Radiant, great looking skin is often considered evidence of overall good health. Internal imbalances in sex hormones that happen with ageing can disrupt delicate harmony in the body and cause skin changes that seemingly give a person an older appearance. Hormone replacement with bioidentical hormones stands out as an effective way to prevent accelerated skin ageing.
Changes in skin and overall appearance with increasing age can be partially attributed to declining hormone levels. Hormonal deficiencies affect both men and women as they go through a natural age-related reduction of sex hormones oestradiol and testosterone accompanying menopause and andropause.
Skin ages differently than the rest of the body.
The fact that skin follows its own pace of ageing has been discovered when scientists used ageing clocks to look into the biological age of different body systems. The striking revelation was that a good biological age score of almost all ageing clocks is associated with cancerous skin changes like skin melanoma. When we think about this discovery, one could conclude that leading a very active and outdoor lifestyle can bring you optimal general health, but your skin may be burdened with numerous environmental damages, one of which is an overload of sun exposure.
When we return from skiing or a midwinter tropical escape, satisfied with our tan and positive emotions, we often forget that our skin needs regeneration. In addition to craving hydration and enhanced care, we need to dedicate our time and effort to taking care of the intake of micronutrients needed for skin health.
Nevertheless, the real question is, can the pace of ageing be driven solely by external factors, or can we mitigate skin ageing from the inside?
Skin is our interface towards the world.
Skin is our largest organ that covers the whole body. It is on the front line of immune protection against environmental injuries, toxins, and microbes. Skin regulates body temperature and is essential for the sense of touch, pain, cold, and warmth.
Skin is composed of three different layers:
- Epidermis – a thin outer layer made of keratinocytes (special cells that prevent excessive water evaporation).
- Dermis – a thick inner layer of connective tissue with embedded hair follicles, nerve ends, sweat and sebaceous glands, and blood vessels scaffolded with elastin, collagen, and hyaluronic acid.
- Subcutis – a deeper fatty layer.
Healthy skin has active keratinocytes, which repair the skin surface, and plenty of collagen and hyaluronic acid. These last two skin components are unique sugar biomolecules called glycans, which keep the skin hydrated and are responsible for a glowing and youthful skin appearance. Our cells naturally produce elastin, collagen, and hyaluronic acid to balance moisture levels keeping the skin firm and elastic, but their production, unfortunately, begins to decline as we age.
Sex hormones affect skin ageing in women.
The factors that influence collagen production over a lifetime are physiological conditions like puberty, pregnancy, menopause and andropause, intrinsic factors like genetics, age, and ethnicity and extrinsic factors like UV radiation from sun exposure, pollution, and smoking.
Skin ages when cells accumulate faults affecting the structure and function of the protein scaffold responsible for skin integrity – the number of cells in the dermis decreases, blood vessels become thinner, which disrupts the blood supply, and the number of collagen fibres decreases. Approximately 1% of collagen fibres are lost annually after the twenties, resulting in long-term loss of skin elasticity and thickness.
After menopause, the loss of collagen is even more pronounced – around 30% is lost during the first five years of menopause and continues to drop by another 0.5% yearly. Research shows that type I procollagen content, a marker of ongoing collagen synthesis, decreases by 68% in old skin (eighty years of age) versus young skin (twenty years of age) in women – identifying collagen deficiency as a hallmark of skin ageing. What is more interesting is that collagen production starts to decline already in the thirties – alongside with decline in sex hormone production.
A change in skin structure is the reason for skin relaxation and wrinkles.
The world population doubled in the last fifty years and continues to grow. We live longer thanks to improved nutrition, healthcare services, and medical advances. However, there is a significant age gap in Europe and North America, where almost 20% are elderly above sixty-five. In their early twenties, women’s ovaries work optimally, producing considerable amounts of sex hormones that affect every aspect of body well-being as reflected through healthy skin. As our population ages, both women and men will live a longer part of their life in a hormone-deficient state.
As every coin has two sides, the benefits of a longer lifespan have put a tremendous burden on people to be active participants and to appear younger and attractive to society.
In a review article published in the International Journal of Dermatology, scientists have highlighted the role of bioidentical hormone replacement therapy (HRT) in antiageing medicine. They primarily looked into the benefits of sex hormone supplementation on skin structure in several studies on women undergoing menopause transition. They discovered that hormones have a crucial role in the ageing processes of the skin but are also involved in the general ageing of the body, which was recently reported in an ageing study relating oestradiol levels with biological ageing in women.
However, many people are still afraid to use hormones for antiageing purposes. Their fear comes from the question of the safety of hormone replacement, as the Women's Health Initiative study reported it to increase the risk for heart disease and breast cancer. Although many future studies refuted the results of the first WHI study, the harm had already been done, and sex hormones came on top of the blacklist.
The change in the attitude towards hormone replacement as a beneficial therapy for men and women whose own hormones are low or out of balance came with the new era of hormone drug development. Since hormones are the leading messengers that regulate every process in the body, artificial hormones must be as similar as possible to those our body produces naturally. Nowadays, menopause experts advise on the use of either bioidentical or body-identical hormones. Superiority of such hormones over their synthetic counterparts lies in the fact that they are the closest to the real thing – the hormones produced by the human body itself.
With bioidentical hormones, you can customise doses and application methods to address your individual needs, whereas body-identical hormones are produced in regulated, set doses and application methods as a part of a one-size-fits-all approach.
Hormonal replacement with bioidentical hormones is an effective way to prevent skin ageing.
For example, oestrogen replacement therapy in menopause can have an apparent cosmetic improvement as it increases skin hydration and elasticity, reduces wrinkles, increases the level of vascularisation, and enhances the number and quality of collagen. Concurrent progesterone supplementation can further amplify the effect of oestrogen by increasing the skin-surface lipids and creating a more youthful glow, which highlights the benefits of hormone replacement in antiageing of the skin. However, the scientists showed that treatment with hormones gives the best results in men and women if started in the years immediately around menopause or andropause, maintaining constant hormone levels and avoiding a hormonal deficient state.
If eyes are the window to the soul, the skin is a mirror of the body.
With the onset of ageing, we are no longer capable of producing the optimal amount of hormones. New findings on the benefits of HRT are precisely what should encourage us to nourish our body and skin not only from the inside but also from the outside. Scientists say that applying oestrogen cream or gel directly on the skin can have the same, if not even better, effect than the oral hormone admission, resulting in clear and dewy face skin complexion reflecting our good general health, which is the key to external beauty.
Declining hormone levels are often the cause of many age-related signs and symptoms of skin deterioration, and HRT may help to prevent hormonal decline and its negative cosmetic side effects on the skin and also benefit the entire well-being of a person if administered properly.