Different types of hormones have different effects on our skin. As we age our hormones can become imbalanced and cause skin problems and ageing. Dr Terry Loong shares some common hormonal problems affecting the skin and reveals some simple actions for hormone and skin optimisation
There are lots of hormones in our body which have direct and indirect effects on our skin. A few in particular are important—oestrogen, progesterone, testosterone, cortisol thyroid and insulin.
Oestrogen, the female hormone, increases the rate of cell renewal and increases collagen and elastin production. It slows the rate of hair growth, keeps sebaceous secretions thin and less fatty and reduces hyaluronidase. This is important because hyaluronidase is the enzyme that breaks the hyaluronic acid, which maintains the moisture of the skin and bone density. As we age, we lose the reabsorption of the chin and our cheeks, so the foundations of our facial structure fall.
The International Academy of Cosmetic Dermatology (IACD) in 2008 showed that after 10 years of menopause women can lose 30% of their dermal collagen. We may be pumping our patients up with fillers, skin boosters and toxins, but as we age we lose around 30% of our collagen. That’s a huge amount.
Oestrogen is very important to the skin, but if we lose oestrogen does it actually work to replace it? The IACD analysed almost 3,000 women going through the menopause. They found that women on oestrogen replacement therapy showed a decrease in wrinkling and dryness.
The International Journal of Pharmacology in 1998 found that after six months of treatment with oestrogen, the elasticity, firmness and hydration of skin improved and wrinkle depth and pore size actually decreased by 61-100%. In August 2005, Fertility and Sterility Magazine looked at long-term effects of hormone therapy on skin rigidity and wrinkles and found that wrinkle scores were lower in hormone users than in non-users.
Some of my own patients who are on HRT or bio-identical hormone replacement therapy tell me that their skin feels springier and tighter. They’ve continued to use dermal fillers but they feel their skin has improved generally.
Progesterone and testosterone
Progesterone is oestrogen’s best friend. Its role is to support oestrogen, helping to fight immunity and reduce swelling and inflammation. It assists oestrogen in firming up the skin and maintains nerve function. The British Journal of Dermatology in 2005 used 2% progesterone cream on the skin of perimenopausal and menopausal women. The results were a greater reduction in wrinkle count, depth and skin firmness without any side-effects.
As for testosterone, all women produce it and a little bit can be good for skin. It increases cell renewal, skin thickness and libido, but if there’s too much it increases hair growth, sebum size and sebum activity. IGF, growth hormone, research in 2002 shows that testosterone increases collagen and maintains skin thickness.
Cortisol and stress
Cortisol, the stress hormone, is a huge topic in regenerative anti-ageing. We get it from pollution, from smoking, from the food we eat, from caffeine and all sorts of stressful conditions in our daily lives.
When you have too much stress, or cortisol, it’s referred to as the death hormone. As we grow older we have more and more cortisol in our lives. Daily stresses and big stresses such as divorce, death and financial worries can make people feel and look as though they’ve aged considerably.
Excess cortisol inhibits collagen production because it limits protein synthesis. It also reduces bone formation and immunity. That’s why people who work really hard for the whole year end up falling ill during Christmas time. Stress raises DHEA and testosterone levels and lowers thyroid hormones, oestrogen, progesterone and growth hormones.
There are many types of hormone imbalance and they cause a variety of skin problems. There are a few common ones that I see in my practice. I once had a patient who was drinking 17 cups of coffee a day just to keep going, which greatly increases cortisol production. She came to me at the verge of 50 years old trying to improve herself. She had low progesterone, PMS, heavy periods and insomnia.
Women between 35–50 years often experience oestrogen dominance (excess oestrogen) and low progesterone. This is a common presentation for women going through peri-menopause due to the toxic environment, unhealthy lifestyle, chronic stress and diminishing ovarian reserves. Oestrogen dominance and low progesterone can present with PMS, feeling bloated, weight gain, painful breasts, heavy bleeding, breast cysts, endometriosis or fibroids.
When women go through menopause, all the hormones will drop due to age. However, testosterone which maintains firm skin and muscle tone becomes relatively high (as oestrogen drops further) and it can cause acne, facial hair and male pattern balding (hence older women may suffer from whiskers, breakouts and thinning hair).
