Have Persistent Skin Problems? Think Hormones

It certainly isn't news that hormones are involved in skin health. But it may be news that effects of declining estrogen levels are more obvious on the skin of the face than elsewhere on the body. 

How so? Read on.

Lower Hormone Levels = Lower Skin Vitality

Women and their doctors have known for a long time that the decline in hormone levels as we age has a negative impact on skin properties, and we typically see skin thinning, wrinkling, discoloration, and dryness. This is because hormones are intrinsically involved with maintaining collagen content, skin lipid levels, elasticity, wound healing, and glycosaminoglycan content. Not only do hormones act at prolific receptor sites throughout the skin, but also several cellular components of skin including the sebaceous glands, fibroblasts, sweat gland cells, subcutaneous fat cells, and epidermal keratinocytes actively produce androgens and estrogens for local use.

Facial skin expresses much higher concentrations of estrogen receptors than the skin of the breast or the thigh. This means that the effects of declining estrogen levels as women progress through menopause are more obvious on the skin of the face than on the skin covering other parts of the body. Reduced availability of estrogen affects skin health in a number of ways: these include wrinkling, dryness, thinning, reduced collagen content, slower wound healing and loss of elasticity.

Higher Estrogen Means Better Skin – But Don't Overdo It

Obese men and women often don't show this deterioration in skin health to the same extent as normal weight people; this is because they maintain higher estrogen levels as a result of increased aromatase activity in fat and skin tissue. Aromatase is an enzyme that converts testosterone into estradiol and androstenedione into estrone, and it is present in large quantities in fat tissue, including the fat layer just below the skin. Estrone and estradiol are therefore found in larger amounts in obese individuals than in normal weight people of the same age.

Studies of estrogen replacement therapy have shown some improvement in those skin properties affected by low estrogen levels, e.g. increased collagen content, skin thickness, and skin elasticity. Hormone replacement has also been found to increase skin surface lipids, which enhances the barrier function and may prevent dryness. Estrogen, too, plays a role in maintaining skin glycosaminoglycan content, which retains moisture. Such are the benefits of estrogens for the skin that estriol, a weak estrogen, is now included in many skin creams available commercially. Some doctors even recommend that women can apply topical prescription estrogen creams for hormone replacement directly onto the face.

However, it's important to remember that hormones applied topically are absorbed systemically. Studies show that serum testing does not reveal the extent of hormone absorption from topical preparations, yet saliva testing does reflect exposure of tissues to hormone that is distributed throughout the body after being absorbed through the skin. ZRT tests hormones in saliva and can therefore detect whether excessive amounts of hormone are being absorbed from either prescription or over-the-counter hormone creams. Excess exposure to hormones carries a risk of cancer and other health problems, and can have a negative effect on the skin as receptors are down-regulated, so the expected benefits of using an estrogen cream can even be negated with over-use. High estrogen levels are also associated with melasma, a dark discoloration seen in up to 70% of pregnant women and up to a third of women using birth control pills or HRT.

Other Hormones Also Affect Skin Quality

Low testosterone in men is also associated with thinning skin. This is thought to be because there is less testosterone available for local conversion to estrogen through the action of aromatase present in the skin. Testosterone replacement has been found to increase skin thickness. Low progesterone levels are thought to increase the impact of androgens on sebaceous glands and body and head hair. This is because progesterone reduces 5-alpha reductase activity, which converts testosterone to its active metabolite dihydrotestosterone (DHT). DHT is the culprit for androgenic side effects in women such as unwanted facial hair growth, which tends to appear with ageing or in androgen excess conditions such as PCOS. In both men and women, excess DHT in the skin contributes to acne, and in the skin of the scalp it is responsible for male pattern baldness.

Progesterone has been used in cosmetic skin creams as well as in hormone replacement therapy, and has been found to improve skin thickness and elasticity. Studies have indicated no adverse effects when progesterone is used for this purpose.

