Hormones and Skin: How Hormones Impact Skin Aging and Conditions

Why is that the skin behaves differently at certain times of the month or acne tends to flare up during times of stress?

The short answer is: hormones!

Hormones play a vital role in regulating the most important functions in the body, including your skin.

In this article, I am going to put on my pharmacist's hat and discuss with you the key relationship between skin and hormones (for men and women). We'll talk about estrogen, estriol, progesterone, and testosterone and their impact on your skin's appearance and, of course, aging.

For instance, when estrogen levels are high, the skin tends to be more hydrated and elastic, contributing to a youthful glow. Conversely, when estrogen levels drop, as seen during menopause, the skin may become dry, thin, and more prone to wrinkles.

Testosterone, while often associated with male characteristics, also affects women by stimulating sebaceous glands and increasing oil production. This can lead to clogged pores and subsequent breakouts or excessive facial hair. Not surprisingly, in my experience, women feel uncomfortable talking about testosterone because it's related to men. Know that testosterone is important for women too and we should be talking about it!

Also cortisol, the stress hormone, can wreak havoc on skin conditions. Elevated cortisol levels increase oil production and inflammation, exacerbating acne and causing flare-ups in conditions like psoriasis and eczema. 

These are just examples to show you that when we talk about the skin, we must talk about hormones.

What are hormones anyway?

Hormones are chemical messengers produced by glands in our endocrine system. The body's biggest gland is the thyroid, followed by the pancreas (that produces insulin). Cortisol is produced by the adrenal glands right above the kidneys.

Hormones travel through the bloodstream to organs and tissues, delivering instructions that regulate various bodily functions, including growth, metabolism, mood, immune response, and reproductive processes.

Each hormone is designed to target specific cells with matching receptors, much like a key fitting into a lock. Once a hormone binds to its receptor, it triggers a particular response in the cell that is very specific. 

Hormone levels are carefully regulated by what's called a negative loop feedback system in the body to maintain balance. This basically means that when hormone levels drop too low, the body signals for more production and vice versa. This balance is essential for health, but it can be disrupted by medications, chronic stress, malfunction, or illness.

Hormonal imbalances and skin issues in adults

As we mature from adolescence into adulthood, hormonal imbalances can continue to influence skin health. Conditions such as polycystic ovary syndrome (PCOS), thyroid disorders, and menopause can lead to significant fluctuations in hormone levels, resulting in various skin issues. For instance, women with PCOS often experience hormonal acne due to elevated androgen levels, which stimulate oil production and lead to clogged pores.

Also thyroid imbalances can manifest in different ways on the skin. Hypothyroidism may cause dry, flaky skin and a loss of elasticity, while hyperthyroidism can lead to excessive sweating and oily skin. These imbalances not only affect the skin's appearance but can also impact overall skin health, making it crucial for individuals to seek medical advice and proper diagnosis when experiencing persistent skin issues.

Additionally, stress and lifestyle factors play a crucial role in hormonal balance. Chronic stress can lead to elevated cortisol levels, exacerbating skin conditions such as acne, eczema, and psoriasis. 

 How hormonal changes affect skin aging

As we age, levels of hormones such as estrogen and collagen begin to decline, leading to various signs of aging on the skin. Estrogen in particular, plays a crucial role in maintaining skin thickness, hydration, and elasticity. As estrogen levels decrease during menopause, many women notice increased dryness, wrinkles, and sagging skin.

Also testosterone levels impact skin aging. In women, decreased testosterone can lead to thinning skin and a reduction in oil production, making the skin more susceptible to environmental damage and premature aging. 

Cortisol, often referred to as the "stress hormone,"  further accelerates the aging process. Chronic stress and elevated cortisol levels lead to inflammation, oxidative stress, and the breakdown of collagen, contributing to fine lines, wrinkles, and an overall dull complexion. 

The Role of Female Hormones in Skin Aging

For women, estrogen is the star player when it comes to skin health and aging. Estrogen stimulates collagen production, which gives skin its firmness, and promotes hydration by supporting the skin’s natural moisture barrier. This results in a youthful, plump, and smooth complexion. However, during menopause, estrogen levels drop sharply, causing a rapid loss of collagen, skin thickness, and hydration. As a result, women often experience increased dryness, fine lines, and sagging skin.

Progesterone also plays a subtle role in skin health, supporting skin elasticity and balance. While progesterone levels fluctuate throughout a woman’s life, its decline in menopause can contribute to skin dryness and dullness. The result is often a noticeable shift in skin tone and texture.

 

Male Hormones and Skin Aging

Men’s skin is influenced primarily by testosterone, which contributes to skin thickness, elasticity, and oil production. Testosterone gives men a natural advantage when it comes to skin aging; higher collagen density and thicker skin generally delay the formation of fine lines and wrinkles. However, as men age, testosterone levels gradually decline in a process sometimes referred to as "andropause." This decrease results in slower collagen production, thinner skin, and a decline in oil production, which can lead to drier skin and an increase in wrinkles.

