Does high testosterone really cause acne in women?

What did @sheydavadipour actually say?

The creator argues that high testosterone is a common hormonal imbalance she sees in women with acne, and that symptoms include oily skin, unwanted hair growth, mood changes, and sleep disturbances. She names PCOS, congenital adrenal hyperplasia (CAH), and going off the pill as root causes. She recommends zinc, saw palmetto, and spearmint tea as natural options, but gives credit where it is due by adding: "until you find out what your specific root cause is, please don't go and take random things." That caveat matters, and it is worth noting.

The overall framing is: identify the cause first, then address it. That is clinically reasonable advice, even if some of the specifics deserve scrutiny. The creator positions herself as a practitioner, which shapes how this video lands with 486,000+ viewers who may take the supplement list as a soft recommendation regardless of the disclaimer.

Does the science back this up?

Mostly, yes, with important nuance. The association between elevated androgens and acne in women is well-established, but "high testosterone" is an oversimplification of the androgen picture. The evidence on supplements like spearmint tea is real but modest, and saw palmetto has weaker data in women specifically.

Androgens, including testosterone and its more potent derivative dihydrotestosterone (DHT), stimulate sebaceous gland activity and follicular hyperkeratinization, both of which contribute to acne pathogenesis. A 2017 review by Zouboulis et al. in the Journal of the European Academy of Dermatology and Venereology confirmed androgens play a direct role in sebum overproduction. However, many women with hormonal acne have testosterone levels within the "normal" lab range, with the real issue being androgen receptor sensitivity at the skin level. That is a distinction this video skips entirely.

On spearmint tea: a small randomized controlled trial by Grant (2010) in Phytotherapy Research found twice-daily spearmint tea reduced free testosterone in women with PCOS over 30 days. Effect sizes were modest. Zinc has reasonable evidence for acne (Yee et al., 2020, Dermatology and Therapy), though it is generally more effective for inflammatory acne than androgenic acne specifically.

What did they get wrong (or right)?

The creator gets the basics right. The causes she lists, PCOS, CAH, and post-pill androgen rebound, are legitimate and supported by endocrinology literature. Post-pill androgen rebound is a real phenomenon, documented in studies like those by Zimmerman et al. (2014) in Contraception, where suppressed SHBG levels can take months to recover, effectively raising free testosterone bioavailability.

What she gets wrong, or at least incomplete: framing this purely as a "high testosterone" problem misses that androgen excess in women is often about free versus total testosterone, SHBG levels, and local androgen receptor sensitivity. You can have a normal total testosterone and still have androgenic symptoms. A clinician ordering labs needs to look at free testosterone, DHEA-S, and SHBG, not just a total testosterone panel.

Saw palmetto is listed without qualification. The evidence for saw palmetto in women is thin. Most human trials involve men with benign prostatic hyperplasia. Its anti-androgenic mechanism is plausible, but recommending it to women, particularly those who might be pregnant or trying to conceive, requires more caution than this video provides.

What should you actually know?

If you have acne along with irregular periods, unwanted facial or body hair, or scalp hair thinning, getting your androgens tested is a reasonable first step. But ask for a full panel: total testosterone, free testosterone, DHEA-S, SHBG, and ideally a morning cortisol if CAH is on the table. A single testosterone number without context can be misleading.

The creator is right that root cause matters. Treating PCOS-driven androgen excess looks different from treating post-pill rebound or CAH. PCOS management often involves lifestyle changes including insulin sensitivity, diet, and exercise, because hyperinsulinemia drives ovarian androgen production. That connection between insulin and androgens did not make it into this video, and it arguably should have, given how central it is to PCOS pathophysiology (Rosenfield and Ehrmann, 2016, Endocrine Reviews).

Supplements are not a substitute for diagnosis. Spearmint tea twice a day is low-risk and may modestly help if you have elevated androgens. Zinc is broadly reasonable for acne. But neither replaces figuring out why your androgens are elevated in the first place.