About one hundred years ago humans doubled their life
expectancy. This was a monumental feat, given that the number of years the
average person was expected to live was a relatively constant number throughout
most of human history. Nutrition, modern medicine and technology were mostly
responsible for this dramatic change. In 2007, average life expectancy was 80.4
years for women, and 75.3 years for men. This gap may be narrowing, but one
thing is clear – there is virtually a new population in the human experience,
and women are the chief contributors. The aging female client is the backbone
of our industry.
Note that while female life expectancy has increased
dramatically over the years, the age of menopause onset has remained stable at
around 50 years of age. This means more and more women live in a
hormone-deprived state, a relatively new phenomenon in human existence. There
is no decisive reason as to why women in particular live long past their
reproductive years, but there is an interesting hypothesis that may shed some
light. In fact, it is called the “grandmother hypothesis” and it argues that having
an older female to help nurture children ensures that the younger generation
reaches its maximal evolutionary potential. That is, having Granny around the
house to help with the kids ensures they are well-behaved, fed and safe so they
too can have long, healthy lives. Although extended longevity seems like a
great advantage of the 21st century, it opens up a lot of doors for age-related
changes and disease. Many of these changes also take place on the skin, so
having a full understanding of how hormones – and the lack of them – affect
skin will benefit the professional skin therapist in everything from
consultation and skin analysis to providing effective and realistic solutions
to the aging, hormone deprived client.
The Role of
Hormones
One of the most important factors involved in the
initiation of aging is the endocrine system. Particularly important for women,
the endocrine system produces and regulates hormones, which decline, sometimes
drastically, with age. Hormones are chemical messengers that are produced in
organs such as the ovaries, adrenal glands and thyroid glands. Sex steroid
hormones, thyroid and growth hormones are involved in many different functions
such as growth, immune, reproductive and metabolic functions, and even hunger
and stress. Unlike extrinsic aging, which requires external factors like
ultraviolet (UV) radiation, lifestyle and pollution to cause deep wrinkling and
photodamage, intrinsic skin aging is governed by our own body’s biological
clock. Dryness, fine wrinkling and paleness is all part of the natural process
of skin aging. Many factors are involved in intrinsic skin aging: genetic
mutations, increased inflammatory signals, decreased lipid production and
decreased hormone levels. These hormone changes are now being more closely
examined to reveal just how important they are to skin health, especially in
women. How do these hormones act on the skin?
And specifically, how do they impact skin aging?
1. Estrogen
When it comes to popular hormones, estrogen takes the prize for most widely known and discussed. However, there are many misconceptions about this elusive and incredibly important substance. First, it is not purely a female hormone. True, it is primarily made in the ovaries and is abundant in females, but it is also found in males and made in different tissues outside of the ovaries. Secondly, the word estrogen actually encompasses a group of chemically similar hormones, so it is not a single substance. Estrogens include estradiol, the most abundant form in adult females, estriol, the primary estrogen during pregnancy and estrone, which is produced during menopause. Interestingly, in females, estrogens are made by converting the male hormones, known collectively as androgens, into estrogens. And these androgens are initially derived from cholesterol, the primary steroid that gives rise to many steroid hormone families. The conversions from cholesterol to androgens, or from androgens to estrogens, is all made via the actions of certain key enzymes. Without these enzymes, conversion would not be possible. The skin, among its myriad of functions, also has the necessary components to produce both cholesterol – and derive sex steroids from it – within the skin.
1. Estrogen
When it comes to popular hormones, estrogen takes the prize for most widely known and discussed. However, there are many misconceptions about this elusive and incredibly important substance. First, it is not purely a female hormone. True, it is primarily made in the ovaries and is abundant in females, but it is also found in males and made in different tissues outside of the ovaries. Secondly, the word estrogen actually encompasses a group of chemically similar hormones, so it is not a single substance. Estrogens include estradiol, the most abundant form in adult females, estriol, the primary estrogen during pregnancy and estrone, which is produced during menopause. Interestingly, in females, estrogens are made by converting the male hormones, known collectively as androgens, into estrogens. And these androgens are initially derived from cholesterol, the primary steroid that gives rise to many steroid hormone families. The conversions from cholesterol to androgens, or from androgens to estrogens, is all made via the actions of certain key enzymes. Without these enzymes, conversion would not be possible. The skin, among its myriad of functions, also has the necessary components to produce both cholesterol – and derive sex steroids from it – within the skin.