Men’s skin also tends to have a rougher texture and larger pores due to higher sebum (oil) production in younger years. As testosterone levels drop, so does sebum, which means that men may experience dryness later in life, along with deeper wrinkles, particularly on the forehead and around the eyes.

Hormone replacement therapy and its effects on the skin

Hormone replacement therapy (HRT) is a treatment option that some individuals consider to alleviate the symptoms of hormonal imbalances, particularly during menopause. HRT involves the administration of hormones.  One of the notable effects of HRT is its impact on skin health, as it can help mitigate some of the aging effects associated with declining hormone levels.
Research indicates that HRT can improve skin elasticity, hydration, and thickness, leading to a more youthful appearance. Estrogen, in particular, plays a critical role in maintaining skin structure and function, and restoring this hormone can lead to significant improvements in skin texture and moisture levels. Many women report a reduction in dryness and the appearance of fine lines after starting HRT, making it an appealing option for those struggling with menopausal skin changes.

A 2% progesterone cream was found safe and beneficial in peri- and postmenopause women. 40 women applied this cream daily, and at the end of the study they noticed wrinkle reduction and an increase in elasticity and firmness.

You might be wondering, why don't we all use hormone replacement therapy then?The reason is that it comes with significant risks, including breast cancer. Other risks are blood clogs (i.e thrombosis) and stroke. These occur in case of long term use but there really isn't a way of knowing how long the long term is. 

If you decide to give HRT a try, you can choose between:

Systemic HRT: hormones are delivered through tablets, patches, or injections, This approach is recommended when there are other symptoms that lower life quality (for example, hot flashes). So it's something that benefits the whole body, not just the skin.

Topical Estrogen Creams: these are applied to the skin, often contain estriol and are designed to improve  skin aging without affecting the whole body (although there is a systemic absorption).

Interestingly enough testosterone creams are prescribed to men but never for anti-aging probably because men's skin tends to age later on in life compared to women's.

Phytoestrogen: can they help with hormonal unbalances?

Phytoestrogens are plant compounds similar to human estrogen. Based on this, it makes sense to think that they can replace estrogen or stimulate its production. Studies show that this is not the case. Their effects on hormones are limited (at best). Because phytoestrogens come from polyphenols, which are antioxidants, they do have some health benefits like reducing blood pressure and cholesterol. 

Phytoestrogen-rich foods are soy, flaxseeds, and chickpeas. Some studies suggest that including these foods, along with nutrients like zinc, magnesium, and vitamin C, may help maintain hormonal balance and support collagen production (take it with a grain of salt).

How about men? 

Men can safely take phytoestrogen too. No study so far has shown negative effects on male reproductive system.

 My experience with hormones and skin

My experience is about acne. I used to have terrible acne in the jaw area. I solved the problem once and for all using spironolactone daily (it's been almost 4 years now). Spironolactone is a drug to lower blood pressure but it also has estrogenic properties. 

When I was younger I used to take  Diane pill; this is an old contraceptive that also works on acne because of its estrogenic & anti-androgen activity.  I stopped taking it after a year because of the weight gain side effect.

Conclusions

If we want healthy and youthful skin, we must take into account hormones. The skin has hormones receptors in its cells and that's why they can be applied topically (minimum blood absorbtion and mainly local activity ) OR taken as pills for a sytemic effect.

There's plenty of evidence that hormone replacement therapy works, but the side effects are not negligible including several kinds of cancer and other potentially fatal problems. 

For more on this watch my interview with Dr. Riegel.

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BIBLIOGRAPHY

G. Holzer, E. Riegler, H. Hönigsmann, S. Farokhnia, B. Schmidt, Effects and side‐effects of 2% progesterone cream on the skin of peri‐ and postmenopausal women: results from a double‐blind, vehicle‐controlled, randomized study, British Journal of Dermatology, Volume 153, Issue 3, 1 September 2005, Pages 626–634, https://doi.org/10.1111/j.1365-2133.2005.06685.x

 

Hamilton-Reeves JM, Vazquez G, Duval SJ, Phipps WR, Kurzer MS, Messina MJ. Clinical studies show no effects of soy protein or isoflavones on reproductive hormones in men: results of a meta-analysis. Fertil Steril. 2010 Aug;94(3):997-1007. doi: 10.1016/j.fertnstert.2009.04.038. Epub 2009 Jun 12. PMID: 19524224.

 

Patisaul HB, Jefferson W. The pros and cons of phytoestrogens. Front Neuroendocrinol. 2010 Oct;31(4):400-19. doi: 10.1016/j.yfrne.2010.03.003. Epub 2010 Mar 27. PMID: 20347861; PMCID: PMC3074428.