Research has demonstrated that estrogen therapy can increase collagen production in postmenopausal skin by approximately 48% after six months of treatment.

Estrogens are crucial for skin health due to their ability to modulate collagen synthesis. They have been shown to increase the activity of fibroblasts—cells responsible for producing collagen and elastin in the dermis—which enhances skin elasticity and hydration.

Studies have shown that estrogen therapy can increase collagen production in postmenopausal skin by approximately 48% after six months of treatment.

Dr. Galán – Neolife Medical Team

During menopause, collagen levels drop significantly, affecting both skin elasticity and hair density and quality.

Menopause is a transitional period in a woman’s life characterized by a decline in the production of sex hormones such as estrogens, testosterone, and progesterone. These hormones play fundamental roles in the homeostasis of various tissues, including skin and hair, which undergo noticeable changes during this phase.

The skin, the largest organ in the human body, and hair follicles highly depend on proper hormonal balance, particularly in terms of collagen synthesis and preservation. Collagen is an essential structural protein that provides elasticity, firmness, and strength. Its loss can lead to noticeable aesthetic changes such as wrinkles, skin laxity, and hair thinning.

Collagen in Skin and Hair

Type I and Type III collagen are the two predominant forms found in the dermis and play a vital role in maintaining skin’s structural integrity. The collagen fiber network not only provides mechanical support but also facilitates cellular regeneration, particularly in hair follicles. During menopause, collagen levels drop significantly, impairing skin elasticity and hair quality. Dermal collagen loss with age contributes to reduced follicle viability and a shorter anagen (growth) phase of the hair cycle, resulting in thinner, more fragile hair.

Changes in Postmenopausal Collagen Levels

Numerous studies have shown that, within the first five years after menopause onset, women experience up to a 30% reduction in dermal collagen, especially in the face and neck area (Brincat et al., 2005). This phenomenon is more pronounced in sun-exposed skin due to the combination of hormonal decline and accumulated UV damage. Accelerated postmenopausal skin aging is associated with decreased collagen and elastin synthesis, leading to a greater susceptibility to wrinkle formation, increased skin fragility, and noticeable volume loss in the facial area.

Additionally, in the scalp, the decline in sex hormones and collagen loss contribute to hair follicle miniaturization, a pathological process that can result in excessive hair shedding and the development of diffuse or female-pattern baldness.

The Role of Estradiol in Skin and Hair Health

Estrogens are crucial for skin health due to their ability to modulate collagen synthesis. Studies have shown that estrogens increase fibroblast activity, the cells responsible for producing collagen and elastin in the dermis, which improves skin elasticity and hydration (Thornton, 2013). Estradiol (E2) enhances fibroblast activity by binding to its specific receptors, primarily ER-α and ER-β. These receptors activate intracellular signaling pathways such as PI3K/Akt and MAPK/ERK, promoting fibroblast proliferation and differentiation. Additionally, estradiol stimulates the production of growth factors like TGF-β (Transforming Growth Factor Beta), which in turn increases Type I and III collagen synthesis.

Increased collagen production: Studies have demonstrated that estrogen therapy can increase collagen production in postmenopausal skin by approximately 48% after six months of treatment (Phillips et al., 2001).
Impact on skin elasticity: Research has shown an increase in skin elasticity and thickness, along with a reduction in collagen fiber fragmentation, thereby improving skin firmness and resilience.

Estrogens also play an important role in regulating matrix metalloproteinases (MMPs), enzymes that degrade collagen fibers. MMPs, particularly MMP-1 (collagenase), MMP-3, and MMP-9, break down collagen in the extracellular matrix. During menopause, the decline in estrogen levels increases the activity of these enzymes, accelerating collagen degradation. Estradiol modulates MMP expression through estrogen receptor (ER) pathways, inhibiting MMP gene transcription and promoting the activity of tissue inhibitors of metalloproteinases (TIMPs), which helps preserve collagen integrity and delay wrinkle formation.

Additionally, estrogens prolong the anagen phase of the hair cycle—the active growth phase—contributing to denser and more voluminous hair.