The Roles of Thyroid, Vitamin D & "Psychodermatology"

Thyroid dysfunction is also characterized by a plethora of associated skin problems, ranging from rashes to myxedema, a classic indicator of severe hypothyroidism caused by increased glycosaminoglycan deposition that results in swelling and facial puffiness. Hypothyroidism can also result in scleroderma, or rough, scaly skin, and dryness because of reduced sebum production and reduced sweating. Overproduction of thyroid hormones in Graves Disease results in thickening of the skin's outer layers and increased skin pigmentation, erythema, smoothness, and sweating.

Stress, too, has a large impact on skin health; many skin disorders are linked to emotional and psychological problems, spawning a whole health field known as psychodermatology. A diurnal cortisol test can help assess the extent of disturbance in hypothalamic-pituitary-adrenal axis (HPA axis) function as a result of chronic stress.

The skin contains vitamin D receptors, and adequate vitamin D is needed to regulate epidermal proliferation and differentiation to maintain its barrier function and suppress tumor cell formation. Vitamin D is also important for proper immune system function; a compromised immune system can exacerbate psoriasis and acne, and can impede wound healing. Vitamin D analogs are being used for the topical treatment of plaque psoriasis.

Related Resources



  1. Zouboulis CC. The human skin as a hormone target and an endocrine gland. Hormones (Athens). 2004;3:9-26.
  2. Pontius AT, Smith PW. An antiaging and regenerative medicine approach to optimal skin health. Facial Plast Surg. 2011;27:29-34.
  3. Sator PG, Schmidt JB, Rabe T, Zouboulis CC. Skin aging and sex hormones in women -- clinical perspectives for intervention by hormone replacement therapy. Exp Dermatol. 2004;13 Suppl 4:36-40.
  4. Demling RH. The role of anabolic hormones for wound healing in catabolic states. J Burns Wounds. 2005;4:e2.
  5. Shaw JC. Acne: effect of hormones on pathogenesis and management. Am J Clin Dermatol. 2002;3:571-8.
  6. Cassidenti DL, Paulson RJ, Serafini P, Stanczyk FZ, Lobo RA. Effects of sex steroids on skin 5 alpha-reductase activity in vitro. Obstet Gynecol. 1991;78:103-7.
  7. Holzer G, Riegler E, Hönigsmann H, Farokhnia S, Schmidt JB. 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. Br J Dermatol. 2005;153:626-34. Erratum in: Br J Dermatol. 2005;153:1092.
  8. Evers AW, Verhoeven EW, Kraaimaat FW, et al. How stress gets under the skin: cortisol and stress reactivity in psoriasis. Br J Dermatol. 2010;163:986-91.
  9. Jafferany M. Psychodermatology: a guide to understanding common psychocutaneous disorders. Prim Care Companion J Clin Psychiatry. 2007;9(3):203-13.
  10. Niepomniszcze H, Amad RH. Skin disorders and thyroid diseases. J Endocrinol Invest. 2001;24:628-38.
  11. Safer JD. Thyroid hormone action on skin. Dermatoendocrinol. 2011;3:211-5.
  12. Murphy G, Reich K. In touch with psoriasis: topical treatments and current guidelines. J Eur Acad Dermatol Venereol. 2011;25 Suppl 4:3-8.
  13. Bikle DD. Vitamin D metabolism and function in the skin. Mol Cell Endocrinol. 2011;347:80-9.
  14. Du JY, Sanchez P, Kim L, Azen CG, Zava DT, Stanczyk FZ. Percutaneous progesterone delivery via cream or gel application in postmenopausal women: a randomized cross-over study of progesterone levels in serum, whole blood, saliva, and capillary blood. Menopause 2013;20:1169-75.
  15. Komori S, Ito Y, Nakamura Y, Aoki M, Takashi T, Kinuta T, Tanaka H, Koyama K. A long-term user of cosmetic cream containing estrogen developed breast cancer and endometrial hyperplasia. Menopause. 2008;15:1191-2.
  16. Donovan M, Tiwary CM, Axelrod D, Sasco AJ, Jones L, Hajek R, Sauber E, Kuo J, Davis DL. Personal care products that contain estrogens or xenoestrogens may increase breast cancer risk. Med Hypotheses. 2007;68:756-66.