The protective role of estrogens, mainly, and of other hormones to a lesser extent, as well as their numerous benefits for the skin, is well known. The maximum level of estrogen in women occurs at the end of the second decade of their life, decreasing by 50% at age 50 and reducing dramatically after menopause.
This loss of estrogen contributes to an evident deterioration of skin health, while Hormone Replacement Therapy (HRT) can restore skin health again. Several studies have revealed the clear relationship that exists between circulating estrogen levels and the age that women appear, their attractiveness, their skin health and their facial coloration.
Débora Nuevo Ejeda – Neolife Medical Team
How does skin age?
Skin aging is influenced by various factors, both genetic and environmental, as well as hormonal. From a scientific, dermatological and endocrine point of view, and even from a psychological perspective, the role of estrogens is decisive for skin aging.
There are general changes that affect the synthesis and maintenance of various skin structures during this process.
Until the age of 20, the thickness of the skin increases, and from there, and during the rest of adulthood, it progressively thins. This affects the 3 layers of the skin: epidermis, dermis and hypodermis.
In the epidermis, there are alterations in the shape and structure of keratinocytes and in the unions between them, which increases the size and number of pores.
The significant thinning of the dermis is caused by the loss of collagen, elastin and hyaluronic acid. Collagen fibers are fragmented by the action of metalloproteinases that increase oxidative stress and disrupt the fibroblast pathway. This causes a loss of tone and an increase in skin distensibility, which ultimately results in the appearance of wrinkles.
In the dermis and hypodermis, the structure of the sweat glands is distorted and also decreases the vascularization of the skin. Finally, the thickness of the dermis decreases and the distribution of subcutaneous fat in the hypodermis increases.
Menopause, hormones and skin
Alterations due to menopause include changes in the skin’s barrier function and sensory and pain perception, which worsens thermoregulation and wound healing, alters the immune response and disrupts the production of vitamin D.
The collagen content in the skin is primarily responsible for its elasticity and strength. Postmenopausal women experience a significant decrease in collagen content compared to premenopausal women. It has been shown that Type I collagen and Type III collagen decrease by up to 30% in the first five years after menopause.
Estrogens have been shown to increase collagen, elastin, vascularization and skin thickness. They are also modulators of metalloproteinases, blocking the fragmentation of collagen fibers, improving healing, increasing the viability of fibroblasts and stimulating the proliferation of keratinocytes. Finally, estrogens stimulate the hair follicle in the scalp and act as antioxidants, protecting against stress and inflammation.
Testosterone, on the other hand, and despite the bad reputation it has for the skin, also has an important beneficial effect on it. On the one hand, it also increases the production of collagen, increasing the thickness of the skin and improving its texture, but on the other hand, it decreases fat deposit and the appearance of cellulite.
Hormone Replacement Therapy (HRT) during menopause
Hormone Replacement Therapy has revealed the powerful influence of estrogen on the skin. 30% of the loss of collagen during the first 5 years of menopause can be prevented and even reversed with estrogen replacement. However, this great improvement has not been demonstrated in such an obvious way, if the therapy is started after 5 years of menopause, at least in terms of the appearance of wrinkles.
Several studies have shown an increase in skin collagen in menopausal women undergoing hormone replacement therapy. Skin biopsies of these women had a higher proportion of collagen, especially type III, compared to women who did not undergo such therapy. And the most striking fact is that the changes in the amount of collagen were observed in the first 6 months of treatment, reaching its maximum expression at 3-5 years after the start of therapy.
Thus, it can be concluded that numerous studies have shown the important role of estrogens and to a lesser extent other hormones, such as testosterone, in the appearance and health of the skin. Hormone Replacement Therapy has shown to be an important tool to help restore skin health.
At Neolife we perform hormonal replacement with bioidentical hormones, individually prescribing the dose each patient needs at each moment of their life.
(1) Lephart ED. A review of the role of estrogen in dermal aging and facial attractiveness in women. J Cosmet Dermatol. 2018;00:1–7. https://doi.org/10.1111/ jocd.12508
(2) M. Savvas. G. Laurent. Type II collagen content in the skin of postmenopausal women receiving oestradiol and testosterone implants. British Journal of Obstetrics and Gynaecology. Feb 1998. Vol 100 . pp 154-156
(3) Lephart ED. Skin aging and oxidative stress: equol’s anti-aging effects via biochemical and molecular mechanisms. Ageing Res Rev.
(4) Pomari E, Valle LD, Pertile P, et al. Intracrine sex steroid synthesis and signaling in human epidermal keratinocytes and dermal fibroblasts. FASEB J. 2015;29:508-524. 2016;2016:36-54.