The Role of Testosterone in Skin and Hair Health

Sebaceous Secretion

Testosterone stimulates the sebaceous glands, increasing sebum production. In postmenopausal women receiving testosterone therapy, an increase in sebaceous gland activity has been observed. This effect is due to the conversion of testosterone into dihydrotestosterone (DHT) by the enzyme 5-alpha reductase in the skin, which enhances sebaceous activity.

Skin Thickness, Collagen, and Elastin

The decline in estrogen levels during menopause leads to a reduction in collagen and elastin synthesis, essential proteins for skin firmness and elasticity. Although testosterone is not the primary hormone regulating these proteins, some studies suggest that testosterone therapy may partially counteract collagen loss and improve skin thickness. The proposed mechanism involves the conversion of testosterone into estrogens via the aromatase enzyme in skin tissues, which may stimulate collagen and elastin production.

Wrinkle Depth

The reduction in collagen and elastin during menopause contributes to wrinkle formation and deepening. By potentially increasing the synthesis of these proteins, testosterone therapy may reduce wrinkle depth and improve overall skin appearance.

Comparing the Effects of Estradiol and Testosterone on Collagen Synthesis

Estradiol’s effect on collagen production is significantly stronger than that of testosterone. While estradiol directly activates the expression of collagen-related genes, testosterone has a less pronounced effect and largely depends on its conversion to estradiol via the aromatase enzyme in the skin. Comparative studies have shown that estradiol increases collagen production in postmenopausal skin by 48%, while testosterone has a modest effect, increasing synthesis by only 10-15% when administered in physiological doses (Shen et al., 2014).

The Role of Progesterone in Skin and Hair Health

Progesterone has a complementary role in hormonal balance and, as mentioned in previous discussions, is a vital hormone in the context of hormone replacement therapy (HRT). In this context, it plays an additional role in modulating the androgenic effects of testosterone by acting as an inhibitor of 5-alpha reductase, reducing the conversion of testosterone into DHT. This helps mitigate potential adverse effects on the scalp in predisposed women. Additionally, progesterone promotes skin hydration and may improve overall hair quality by preventing hair loss and maintaining proper hormonal balance.

Overall Impact of Hormone Replacement Therapy (HRT) on Skin and Hair

Clinical studies have evaluated the impact of HRT on the skin and have shown that estrogen treatment reduces wrinkle depth by 30% to 40% after one year of therapy (Sumino et al., 2004). This is associated with an increase in dermal collagen content and improved skin hydration.

Histological studies in postmenopausal women receiving HRT have shown a significant increase in Type III collagen, particularly in the first year of treatment, suggesting an improvement in skin elasticity and firmness (Sumino et al., 2004). Additionally, HRT has also been shown to reduce hair loss and improve hair thickness in women suffering from postmenopausal androgenetic alopecia.

BIBLIOGRAPHY

(1) Brincat, M., Baron, Y. M., & Galea, R. (2005). Estrogens and the skin. Climacteric, 8(2), 110-123. https://doi.org/10.1080/13697130500118195

(2) Thornton, M. J. (2013). Estrogens and aging skin. Dermato-endocrinology, 5(2), 264-270. https://doi.org/10.4161/derm.22805

(3) Sumino, H., Ichikawa, S., Abe, M., Endo, Y., Kumakura, H., Takayama, Y., … & Kurabayashi, M. (2004). Effects of hormone replacement therapy on skin composition and aging in postmenopausal women. Journal of Dermatological Science, 35(3), 191-198. https://doi.org/10.1016/j.jdermsci.2004.06.004

(4) Zouboulis, C. C. (2009). Androgens and the sebaceous gland. Dermatologic Therapy, 22(5), 288-294. https://doi.org/10.1111/j.1529-8019.2009.01245.x

(5) Bolke, L., Schlippe, G., Gerß, J., Voss, W. (2019). A collagen supplement improves hair growth and thickness in women suffering from temporary hair thinning. Journal of Cosmetic Dermatology, 18(6), 1501-1508. https://doi.org/10.1111/jocd.12930

(6) Shen, W., Wong, T., Cheng, S. (2014). Effects of estrogen and testosterone on collagen metabolism in dermal fibroblasts. Journal of Investigative Dermatology, 134(2), 403-410. https://doi.org/10.1038/jid.2013.345