Today, aesthetic physicians are more aware than ever of the implications of hormonal changes on cosmetic treatment outcomes. Thus, many are taking a proactive approach to restore and balance patient hormones as part of a holistic approach to aesthetic treatment. Hormonal tests and holistic therapy plans are designed to identify and improve declining hormone levels to better manage the usual transformations that come with these shifts for better, longer-lasting aesthetic results.
The Role of Hormones and the Skin
A healthy, optimally functioning endocrine system is critical for overall health. Dual boardcertified dermatologist, somatic trauma therapy practitioner and mind-body medicine specialist Keira Barr, MD, (Sacramento, Calif.) described the endocrine system as a network of glands that produces hormones and regulates everything from metabolism to immune function and skin health.1 “The balance of these hormones shifts with age, leading to skin texture, elasticity and appearance changes. Insulin and cortisol play a significant role in skin aging, resulting in inflammation and oxidative stress which ultimately accelerates skin aging,” she explained.
According to dermatologist Serena Mraz, MD, (Vallejo, Calif.), the skin, underlying soft tissues and bony structures play prominent roles in aesthetic ideals. “A 
healthy state is viewed as attractive with every organ system in a constant state of regeneration and degeneration,” she explained. “When the balance tips more towards breakdown than regeneration, age-related changes occur. An imbalance or dysfunction of the endocrine system accelerates degeneration and impairs regeneration, causing the skin to appear dull and wrinkled.”
Modern science shows concrete evidence of hormones influencing skin aging and health.2 “This is more the case in women than men since estrogen impacts skin health, elasticity, hydration, and wound healing,” stated Jessie Cheung, MD, board-certified dermatologist and founder of Cheung Aesthetics & Wellness (Chicago, Ill.). Still, endocrine dysfunction affects both sexes.
The most significant difference between hormonal changes in men and women is that men experience a gradual decline of androgens, whereas female estrogen levels fall off a cliff with menopause, Dr. Mraz added. Optimizing and balancing a lack of estrogen and other essential hormones can influence the health and appearance of the skin “...while leading to improved healing after aesthetic procedures, better outcomes and reduced recovery times,” she noted.
Endocrine Disruptors and ‘Clean’ Beauty
The clean beauty trend focuses on eschewing chemical laden products for those made with safe, non-toxic and environmentally friendly ingredients. It is a philosophy that intersects with endocrine system concerns. Chemicals such as bisphenol A, dioxins, phthalates, parabens, perfluorinated compounds, triclosan, certain heavy metals, pesticides and flame retardants (all of which should be avoided) interfere with the body’s normal hormone function and cycles. Increased cortisol levels or disrupted insulin sensitivity creates imbalances that generate higher-than-normal amounts of inflammation, fat, hormonal dips that impact puberty, menstruation cycles and testosterone production, diabetes and even cancer.3 Furthermore, according to Dr. Mraz, these chemicals can compete with natural hormones and drive certain skin issues, including acne, hyperpigmentation, an impaired skin barrier, textural changes, eczema and premature aging. Endocrine disruptors can also wreak havoc on normal hair growth patterns, leading to thinning and textural changes.
Hormonal imbalances from exposure to endocrine disruptors can undermine the effectiveness of aesthetic treatments by exacerbating inflammation and reducing the skin’s ability to repair itself, explained Dr. Barr. “By minimizing exposure to them, patients can protect their hormonal health and achieve and maintain optimal skin and hair health.”
The Skin-Cortisol Connection
Cortisol is crucial for human life and basic function, but chronically elevated stress-induced cortisol levels can negatively affect the skin and hair, contribute to collagen and elastin breakdown, drive inflammation and slow the body’s natural ability to repair itself. “Stressed-out skin is less resilient and has a harder time defending itself and maintaining adequate moisture levels, so it gets dry and irritated more easily,” Dr. Cheung stated. Hardto- manage stress can also lead to acne.4 “Acne transpires when cortisol drives oil production and inflammation in the pores,” she explained.
Fine lines, wrinkles, jowls and sagging skin also become more prominent when cortisol levels are elevated. Collagen breakdown can result in enlarged pores, Dr. Barr added. Studies show that women lose about 30% of their collagen during the first five years of menopause and 2% each year after,5 which Dr. Barr noted, causes reduced firmness and sagging tissue and skin. High cortisol levels in the body can also be blamed for a puffy or an overtly round face, known as “cortisol face.” Besides contributing to facial puffiness, hypercortisolism can cause skin fragility, bruising susceptibility and fat redistribution. “These are just a few aesthetically undesirable symptoms,” stated Dr. Mraz.
Physicians test cortisol levels via saliva, blood or urine. Dr. Barr finds saliva tests useful for assessing the diurnal rhythm of cortisol throughout the day. “If cortisol levels are elevated, I recommend a multifaceted approach to balance them, including stress-reduction techniques such as mindfulness meditation, yoga and deep breathing exercises to calm the nervous system. Somatic therapies release stored tension to reduce cortisol levels,” she explained. In addition, adaptogenic herbs, like ashwagandha and rhodiola, with magnesium and omega-3 fatty acids help to lower cortisol levels, she added.
