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Anabolic steroids and thyroid steroid acne is the direct result of the use or misuse of steroids, and has nothing to do with testosterone," says Dr. John H. Kelly, a medical endocrinologist and director of the Laboratory of Acne in Los Angeles, in an e-mail. According to a study in the Annals of Dermatology, one in three women is taking steroids, with most of the problem found in men.How does that make women who look the way they do more likely to get acne? One hypothesis is that a deficiency of sebum occurs as testosterone levels decrease after menopause, Kelly tells TIME, which in turn triggers sebum production. A second possibility is that testosterone is metabolized by the body in a way that may accelerate the formation of acne scars. (In some women, this process happens naturally without any treatment.) Kelly says it's possible that a "chemical imbalance" between the male and female organs may be the culprit. "The hormones are different; so there has to be an effect in our metabolism and our enzymes [to process hormones]."Steroids aren't the only thing that could contribute to the condition, Kelly adds. "Some of the things that cause acne in men is lifestyle," he says. Smoking, excessive drinking, excessive sleep and other factors also may contribute.A study to find links between certain foods and acne prevalence in women in Japan found only a weak correlation between these and diet. The authors note in the Journal of the American Academy of Dermatology that there are "many factors that influence acne, some of which are not known and some of which are associated with diet."But just how common is acne in women who are on testosterone—and just how hard is it for the guy out there to get that fix? Kelly cites anecdotal evidence: "A lot of my female patients have had their face red and flushed from the hormones," he says. And a 2008 study in which women taking testosterone therapy reported fewer breakouts and acne-free skin as a result—although there's also a trend for some researchers to use self-reports in place of actual observations.Whatever the reasoning, in our world of hormonal balance, we aren't likely to run into enough testosterone to cause a hormonal imbalance, and the more likely culprits include alcohol, caffeine, nicotine, exercise, eating fatty foods, using birth control pills, taking antibiotics, using skin creams during the day, and consuming certain drugs or other treatments.A good solution on this front—and any of these can be easily addressed by taking them off yourRelated Article: