Three tells separate them. Location: hormonal acne clusters on the lower third of the face — jawline, chin, neck — while bacterial acne spreads across the T-zone, forehead, and cheeks where oil glands cluster. Lesion type: hormonal acne forms deep, tender cysts that rarely come to a head; bacterial acne presents as surface whiteheads, blackheads, and small pustules. Timing: hormonal flares track the menstrual cycle, hitting 7-10 days before the period, and stay persistent month after month; bacterial breakouts appear randomly and respond within 1-2 weeks to topical 2.5% benzoyl peroxide or salicylic acid. If spot treatments and patches do nothing, it is hormonal — see a dermatologist about spironolactone or hormonal birth control.