“H” 2: Hormones

In my description of the “Four Hs” to Skin Care the hormones play a significant role. The loss may cause a skin aging phenomenon while an imbalance can cause inflammation. Keep in mind the radiance and luster to the skin can be helped by bioidentical hormones or aggravated by the imbalance or usage of the wrong type of hormones. Let us break them down by category.

Estrogen:

The skin has estrogen receptors of various concentrations depending upon the site. For instance, the facial skin has more estrogen receptors than other sites of the body. The epidermis gets thinner with estrogen loss and preventing the loss of estrogen may help to keep skin layers robust, but research now shows that estradiol also cuts down the number of inflammatory proteins that could otherwise attract macrophages (cells of the immune system). Estrogen could add the plumpness in the epidermis. I have also ascribed that “E=Elasticity.” Notably in the vaginal area, the menopausal woman can attest to the dryness and lack of distensibility in that area of the skin.

In the dermal layer estrogens can protect from the effects of aging by complicated pathways of stimulating hyaluronic acid, collagen, and water production. Whether your skin is young or old, these key components in the dermal layer promote elasticity, immune health, and decreased inflammation. Certain estrogen receptor modulators (“SERMS”) demonstrate benefits with limitations in their side effect profiles. The pigment is affected by the distribution and changes of the hormones, and in a crude understanding, melanin goes up with estrogen and down with progesterone. These studies are in their infancy and more will follow to ascertain if there could be a therapeutic benefit to modulating melanin production with hormonal tactics. Could the administration of estrogen in menopausal years delay the effects of skin aging? The answer is yes with the careful selection and balance.

Progesterone

The oil glands of the skin are very responsive to progesterone. We need the right balance to have enough oil (sebum) to prop the dermis and stay firm without having too much which may clog the pores or become fuel for p. acnes, a skin bacterium responsible for cystic acne. Progesterone is highest in the second phase of the menstrual cycle and may go in overdrive in a young woman in the “premenstrual” phase of the month. And yet, there is a delicate balance between these two hormones as they dance with each other throughout the cycle. In the menopausal phase of a women’s lifecycle, we see the loss of sebum leading to a dry, sallow, wrinkled appearance to the skin. The bioidentical camp of hormone replacement uses a natural progesterone which is identical to that progesterone which our ovaries make. The body enjoys this and knows how to process this. Progestins, which are contained in some IUD’s, Depo-Provera, and birth control pills are not the same, and the body may have difficulty processing a synthetic progestin leading to an inflammatory response. Of course, there are other factors that contribute to an inflammatory response such as food, stress, sleep, medication effects, but hormones are at the foundational balance of skin health.

Testosterone

If testosterone is not balanced, or in excess, too much sebum can be produced. Testosterone also is secreted during the premenstrual phase from the ovaries. This may yield the unwanted clogged pores. In the case of males, a portion of the testosterone can be converted over in estrogen at the fatty levels of the body and provides balancing of these two hormones. As a male ages, the increase of sex-hormone binding globulin will take some of the testosterone out of circulation, yielding estrogen levels to go up in response. Testosterone has been touted as helping to improve skin tightening and improving skin elasticity in general. Less testosterone and increased estrogen in a man will interplay with the di-hydrotestosterone receptors at the skin level to complicate the effects of testosterone losses even further.

Research is underway to assess the differences in male versus female skin and the effects of losses and imbalances of the hormones. Thus far, optimizing testosterone helps a man’s skin aging, just as estrogen and progesterone assist in promoting female skin health.

5-alpha DHT (dihydrotestosterone):

Hair is manufactured at the skin and primarily determined by the level of DHT. Elevated levels as seen in polycystic ovarian patients explain the high presence of unwanted hair. Blockers of this hormone will block the hair growth. The highest concentration of DHT is in the skin and liver, and one of the key differences between DHT and testosterone is that DHT will not convert over to estrogen. Testosterone can freely convert over to estrogen and these estrogen levels need to be checked in a patient receiving testosterone therapy.

DHEA :

DHEA is primarily manufactured at the adrenal gland as a precursor hormone that can manufacture the other sex hormones in a pinch. However, the skin itself can take DHEA and convert it into the other sex hormones at the skin level itself. In the main categories of improved skin health, DHEA has been researched topically and orally to provide hydration to the skin as well as improved sebum productions. Skin pigmentation may even out and improve epidermal thickness. Some women prefer the gentler approach to adding a little bit of DHEA rather than the estrogen/progesterone/testosterone combinations.

Cortisol

Did you know that the skin has its own HPA axis such that the hypothalamus, pituitary, and adrenal gland will communicate by corticotropin releasing hormone (CRH) and can attach to the receptors found in the epidermis, dermis, and subdermis? The direct communication to the skin may have the skin release local immune factors and inflammation responses. The adrenocorticotropin (ACTH) that talks to the adrenal gland to release cortisol has receptors to talk directly to the skin. The function of ACTH and cortisol on skin may cause mast cells to degranulate and release contents. Angiogenesis, increasing the amount of blood vessels, gets turned on in response to CRH, and sebum and melanin production also is affected by the affects of these hormones, once thought to only affect the adrenal gland. This may explain a “top down” approach to the affects of cortisol, but is there feedback from the skin itself to the feedback loop of the stress reaction? Yes, indeed! Epinephrine is synthesized by skin cells, melanocytes, and fibroblasts and important in local wound healing (as a classic example) as this stress hormone talks to the nearby cells to solve a skin problem.

Prolactin

We used to think the only role prolactin had was in the production of milk (pro- “lactin”). At the skin level prolactin can stimulate sebum production and proliferation of keratinocytes. There is an added job of promoting new blood vessel to form as well as combat the effects of steroids while stabilizing t-cell lymphocytes and macrophages. Wow!

Vitamin D

The skin is the manufacturing site of the hormone. The kidney and liver are needed to make this compound usable in the body but suffice to say the skin cells have the engineering centers to produce Vitamin D3 as well as its receptor. Vitamin D is at the heart of a balanced immune system. We have described our skin as the largest detoxing organ, but between it and the gut system, it is a substantial portion of our immune system, and not just for barrier purposes.