For adult hormonal acne in women, the most informative panel typically includes estradiol, fasting insulin (or HOMA-IR), and — in many cases — total and free testosterone plus DHEA-S. The combination lets you distinguish between the two main hormonal drivers of adult acne.
The two dominant patterns:
Insulin-driven acne. Elevated fasting insulin drives IGF-1 signaling, which stimulates sebum production and androgen activity. This pattern shows up as adult acne on the jawline and chin, often worse in the luteal phase, and often paired with skin tags, larger visible pores, and weight-management difficulty. Kraft's original work established that fasting insulin shifts years before glucose does (Kraft, 1975; DiNicolantonio, 2017).
Androgen-driven acne. Elevated free testosterone or DHEA-S — sometimes with PCOS as the underlying cause — drives sebum production directly and increases follicular hyperkeratinization. Often paired with irregular cycles, hair growth changes (chin, upper lip), and thinning scalp hair (Diamanti-Kandarakis, 2012).
These patterns often overlap. Insulin resistance is a common feature of PCOS and can amplify androgen-driven acne. That's why measuring both categories together is more informative than either alone.
The JenSkin panel measures estradiol and fasting insulin as part of the standard nine biomarkers. For a full hormonal-acne workup, adding total and free testosterone, DHEA-S, and SHBG through your primary care provider or JenSkin's add-on options gives you the complete picture.