Supplements for hormonal acne: the evidence

Supplements sold for hormonal acne promise to "balance hormones" and clear skin from the inside. This guide checks those promises against the research. It covers the ingredients these products most often contain, including zinc, DIM, probiotics and vitamins, plus fish oil, saw palmetto and vitex, and it sets out the risks, which are real for some of them. For proven treatments, see the hormonal acne treatment guide.

Skinli gives general education and is not a doctor. Tell your doctor and pharmacist about every supplement you take, especially if you take a prescription medicine or could become pregnant.

How supplements are regulated

The FDA says it does not have the authority to approve dietary supplements for safety and effectiveness, or to approve their labels, before they are sold. Under US law, the company that sells a supplement is responsible for making sure it meets safety standards. The FDA can act once a product on sale is found to be unsafe.

The FDA also says many supplements contain ingredients with strong effects in the body, and some can interact with medicines, interfere with lab tests or cause problems during surgery. The US National Center for Complementary and Integrative Health (NCCIH) adds that many supplements have not been tested in pregnant women, nursing mothers or children, and that strong evidence for supplement claims is often lacking.

A 2024 review in the Journal of Clinical and Aesthetic Dermatology looked at 13 popular supplements sold for acne. It found the most common ingredients were probiotics, DIM, vitamin A, B vitamins and zinc. The authors raised concerns about safety, unclear labels and dosing, and possible interactions with medicines that the labels often do not mention.

What the evidence shows, ingredient by ingredient

Ingredient	Best evidence found	What it showed	Main risks
Zinc	2020 review and meta-analysis	Fewer inflamed bumps with zinc. Some single trials found no benefit	Stomach upset
Probiotics	2024 trial of 74 people aged 12 to 30	50% improved on a severity scale against 29% on a dummy capsule	Little detailed safety data, NCCIH says
Fish oil (omega-3)	2014 trial of 45 people	Fewer spots after 10 weeks	No severe side effects reported
Green tea extract	2016 trial of 80 women aged 25 to 45	Fewer inflamed spots on the nose, mouth area and chin. No change in total spots	Short, 4-week trial
Vitamin D	2021 review	Lower vitamin D in people with acne. Benefit of supplements unproven	Ask a doctor about dose
Vitamin A	Older trials of high doses, in the 2024 review	Cleared acne at high doses	Birth defects at high doses in early pregnancy
DIM	2024 review	No clinical studies for acne	Case reports of blood clots, strokes and a severe drug reaction
Saw palmetto	NCCIH	Not enough evidence for uses beyond the prostate	May be unsafe in pregnancy
Vitex (chasteberry)	NCCIH	No reliable evidence for acne	May be unsafe in pregnancy

Zinc

A 2020 review and meta-analysis in Dermatologic Therapy found that people with acne had lower blood levels of zinc than people without acne, and that those treated with zinc had fewer inflamed bumps than those who were not. The 2024 review says several trials show improvement in spot counts and severity, while a few found no difference from a dummy pill. In studies that compared zinc with tetracycline antibiotics, two found the antibiotic worked better and one found no difference. Stomach upset is the most reported side effect. The NHS says a pharmacist can recommend acne supplements such as zinc.

Probiotics

Probiotics are live bacteria meant to help the gut. In a 2024 trial in Acta Dermato-Venereologica, people aged 12 to 30 with acne took a probiotic capsule or a dummy capsule for 12 weeks. Of those taking the probiotic, 50% improved on an acne severity scale, against 29% in the dummy group, and blackheads and whiteheads fell more. The difference in total spots did not reach statistical significance. NCCIH says research in people on probiotics for acne is limited, and that their long history of apparently safe use comes with little detailed data on side effects.

DIM

DIM, short for diindolylmethane, is made in the body from a compound found in broccoli, cauliflower and cabbage, the 2024 review says. It is often sold for hormonal acne. The 2024 review found no clinical studies of DIM for acne. It found one laboratory study on acne bacteria and one case report of better periods after DIM combined with chasteberry and acupuncture. It also found case reports of serious harm:

• A severe drug reaction called DRESS
• Blood clots in the legs and lungs
• Strokes
• An eye condition that affects vision

The review says DIM changes how the liver breaks down some medicines, which can cause serious interactions.

Vitamins

• Vitamin A. The 2024 review says high doses cleared acne in four older trials, but caused side effects like those of isotretinoin and can cause birth defects. It says doses above 10,000 IU a day have been found dangerous in the first three months of pregnancy, and that not all supplements state this risk. The NHS lists vitamin A among acne supplements a pharmacist can recommend. Anyone who could become pregnant should ask a doctor before taking vitamin A. The FDA label for isotretinoin says to avoid supplements that contain vitamin A. See the Accutane side effects guide.
• Vitamin D. A 2021 review found lower vitamin D levels in people with acne, and pointed to the prospect of benefit from supplements without proving it.
• B vitamins. The 2024 review says B vitamins such as nicotinamide have been studied only in mixes with other ingredients, so their own effect is unclear.

Fish oil

In a 2014 trial, 45 people with mild to moderate acne took omega-3 fatty acids, borage oil or no supplement for 10 weeks. Both supplement groups had fewer spots, and no severe side effects were reported. The trial was small, and the authors described omega-3 as a possible add-on to standard care.

Herbs sold for hormone balance

NCCIH says chasteberry, also sold as vitex, was traditionally used for hormone-related skin conditions. It says the herb may be unsafe during pregnancy or breastfeeding, and may not be safe for women with hormone-sensitive conditions such as breast, uterine or ovarian cancer. For saw palmetto, NCCIH says there is not enough evidence to know if it helps beyond prostate symptoms, and that it may be unsafe in pregnancy or breastfeeding. Spearmint tea is covered in the natural remedies guide.

Supplements and hormonal acne medicines

Some supplements clash with the prescription medicines used for hormonal acne:

• Spironolactone and potassium. The American Academy of Dermatology (AAD) says to skip supplements that contain potassium while taking spironolactone, and the NHS lists potassium supplements among products that may not mix with it. See spironolactone for acne.
• Any prescription. The AAD asks patients to tell their dermatologist about all supplements and natural products before hormonal therapy. NCCIH says some herbs and medicines interact in harmful ways.

Supplements during pregnancy

Pregnancy is where supplement risks are highest. High-dose vitamin A can cause birth defects, and NCCIH says chasteberry and saw palmetto may be unsafe in pregnancy. Most acne supplements have not been tested in pregnant women. If you are pregnant or planning to be, read the pregnancy acne guide and ask your obstetrician before taking any supplement.

Reading a supplement label

The 2024 review found that acne supplement labels are often hard to read or do not list clear doses. It cites a study of vitamin A acne supplements sold online in which some products did not list the dose, different websites gave different amounts for the same product, and the percent of daily value did not match the amount inside. That study found at least three products with enough vitamin A to risk birth defects. Look for the amount of each ingredient per serving, and ask a pharmacist to check it.

A practical approach

If you still want to try a supplement:

1. Choose a product with a single ingredient that has some evidence, such as zinc.
2. Check the label for vitamin A, DIM and herbs, and skip them if you could become pregnant.
3. Tell your doctor and pharmacist before starting it.
4. Keep your acne treatment going, and give the supplement 10 to 12 weeks, the length of the fish oil and probiotic trials.
5. Stop it if you get stomach upset, a rash or any new symptom.

Use any supplement alongside proven treatment, as the fish oil trial authors suggested. Skinli's free acne plan builds that treatment routine from a photo. Skinli's guides to zinc for acne, vitamin A and acne, fish oil and acne and biotin and acne cover doses and safety limits in more detail.