Hormones impact the skin in some drastic ways, from acne to hydration to collagen and ageing to pigmentation. Dr Ginni Mansberg breaks down 10 amazing ways hormones affect the skin.
Hormones are basically your body's chemical messengers. They regulate functions in the body, from metabolism to behaviour. They are secreted by various glands and tissues throughout the body which release them into the bloodstream.
Then they travel through the blood to the various tissues and organs, binding or locking on to specific parts of the cell called receptors.
By binding to receptors, hormones trigger specific reactions in the tissues that contain the receptors.
For the purposes of this article we’re talking mainly about male and female hormones, but other hormones including the thyroid hormones, hunger hormones and those that control your blood pressure and even your heart may play a role, too.
1. Oestrogen helps the skin build collagen
Oestrogen helps maintain skin thickness and collagen production, which keeps skin looking firm and youthful. After menopause, as oestrogen levels decline, we see a 30% drop in collagen within the first five years, making skin thinner and less elastic.
This collagen loss then continues with a further dip of 2.1% of the skin’s collagen per year after menopause.
One study found that taking oral oestrogen in the form of hormone replacement therapy or HRT for one year can increase skin thickness by 30% in post-menopausal women. Another study showed a 6.49% increase in skin collagen after just six months on the treatment.
Hormone replacement therapy is especially effective as a collagen builder for women who entered menopause with very low collagen levels in their skin. But for those with only mild collagen loss, it acts more as a preventative measure.
Topical oestrogen (hello TikTok!) can also boost skin collagen but only affects the specific area where it’s applied.
2. Oestrogen in the skin is an anti-inflammatory hormone
Oestrogen helps the skin heal by reducing inflammation and controlling oxidative stress. We’re not exactly sure how it exerts it’s anti inflammatory power.
However, we do know that oestrogen lowers the activity of harmful inflammatory chemical signals that regulate immune system behaviour. It switches off IL-1 and TNFα and boosts anti-inflammatory chemicals like IL-4 and IL-10, creating a better environment for healing. This is not just in the skin.
Across the body almost every cell involved in tissue repair and inflammation has oestrogen receptors on them. Oestrogen also helps wounds to heal and promotes the activity of antioxidants, which protect against damage. Additionally, it prevents excessive breakdown of tissue components needed for repair.
3. Oestrogen is terrific for skin hydration
Oestrogen plays a key role in keeping the skin hydrated and healthy. It is essential to make hydrating hyaluronic acid in the skin as well as sebum or oil.
The effects help reduce what we call TEWL or transepidermal water loss (loss of water out of the skin) and improve skin barrier function and hydration.
It boosts blood flow and increases skin hydration by stimulating the production of hyaluronic acid, mucopolysaccharides, and natural oils or sebum. Ask any menopausal woman and she will tell you her skin feel so much drier!
Oestrogen therapy or HRT after menopause has been shown to improve skin quality, making it thicker, more elastic, and better hydrated. It elevates hyaluronic acid levels in the skin, helping to maintain hydration and strengthen the skin’s protective barrier.
4. Testosterone powers acne in many ways
Testosterone and other so called “male hormones” or androgens can have a big impact on the skin. By the way, females have androgens too, just not at the same levels as we see in men.
Androgens increase oil production in the sebaceous glands, leading to greasier skin. They also cause skin cells in hair follicles to multiply too quickly, but clump together instead of shedding the dead cells contributing to clogged pores.
This creates an ideal environment for C. acnes bacteria to grow, leading to inflammation and acne. Plus androgens are pro-inflammatory in skin, making acne worse!
5. Healing power of oestrogen
Oestrogen plays a role in all stages of wound repair, reducing inflammation and supporting skin remodelling and new skin growth.
Oestrogen helps wounds heal faster by reducing inflammation and improving blood flow to the area. It encourages the cells that rebuild skin and form new blood vessels, making the healing process more efficient.
Without enough oestrogen, for example after a woman passes into menopause, healing can slow down, and wounds may take longer to close. Taking oestrogen in the form of HRT can help speed up this process and improve overall skin repair.
6. Premenstrual acne flares are common
Hormone fluctuations throughout the menstrual cycle can have a big impact on acne breakouts.
In fact, up to 85% of women notice their acne getting worse in the days just before their period. Interestingly, women over 30 are more likely to experience these premenstrual acne flares compared to younger women.
While some women may have underlying hormonal issues like PCOS or high androgen levels, many who struggle with acne actually have normal hormone levels. So, even without obvious hormone imbalances, those monthly ups and downs can still trigger breakouts!
For women with a regular cycle, extra attention to compliance with their skincare regime before the period might be beneficial, although studies are yet to be done.
It seems that acne might be just one of the so called catamenial skin conditions. That means that the time of your cycle influences what is happening in the skin.
We see this with everything from eczema to psoriasis and a raft of autoimmune diseases of the skin. They all get worse around the period when oestrogen levels are at their lowest.
7. Oestrogen and pigmentation
Oestrogen plays a role in skin pigmentation by stimulating melanin production, especially when combined with UV exposure.
Oestrogen affects pigmentation directly by activating melanocytes (the cells that make melanin) and indirectly through making the skin cells or keratinocytes more susceptible to receiving melanin from adjacent melanocytes.
Oestrogen also increases blood vessels in the skin, which might lead to more of a protein called endothelin-1 that further stimulates melanin production.
In short, oestrogen makes the skin more reactive to UV light, leading to conditions like melasma in predisposed individuals.
8. In hormonal acne, location is key
Hormonal acne is different from the typical teenage acne. It usually appears as deeper, inflamed pimples and pustules that form on the lower parts of the face, like the jawline, chin, and neck (teens and those whose acne is less hormonal get more T-zone acne).
It tends to be mild-to-moderate in severity, unlike the more widespread breakouts often seen in adolescence. The pimples are usually not as superficial and can be more stubborn to treat.
9. Hormonal acne combined with stress hormones: a tricky combination!
Studies show that stress is a triggering factor for acne in between 25.7% and 71% of patients with adult acne. Stress can trigger acne by increasing adrenal cortisol levels. Higher cortisol levels lead to more oil production and clogged pores. Cortisol also increases the enzyme that activates androgens in the skin.
It also weakens the immune system and disrupts the skin barrier, making it harder for the skin to heal and recover.
This can cause more breakouts, especially during high-stress situations like exams or major life changes.
10. Choosing the right pill for hormonal acne:
When it comes to tackling hormonal acne, picking the right combined oral contraceptive pill is critical. New research shows that different pills have different effects on acne. Oestrogens in the pill are not the issue. First-generation progestins like norethisterone have strong androgenic effects and can worsen acne, so they should be avoided in acne-prone women.
Second-generation progestins (like levonorgestrel) may help some women but worsen acne in others.
Third- and fourth-generation progestins, such as desogestrel, gestodene and dienogest and drospirenone, are less androgenic and more effective for treating acne. A diuretic called spironolactone also suppress the actions of androgens like testosterone on the skin’s sebaceous glands, so are a non hormonal option for the treatment of acne.
Dr Ginni Mansberg is a GP, TV presenter, podcaster, author and columnist. She is a physician specialising in women's health, menopause and all things skin. She is also the co-founder and medical director of science-based cosmeceutical skincare brand, Evidence Skincare (ESK), and author of bestseller, The M Word, How to Thrive in Menopause.