In the skin, estrogens affect skin thickness, wrinkle
formation and skin moisture. Estrogens can increase glycosaminoglycans (GAGs),
such as Hyaluronic Acid, to maintain fluid balance and structural integrity.
They can also increase collagen production in the skin, where they maintain
epidermal thickness and allow skin to remain plump, hydrated and wrinkle-free.
During periods of elevated hormonal activity, such as pregnancy or with some
oral contraceptives, skin pigmentation is exacerbated in certain sun-exposed
areas such as the forehead, nose and cheeks. This phenomenon, known as melasma,
is strictly hormone-related and is a clear example of hormonal effects on the
skin pigmentation. The skin is not the only external feature that benefits from
estrogens. Besides resulting in plump, healthy skin, estrogens can also make
hair grow long and healthy. During pregnancy, women often experience hair
growth, where the anagen phase is prolonged. The plummeting post-partum and
even menopausal estrogenic levels cause thinning and falling hair, sometimes
resulting in clinically significant hair loss, the so-called telogen effluvium.
In essence, estrogens help our skin and hair remain
youthful. Of course, with puberty, menstruation and menopause, progesterone is
also a key player. However, the research is still scant in this area. Future
research will hopefully shed some light on the interactions between estrogens
and progesterone, to better understand these described changes in skin and
hair.
Phytoestrogens (plant estrogens) are compounds found
naturally in plant foods, one you may have heard of is flaxseed. Although it’s
known as a natural estrogen mimicker, eating flaxseed actually helps estrogen
metabolism improving the breakdown and removal of estrogen helping to avoid
excess levels in your body. Too high levels of estrogen can cause other
problems which we will get to.
Various herbs and botanicals such as maca, black cohosh,
and hops have also been shown to help address symptoms of low estrogen. In some
cases, women may benefit from bioidentical hormone therapy (BHT), which
requires the support of a well-trained hormone specialist.
Having estrogen levels that are too high is not good
either. This can trigger melasma, or can worsen PMS. And, if estrogens aren’t
being properly metabolized, then it could increase your risk for certain types
of cancer (such as breast cancer). Eating seaweed and cruciferous veggies
(broccoli and kale), seasoning foods with turmeric, and taking supplements such
as DIM (diindolylmethane, found in cruciferous vegetables) can help boost your
metabolism of estrogen, which can naturally help lower the levels.
2. Cortisol
Ever noticed how your skin goes out of whack when you spend your nights working on a big presentation? Cortisol is responsible for that. Popularly known as the stress hormone, cortisol is a produced as a natural reflex to help the body deal with stress. However, if cortisol is sustained in in high doses over a long period of time, it affects the skin and leaves it pimple-ridden and excessively dull.
Not all stress is bad, and your body is well equipped to
handle it. This physical response helps us to react quickly when faced with a
dangerous situation — but balance is key. The problems occur when we are
exposed to repeated or continuous stress. This is when your body has a hard
time maintaining homeostasis and will keep triggering physical
reactions—eventually overwhelming your systems.
Chronic stress can worsen conditions including acne,
eczema, rosacea, and vitiligo. Practicing relaxation techniques such as breath
work, moderate exercise, and meditation can effectively help manage stress,
especially when you make them a daily practice.
If you often feel “tired but wired,” you may have
imbalances in your cortisol levels, also called adrenal fatigue. Have you
noticed you’ve gained extra weight around your midsection or have fatigue,
sugar cravings or insomnia? If so, you’ll need extra support for your adrenals
to balance your cortisol levels. Adaptogenic herbs such as Rhodiola,
ashwagandha, astragalus, and ginseng may help.
An easy saliva test of your cortisol level can help you
find out what your levels are, so talk to your healthcare provider for more
information about testing. If you do suffer from imbalances in cortisol, the
recommendations I give in my book will help support your adrenal function.
You can also support your skin externally with skincare
products containing adaptogenic herbs like ginseng (Eleutherococcus senticosus)
root extract. Ginseng is a powerful adaptogen herb that increases the overall
resistance to all types of stress and helps rejuvenate and invigorate
tired-looking skin.
