hence the lower their bodily DHT levels were.
Another study analysed DHT from a separate angle; the conversion of testosterone into DHT. All DHT is manufactured from testosterone molecules, specifically by the 5-alpha reductase enzyme. For example, hair loss patients fear DHT as it’s said to prematurely deactivate hair follicles, and hence they’re obsessed with deactivating 5-alpha-reductase. Scientists found that excess body fat significantly inhibited the activity of the 5-alpha reductase enzyme.
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What this means is that being fat, overweight, obese, or even slightly chubbier than average can prevent acne in two ways. Firstly, by lowering overall testosterone levels. Secondly, by shifting the overall ratio of androgens away from DHT and towards testosterone. Both work by significantly reducing your sebum production and clogged pores.
The interesting thing is that with 5ar being blocked, you’d expect testosterone to increase. Essentially, less would be depleted in the conversion process. However, levels still declined alongside DHT, which shows just how strongly being overweight reduces your androgens levels overall.
Fat cells increase estrogen levels
In addition to clear skin, you might have noticed that fat people’s skin is often quite beautiful and healthy looking, or even young for their age.
There’s a simple explanation for this, and another explanation for the reduction in testosterone, as fat cells are where estrogen molecules are born.
Adipose tissue produces a major player in human hormones called the aromatase enzyme. This enzyme is responsible for the conversion of male androgenic hormones into female hormones, including estrogen.
Woman produce most of their estrogen through their ovaries, and a small portion in fat cells. Men, meanwhile, produce a big portion through their fat cells.
The more fat tissue you have, the more aromatase enzyme you produce, and the higher your estrogen will be.
This study on morbidly obese men found that two common types of estrogen were elevated two fold. In fact, the estrogen was elevated in direct proportion to their obesity. This study concluded that “adipose tissue can contribute significantly to the circulating pool of estrogen”.
This study, meanwhile, concluded that obesity had little effect on estrogen in women. That isn’t surprising, as the estrogen probably vanishes into the huge pool that women naturally produce, but overweight men had significantly higher levels.
Estrogen has many benefits for skin tone, including faster wound healing, delayed ageing and improved collagen content (study).
I don’t recommend increasing estrogen levels for men, far from it, but’s undeniably beneficial for your skin tone in certain circumstances. That includes the strangely clear skin of fat people.
More importantly, estrogen is another explanation for the reduced testosterone, as the hormones are in direct competition.
Estrogen can target enzymes down in your balls before they even make testosterone. Estrogen can inhibit a bunch of different enzymes like P450c17 and HSD17B – meaningless to most people, but without them you make very little of the big T. This study found that these vital enzymes were reduced “severely” in the presence of estrogen.
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Studies have confirmed that high estrogen levels lead to suppressed testosterone, but it’s common knowledge really. Estrogen can reduce testosterone production by 20-30% in both rats and humans (study), by manipulating certain genes. Estrogen targets testosterone at its root.
What’s more, estrogen and testosterone compete for similar receptors in the human body. If a DHT molecule shows up to find estrogen stimulating the skin, then its ability to increase sebum production will be impaired.
Is estrogen the main reason why being fat reduces testosterone, and hence acne? I’d say that it accounts for at least half of the reduction.
The cortisol connection
There’s one final connection to hormones, but the evidence is much less conclusive than with DHT or estrogen. It’s cortisol, the widely feared stress hormone.
The most convincing study by far is this one that compared 6 lean or obese humans. In the human body, there exists cortisol and its derivative cortisone, which has similar biological effects but is far less biologically active. Cortisol is created from cortisone by the 11HSD1 enzyme, and our study found that 11HSD1 was much higher in the abdominal fat of obese people.
If true, cortisol would fall alongside estrogen and effectively be manufactured by fat cells themselves; you would have rows of tiny cortisol factories lining your body.
Yet this study found that body fat was associated with a slight hypocortisolemia, AKA low levels. This study was similar; the results “even point to an inverse association of body weight with cortisol levels“.
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Normally, cortisol is a disastrous hormone for clear skin, as it delays acne nutrient absorption and slows wound healing (via collagen).
But with obese people there could be an absurd twist of fate, as like estrogen, cortisol is an antagonist of testosterone. Cortisol can destroy molecules of testosterone the very moment they enter the bloodstream. The synthesis of cortisol also depletes cholesterol, an important building block of testosterone. If fat people generate more cortisol than normal, then it could push their testosterone (and oily skin) even further into nothingness.
The cortisol link is possible, but definitely unproven.
Conclusion
Obese people do have less acne, it isn’t a myth. If you’ve noticed the phenomenon in the past without your friends or family telling you about it, then well done. It’s all down to lowered androgenic hormones.
Other factors could be at play; maybe eating lots of foods equals eating lots of nutrients. Obese people could be pumping their bodies with so many compounds that they don’t need to think about the specific vitamins and minerals.
Nevertheless, diminished stimulation of the sebaceous glands is the main factor. Also, if you’ve found this article exciting for your own acne, then don’t get it confused. I recommend against lowering testosterone if you’re a man, and I definitely recommend against getting fat.
The goal of this article is simpler: to expose the truth about this classic acne mystery. If you’re a newcomer to Supernatural Acne Treatment, then here’s what you should do: read part 1 and part 2 of the root causes of acne.
NEXT: get the complete strategy for clearing acne naturally
Thanks for reading!