A low thyroid is also very common and often misdiagnosed. It can cause get weight gain, fatigue, mood problems, dry skin and weak hair, usually visible in the eyebrows. When you examine someone’s face and you notice thin hair on the lateral parts of the eyebrows, this is potentially a low thyroid problem.
So why does it happen? Why are we seeing much more hormone imbalance? Modern lifestyle—a high sugar and carbohydrate diet, pollution, radiation and low environmental toxicity—causes high stress levels, high cortisol, low progesterone, high testosterone and oestrogen dominance.
All the hormones present when we’re drinking water or drinking from plastic or Styrofoam cups or eating—chicken is pumped full of them—are absorbing into our fat. Our fat holds a lot of these hormones and that’s why children are becoming bigger, earlier. We have too much oestrogen going around in the environment.
So what does this affect? It increases free radicals, increases breakdown of cells and means poor gut function and a toxic gut environment. When I started prescribing hormones for patients, often they thought that it would solve all their problems. It doesn’t work that way. It’s a process which means if your gut is toxic, it’s still going to be toxic after taking hormones. So you have to clean everything up to get the most out of it.
Hormones and the menopause
Why do perimenopausal and menopausal patients get all the problems that we see? When we have declining oestrogen and progesterone, there’s a reduction in cell renewal—so patients get rough skin. Their vessels become more fragile, they get broken veins and they get facial bone loss, so they literally shrink.
Patients also get reduced immunity, which can mean increased sensitivity. Some patients get much redder in the skin and much more sensitive to skin products. There is an increase in the breakdown of hyaluronic acid in their skin so they get dryer skin. There’s also the 30% reduction in collagen production 10 years into menopause mentioned above, which can mean wrinkles and loss of volume. So when oestrogen and progesterone drop, that’s what we get.
Oestrogen, progesterone and testosterone are always in balance, but in menopause all of them drop. Oestrogen and progesterone drop faster, or lower, than testosterone—it doesn’t mean there are higher levels of testosterone, just high relative to oestrogen or progesterone levels.
When you have relatively high levels of testosterone, sebum increases in size and activity. That’s why patients come to us for adult acne. As well as increased hair growth on their face, some women get male pattern balding with thinning and finer hair on top. This can also be caused from too little of the thyroid hormone. Not all people with a low thyroid put on weight so it’s worth testing for this.
Melasma—overstimulation of melanin by oestrogen—can also happen in menopause. People on the pill or going through pregnancy can get melasma too, so it can be a common skin ailment.
Treating hormone imbalance
If someone is on or has been on HRT they can experience new hormone balance; peace of mind, a good night’s sleep, a good libido, good energy, better muscle tone and better sugar regulation for weight loss. It also helps cortisol levels because patients are less stressed, which will have an indirect effect on the skin.
So how do you treat hormone imbalance? We always start with the mental and emotional health. We look at how people respond to stress, their nutrition and gut function, cortisol and insulin levels. We then look at their thyroid, oestrogen and progesterone, discussing everything from the bottom level up.
We look at how to resolve stress, with an anti-stress kit. Every person has their own modalities. Some people love meditation or exercise. Some people watch a film or have a glass of wine. So it’s just finding out what works for the patient. We might look at mental and emotional wellbeing, perhaps talking about therapies, relationships and support networks.
I work with a nutritionist and a detox company to help with gut function and nutrition. I get patients to go to a detox program so they can detox the gut, the liver, the gallbladder, kidneys, lungs and skin. Before prescribing something I look at all these things, including healthy eating, healthy food plans, superfoods and supplements as well. If patients do need extra help then we might go towards herbal therapies or alternative therapies.
If you suspect someone isn’t 100% healthy, then definitely look at the above. If someone is internally very toxic and they start taking hormone replacements they will become sick because their system won’t be able to process it.
Hormones play an important role in healthy young skin and modern lifestyle causes many hormone imbalances. We must remember that hormone balancing is a process, not a magic pill.
Dr Terry Loong runs The Skin Energy clinic in London. She originally trained as a surgeon before specialising as an integrative cosmetic and skin doctor.