3. Testosterone
Testosterone is the chief male sex hormone and is the primary reason for everything that makes a man, well… male. Coarser hair, thicker and oilier skin, and generally a later onset for showing signs of skin aging are all due to testosterone. Female pattern alopecia, or baldness, is attributed to increased androgen levels and is the most common cause of hair loss in women. With age, the estrogen-androgen ratio becomes unbalanced, and changes are seen following menopause. Since androgens, and in particular, testosterone, are involved in skin sebum production, females may experience increased oiliness or even adult acne when hormones become unbalanced during menstruation or menopause. The effects of androgens on skin are important in both male and female clients, as both can experience effects of altered androgen levels.
One way to help curb extra sebum production is to avoid
dairy. Dairy products are made from the milk of pregnant and recently pregnant
cows, which means it contains hormones that can potentially throw your own
hormones out of balance. In addition, for many people, eating dairy products
triggers inflammation in the body.
Additionally, it is recommended getting more omega-3s (in
fish and supplements) and zinc. Omega 3 fatty acids are essential fatty acids
which means we have to get them in the foods we eat or supplements we take. A
diet short of these nourishing fats can leave your skin dry, itchy, and prone
to acne so make sure to get enough. You can get zinc in a supplement or from
eating green beans, sesame seeds, and pumpkin seeds.
If you still have trouble with excess sebum and
breakouts, taking a saw palmetto supplement may help, but check with your
healthcare provider before starting any new supplement. You could have a
negative reaction if you take too much of something or you could have an
interaction with medications you’re taking. Also, if you’re supplementing with
testosterone or DHEA (a hormone that converts to testosterone), it could
increase the size and secretion of sebaceous glands. If your doctor has
prescribed these for you and you have acne, double check to make sure you are
on the right treatment regimen.
4. Melatonin
There's a reason they call it beauty sleep, you know - and melatonin is the reason why. It is known as the vampire hormone because it is produced in the darkness of the night and declines by the time dawn breaks. Melatonin is known to be a powerful antioxidant as it neutralizes free radical damage and turns back the signs of ageing.
4. Melatonin
There's a reason they call it beauty sleep, you know - and melatonin is the reason why. It is known as the vampire hormone because it is produced in the darkness of the night and declines by the time dawn breaks. Melatonin is known to be a powerful antioxidant as it neutralizes free radical damage and turns back the signs of ageing.
5. Thyroid Hormones
The thyroid is a small butterfly-shaped gland situated
just in front of the voice box. The thyroid gland makes two thyroid hormones
which affect metabolism, brain development, breathing, body temperature, muscle
strength, bone health, skin dryness, menstrual cycles, weight and cholesterol
levels. Again, balance is key when it comes to these hormones. Too much, and
skin can become warm, sweaty and flushed. Too little, and skin becomes dry,
coarse, thick and even sweating is decreased. Thyroid dysfunction can also lead
to thinning hair and eventual hair loss.
If you suffer from any of these skin problems and have
weight, digestion (constipation or diarrhea), or energy issues (fatigue or
feeling overly stimulated), talk with your doctor about thyroid testing.
If your thyroid is low, high, or you have antibodies,
you’ll want your treatment tailored specifically to the problem. TSH (thyroid
stimulating hormone), Free T3, Free T4, thyroid antibodies and reverse T3 are
the blood tests to ask your doctor to run. When the results come back, ensure
they’re within optimal ranges, rather than the broad “normal” range. To help
achieve optimal thyroid function, consider working with a licensed naturopathic
physician or functional medicine practitioner.
The Female Menopause
In our culture, menopause is frequently seen in a negative light, as something that requires medical attention and signifying a time of loss. Women are bombarded with messages about the impending doom of menopause even before they begin to have children. It is no wonder, then, that women tend to develop a negative body image during this transitional period. However, this transitional period is a completely natural process that must be understood in order to be appreciated. Only then can women take charge of their bodies and transition to menopause in a healthy and positive manner. So, what occurs on the skin during perimenopause – the transitional period before menopause – and after menopause?
