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Hair and skin changes: your 20s and 30s

Hormonal fluctuations in your 20s and 30s can lead to acne and hair loss. Here’s the latest research on how that may affect your hair and skin, plus some suggestions about care.

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Hormonal shifts in your 20s and 30s can cause hair and skin changes, including adult acne and hair thinning. Such changes can be stressful, but below, we offer some steps you can take that may help ease symptoms.

Understanding what is normal and what might indicate a hormonal disorder may also put you at ease no matter what hair or skin changes you face in this period of your life. Dermatologic conditions can have several causes, and it's important to search for the cause before a treatment is determined. Speak to your healthcare provider if you are concerned about any new symptoms. 

Acne in your 20s and 30s 

Acne can be caused by many factors, but in your 20s and 30s, acne is usually cyclic and caused by hormonal changes, linked to your menstrual cycle (including premenstrual flare ups). One reason for flare ups may be the cyclic production of androgens: Testosterone, as well as other androgens, are produced in small quantities through the ovaries, adrenal glands, and the skin (1). Androgens can make the lining of the pores in the skin sticky, whichcan lead to a buildup of keratin and a clogged pore or pimple (3). 

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Adult acne (defined as acne that manifests after the age of 18) expresses itself differently than adolescent acne. Adult acne is typically found on the lower third of the face, jawline, and neck. (Adolescent acne, on the other hand, generally occurs on the forehead, torso, and back) (6).  

Premenstrual flare-ups with acne are more common for women older than 33, compared with women between the ages of 20-33 (1). Here are some ways to care for breakouts:   

  • Combined oral contraceptives and other forms of birth control have been shown to assist with hormonal adult acne, in part, by reducing androgen production (2). You can talk to your healthcare provider about trying birth control for acne.

  • Topical products containing retinoids (chemicals derived from vitamin A) can also help. Retinoids are vitamin A derived products that have anti-inflammatory properties and can reduce the formation of the clogged pores that result in acne formation (2). Speak to your primary healthcare provider or dermatologist for an evaluation of your particular situation, and about acquiring prescription strength products.

  • Using a cleanser containing ingredients like Salicylic acid, benzoyl peroxide, sulfur, LHA, or Glycolic acid may help with acne. Be mindful to check the product directions as misuse of these ingredients can worsen acne and/or make your skin more sensitive to the sun.

  • Photoprotection is essential to prevent long-lasting acne marks (red or brown) on the skin. Choose a high SPF that is suited to oily-prone skin (12).

Hair Changes in your 20s and 30s

Hair density decreases with age and the decline in hair density is noticeably more apparent in women by the age of 40 ( 7). There are many reasons for hair thinning, including genetics, age, environmental factors, and hormonal changes. 

Some women are more prone to experience hair loss than others, due to pregnancy or hormonal disorders. While androgenic alopecia and other forms of hair thinning are not a common experience for women in their 20s and 30s, there are still some experiences that can affect your hair in this life stage.


Increased levels of estrogen lead to fuller and thicker hair (9). After pregnancy, hormone levels normalize, and the hair eventually sheds rapidly (9).

Female androgenetic alopecia

This condition, which leads to increased levels of androgens in the body, can decrease the size of the hair follicles. This results in hair thinning throughout the scalp and the crown of the head (4,5). Hair density typically begins to decrease in the mid-thirties (13).  

Other symptoms include: increased acne, hirsutism (dark, coarse hair), menstrual irregularities, and infertility (5). If you notice changes like these in your body, speak to your healthcare provider.   

Traction alopecia

Traction alopecia is caused by traumatic hairstyle, when the hair is pulled for long periods of time, such as braiding. The hair loss is more accentuated in areas where the tension is higher due to the style of the braids. Chemical and thermic treatments to straighten the hair can increase the hair loss. It is more common in black people due to the higher use of braiding. The best way to avoid traction alopecia is to avoid tension in a hair chemically treated “ no braids on relaxed hair”. If alopecia is already present, is usually treated with minoxidil (14) . 

Thyroid Disorders 

Endocrine disorder leads to fluctuations in certain hormones in the body, which can cause hair loss, and at times, even graying. Both increased and decreased levels of thyroid hormones have been shown to cause both hair thinning and premature graying (10). Primary hypothyroidism is up to eight times more common in women than in men. In the U.S. it affects 4% of women (about 1.3 million people) between the ages of 18-24 years (11) If you notice changes like these in your body, speak to your healthcare provider.   

Generally speaking, the recommended first line treatment for female hair loss is topical 2% minoxidil (or rogaine) and it typically takes 6-12 months to see noticeable improvement (5), and your healthcare provider will evaluate you for a cause. This medication can also be bought over the counter in most drug stores. 

While it may be stressful to still manage breakouts in one’s 20s and 30s, it can be helpful to be prepared for such flare-ups around the time of one’s period and perhaps enlist the help of a good retinoid cream. 

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