Lifestyle changes can also help to decrease elevated cortisol levels. Some physicians order tests to evaluate for hypercortisolism. “Cortisol levels have normal fluctuations with a patient’s circadian rhythm, and imbalances occur when the system is thrown off,” explained Dr. Mraz. “It is an absolute necessity for patients to exercise regularly, focus on regular, adequate sleep and eat a diet void of processed foods and excessive alcohol. Viewing morning sunlight when the sun rises positively impacts cortisol cycling and sleep patterns.”
Tried-And-True Solutions
Despite the best of efforts, the natural aging process does affect the endocrine system and will influence hormonal and skin health. Whether targeting patient skin, hair, fat or muscle concerns, appropriate hormonal treatments will help foster healthy, faster healing and deliver better aesthetic outcomes. “Optimizing hormones gives an edge by improving metabolism, maintaining muscle mass and bone density and skin elasticity,” Dr. Cheung affirmed.
Hormone receptors in the skin play an integral role in maintaining healthy collagen, elastin, vascularity and moisture, supporting the skin’s overall youthful qualities. An absence, imbalance or deficiency in hormones negatively affects these functions. Specific tests to assess and monitor hormones can be used to help determine and devise an effective treatment plan. Collecting multiple salivary tests can determine a daily cortisol rhythm, whereas a serum test provides a snapshot of cortisol levels at a specific time, explained Dr. Cheung.
“Taking a thorough history and digging deep into lifestyle habits can offer information for implementing lifestyle shifts that support hormone regulation without testing,” Dr. Barr added.
Bioidentical hormone replacement therapy (BHRT) is a popular option for creating hormonal balance. Dr. Cheung often starts by optimizing testosterone, estrogen, progesterone and thyroid levels. “There are relatively quick, tangible effects on a patient’s quality of life, sleep, mood, skin and hair. Most women are not afraid of adding a topical estriol serum to their skincare regimen even if they are reluctant to start systemic therapy. Peptide hormone therapy, including growth hormone (GH) and GH secretagogues, also improves skin and hair health,” she said.
According to Dr. Barr, somatic and body-oriented practices can also address chronic and traumatic stress to help regulate the nervous system thereby improving the endocrine system. “These practices help balance cortisol, which positively impacts insulin and sex hormone balance, leading to healthier skin and hair,” she explained. “We can optimize all other systems by bringing regulation into the nervous system.”
Supplements should also be considered a key component of any treatment plan. “It is important for patients to support gut health with probiotics and foods rich in fiber, antioxidants and good fats. Adaptogens, found in supplements that contain ashwagandha, ginseng, rhodiola, bacopa, eleuthero and schisandra, can also help with resilience to stress,” Dr. Cheung shared. Equally important is a diet free of highly processed food and rich in leafy green vegetables and protein so the skin and hair can reap the benefits. “For patients with androgenic alopecia, foods, supplements and drugs that target 5-alpha-reductase, such as finasteride, pumpkin seeds, flaxseed, saw palmetto and those that increase microcirculation, including minoxidil or coenzyme Q 10, can be helpful,” Dr. Mraz stated.
Of course, aesthetic treatments that offer the added benefit of improved skin health should not be glossed over. Injectable collagen stimulators, such as poly-L-lactic acid, calcium hydroxyapatite and polymethyl methacrylate, as well as lasers and energy-based devices can also drive collagen regeneration, helping to improve the health and appearance of the skin.
Aesthetic Medicine Continues to Evolve
As physicians continue to learn more about the endocrine system and how it affects aging, the future of aesthetic medicine will become more personalized and integrated into general health and wellness measures, suggested Dr. Mraz. “So many factors play into the health and beauty of the skin, including genetics, epigenetic factors, the microbiome and lifestyle habits. Physicians and patients are shifting from a purely reactive practice to a more proactive and preventative approach.”
“The tagline at my practice is ‘look better, feel better, perform better,’ which is why I believe in optimizing internal wellness with aesthetic interventions for the best results,” Dr. Cheung stated. “The aesthetic industry will continue to evolve as regenerative medicine becomes more popular. Patients demand better, more long-lasting, natural results, and the endocrine system needs to be addressed as part of a comprehensive anti-aging approach.”
References:
1. Datta D, Madke B, Das A. Skin as an Endocrine Organ: A Narrative Review. Indian J Dermatol Venereol Leprol. 2022;88:590-597.
2. Stevenson S, Thornton J. Effect of Estrogens on Skin Aging and the Potential Role of SERMs. Clin Interv Aging. 2007;2(3):283-297. doi:10.2147/cia.s798
3. Ross M. All About Endocrine Disruptors and Clean Beauty. Jones Road. Accessed September 12, 2024. Available at: https://www.jonesroadbeauty.com/blogs/beauty/ all-about-endocrine-disruptors-and-clean-beauty
4. Zari S, Alrahmani D. The Association Between Stress and Acne Among Female Medical Students in Jeddah, Saudi Arabia. Clin Cosmet Investig Dermatol. 2017;10:503-506. Published 2017 Dec 5. doi:10.2147/CCID.S148499
5. Thornton MJ. Estrogens and aging skin. Dermatoendocrinol. 2013;5(2):264-270. doi:10.4161/derm.23872