We know that the decline of B-Estradiol during menopause
is one of the culprits in the accelerated aging of the skin. We also know that
menopause is mostly caused by age-related changes in the ovaries, and the
number of follicles remaining in the ovaries of menopausal women is
significantly reduced. In addition, the follicles that remain become less
sensitive to stimulation by pituitary hormones, even though their levels are
elevated, resulting in fewer mature follicles and a reduction in the production
of corpora lutea. This results in lowered estrogen and progesterone production,
which in turn leads to changes in the skin.
As a woman gets closer to menopause, the following
changes begin to occur in the skin:
* Oily Skin: During the reproductive years, B-Estradiol
stimulates a more fluid sebaceous gland secretion (“anti-acne” effect). During
menopause, as estrogen levels decrease, testosterone (produced by the adrenal
glands) is no longer masked in the woman’s body. Testosterone reveals itself by
stimulating sebaceous glands to secrete thicker sebum, giving the appearance of
oily skin (and the tendency toward adult acne in some women).
* Facial Hair: Also due to the unmasking of testosterone,
some women may develop facial hair, particularly in the chin area.
* Sagging Skin and Wrinkles: Estrogens stimulate fat
deposits over the female body; as estrogen levels drop during menopause, fat
deposits tend to become redistributed and often concentrated over the abdomen
and/or on the thighs and buttocks. The result is a loss of supportive fat below
the skin of the face, neck, hands and arms; this allows sagging wrinkles to
appear, and the skin over these areas is less easily compressed, as it loses
its mobility. Also, fat deposits are reduced in the breasts, resulting in loss
of turgor, which causes the breasts to begin to sag and flatten.
* Elastosis: Protein synthesis, particularly that of
collagen and elastin, are partially controlled by estrogens. Thus, during
menopause, the lowered estrogen levels result in less production and repair of
collagen and elastin in the dermis of the skin. This lack of repair is
particularly pronounced if the skin is exposed to ultraviolet (UV) rays. UV
rays are very destructive to collagen, and if we lose our repair mechanism,
then we lose our skin’s resiliency. This results in elastosis.
* Thinning Epidermis: The growth and maintenance of blood
capillaries in the dermis are partially under the control of the estrogens.
Thus, blood flow through the dermal capillaries is reduced during menopause,
and less nutrients and oxygen are available to the Stratum Germinativum or
Basal Cell layers of the epidermis. This contributes to the thinning of the
epidermis and a slower cell turnover rate, which is accompanied by a reduction
in the barrier function of the epidermis, leading to increased trans-epidermal
water loss and dry skin.
An interesting note, the cells that make up the surface
of the skin are similar in structure to those of the urinary tract and vagina. Often,
when a woman begins to notice changes in her skin (wrinkling, sagging, dryness,
flaking, loss of resiliency, etc.), there are similar changes occurring in the
lining of the urethra, bladder and vagina. Thus, the skin may be revealing
other tell-tale signs of menopause.
* More Prone to Sun Damage: The maintenance of
Melanocytes (cells that manufacture the pigment Melanin) is under the control
of estrogens. As menopause progresses, the number of melanocytes in the skin is
reduced (they degenerate). With less melanocytes, we produce less of the
protective melanin and skin appears lighter. Menopausal skin is, therefore,
more prone to sun damage, making it even more important to protect the skin
with a sunblock.
* Hyperpigmentation / Age Spots: Estrogens also temper
melanin production. That is, estrogen exerts a regulatory effect on the
production of melanin; it keeps it under control. In areas of the skin that
have been exposed to UV rays over the years, as menopause arrives, melanin
synthesis increases (due to lack of regulation by estrogen). This can result in
brown “age spots” appearing on the face, hands, neck, arms and chest of many
women.
* Hot Flashes: Hot flashes are typically defined by a
strong sense of warmth in the skin, (mainly the face), followed by excessive
sweating. It had long been thought that hot flashes were caused directly by the
abrupt lowering of B-Estradiol levels, but we now know that a woman’s
sympathetic nervous system is more active after menopause because of low
estrogen, causing the dilation of skin arterioles and sweating, as well as the
rise in body temperature and an increase in heart rate. Hour-to-hour changes in
the secretion of the Luteinizing Hormone (LH) from the pituitary gland of
post-menopausal women have also been associated with hot flashes.
Sources and
Additional Information:
