Beyond Skin Deep: How Hormone Optimisation Enhances Aesthetic Procedures
Dr Sohère Roked is a GP, Functional Medicine & Hormone Doctor who specialises in combining bioidentical and body identical hormones and functional medicine to enhance hormone optimisation. She has treated thousands of clients and is recognised as one of the few GPs in the UK to cover both conventional and holistic medicine. We sat down with her to discuss the effects of hormones on skin health.
As a Hormone Doctor my job is to make my patients feel AND look good. Whilst most patients primarily see me about symptoms such as mood, sleep, flushes, focus and concentration, they often have secondary concerns about skin and their appearance too. They often complain of noticing they’ve aged 10 years, or suddenly more aware of lines and wrinkles. Hormone treatment alone may not fully improve their skin and cosmetic concerns, but a baseline of hormone treatment can make aesthetic procedures more effective.
I prescribe bio or body identical hormones, which are hormones that have the same chemical structure as the hormones your own body makes, or was making, and therefore the body can metabolise these better. Body identical hormones are made by pharmaceutical companies, whereas bio identical hormones are made by manufacturing laboratories or pharmacies and can be made in different formats such as creams, slow-release tablets or lozenges or troches and in different dosages. I use a combination of both for my patients, based on their individual needs and preferences.
In menopause and peri menopause, there is a decline of two of the key hormones, progesterone and oestrogen which can also affect skin.
Oestrogen and Skin
Oestrogens have significant effects on skin physiology and modulate epidermal keratinocytes, dermal fibroblasts and melanocytes, in addition to skin appendages including the hair follicle and the sebaceous gland. Importantly, skin aging can be significantly delayed by the administration of oestrogen.
Oestrogen can also increase hyaluronic acid production which will contribute to ‘glowing’ skin.
Hormone replacement therapy (HRT) has been shown to increase epidermal hydration, skin elasticity, skin thickness, and also reduces skin wrinkles. Furthermore, the content and quality of collagen and the level of vascularization is enhanced.
Oestrogen can be prescribed in a body identical form either topically or orally, depending on the patient’s age. Topically, or transdermally, is preferable as it reduces the risk of clots, but women who have had an early menopause (i.e. before 50) can use it orally without the associated risks.
Progesterone and skin
It is important to make the distinction between synthetic progestin and progesterone when prescribing.
The actual hormone progesterone that your body makes in the second half of the cycle can be beneficial to the skin. Progesterone thickens the lining of the uterus in the luteal phase of the cycle after ovulation so that a fertilised egg can implant. It is also high in pregnancy which helps to sustain the pregnancy. I often point out to my patients that pregnant women have lovely thick hair and smooth skin, and this is progesterone related.
In terms of menopause, low progesterone can cause mood issues, bloating, fluid retention and insomnia. Progesterone being low or out of balance is often responsible for pre-menstrual syndrome (PMS) symptoms such as low mood, tiredness, bloating or skin break outs.
Using synergetic progestin to treat this will have little benefit, and in fact can often make these symptoms worse. A synthetic progestin protects the lining of the womb from thickening which could happen if the oestrogen given is unopposed by a progestin or progesterone, but has little symptom benefit.
Using a micronised progesterone which is bio or body identical does have symptom benefit as well as protecting the womb.
In my experience, women often see an improvement in their hair and skin with progesterone, and describe a ‘glow’. Using progesterone premenstrually can also benefit skin and hair. The licensed formulation available for prescription is utrogestan.
There has been little research into the benefits in hair and skin with micronised progesterone, but a study published this year in Climacteric suggests that there is more benefit than using a synthetic progestin, either when used orally or topically.
Progesterone and Oestrogens and Collagen Production
Both progesterone and oestrogen have an impact on collagen production.
In oestrogen deficient women, a study has shown skin thickness is reduced by 1.13% and collagen content by 2% per postmenopausal year. Type I and III skin collagen is thought to decrease by as much as 30% in the first five years after menopause, which parallels the reduction in bone mass observed in post-menopausal women.
The decrease in skin thickness and collagen content seen in elderly females appears to correlate more closely with the period of oestrogen deficiency than with chronological age.
In contrast, another study has demonstrated a closer relationship between chronological age and reduction in skin collagen, than time since menopause. However, for the patients in this study the time spent post-menopause was much shorter, therefore the long-term effects of oestrogen deficiency may not have become apparent.
A difference in collagen subtypes has also been documented in post-menopausal women. When evaluated by immunohistochemistry, compared to pre-menopausal women, post-menopausal women demonstrate a decrease in collagen types I and III and a reduction in the type III/type I ratio within the dermis. Again this correlates more closely with period of oestrogen deficiency than with chronological age
Stress Hormones and Skin
I often talk to patients about their skin care routines. Although hormones will make a significant difference to skin and laxity, I also take into account their alcohol and smoking history, what supplements they take and nutrition and lifestyle. Hormones alone will make some impact, but when combined with lifestyle changes there will be significant improvements. Studies have shown that whilst hormones can benefit skin elasticity and thickness, it doesn’t compensate for time spent in sun exposure or smoking, so it is important for patients to know that HRT cannot compensate for poor lifestyle choices.
Stress hormones being high, such as cortisol and adrenaline, seem to lessen the benefits of HRT so it is important to address this too.
A 2014 paper showed a link between stress hormones and peripheral nerve endings, and local skin cells including keratinocytes, mast cells, and immune cells. There are also feedback mechanisms and crosstalk between the brain and the skin, and pro-inflammatory cytokines and neurogenic inflammatory pathways play huge roles in mediating such responses.
UV irradiation can also induce stress hormones and impact the skin. Stress hormones can cause inflammatory conditions like acne and also impact wound healing, which is an important consideration when performing aesthetic treatments.
Whilst there’s no definitive treatment for reducing stress hormones, supplements like ashwagandha, which is an adaptogen, can help modify cortisol in the body, and talking to patients about practical ways to reduce stress such as delegating, making time for themselves, meditation, yoga, a daily gratitude practice or journaling is an essential part of my work.
We share a joint goal of wanting our patients to look and feel good.
When treating peri menopausal and menopausal women, a holistic approach works best. Taking a history about their menstrual cycle, menopause or if they’re taking hormone replacement therapy is important. This will factor in to how effective their aesthetic treatments and skin care procedures will be.
My approach is to get the hormones in balance and improve skin first so my patients have the best chance of getting the outcomes they want with their aesthetic procedures.
It may not be your area of expertise, but you can guide your patients towards seeking further information on HRT from their GP or someone like myself who specialises in this area. Collaborative care for our patients is best.
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