Skin, hair, and nails are often thought of purely as a beauty thing, but in fact they can be indicative of a lot of other aspects of health. Dr. Andrea Suarez takes us through some of them in this video about the systemic (i.e., whole-body, not just related to sex things) effects of estrogen, and/or a deficiency thereof.

Beyond the cosmetic

Low estrogen levels are usual in women during and after untreated menopause, resulting in various changes in the skin, hair, and nails, that reflect deeper issues, down to bone health, heart health, brain health, and more. Since we can’t see our bones or hearts or brains without scans (or a serious accident/incident), we’re going to focus on the outward signs of estrogen deficiency.

Estrogen helps maintain healthy collagen production, skin elasticity, wound healing, and moisture retention, making it essential for youthful and resilient skin. Declining estrogen levels with menopause lead to a thinner epidermis, decreased collagen production, and more pronounced wrinkles. Skin elasticity also diminishes, which slows the skin’s ability to recover from stretching or deformation. Wound healing also becomes slower, increasing the risk of infections and extended recovery periods after injuries or surgeries—bearing in mind that collagen is needed in everything from our skin to our internal connective tissue (fascia) and joints and bones. So all those things are going to struggle to recover from injury (and surgery is also an injury) without it.

Other visible changes associated with declining estrogen include significant dryness as a result of reduced hyaluronic acid and glycosaminoglycan production, which are essential for moisture retention. The skin becomes more prone to irritation and increased water loss. Additionally, estrogen deficiency results in less resistance to oxidative stress, making the skin more susceptible to damage from environmental factors such as UV radiation and pollution, as well as any from-the-inside pollution that some may have depending on diet and lifestyle.

Acne and enlarged pores are associated with increased testosterone, but testosterone and estrogen are antagonistic in most ways, and in this case a decrease in estrogen will do the same, due increased unopposed androgen signaling affecting the oil glands. The loss of supportive collagen also causes the skin around pores to lose structure, making them appear larger. The reduction in skin hydration further exacerbates the visibility of pores and can contribute to the development of blackheads due to abnormal cell turnover.

Blood vessel issues tend to arise as estrogen levels drop, leading to a reduction in angiogenesis, i.e. the formation and integrity of blood vessels. This results in more fragile and leaky blood vessels, making the skin more prone to bruising, especially on areas frequently exposed to the sun, such as the backs of the hands. This weakened vasculature also further contributes to the slower wound healing that we talked about, due to less efficient delivery of growth factors.

Hair and nail changes often accompany estrogen deficiency. Women may notice hair thinning, increased breakage, and a greater likelihood of androgenic alopecia. The texture of the hair can change, becoming more brittle. Similarly, nails can develop ridges, split more easily, and become more fragile due to reduced collagen and keratin production, which also affects the skin around the nails.

As for what to do about it? Management options for estrogen-deficient skin include:

• Bioidentical hormone replacement therapy (HRT), which can improve skin elasticity, boost collagen production, and reduce dryness and fragility, as well as addressing the many more serious internal things that are caused by the same deficiency as these outward signs.
• Low-dose topical estrogen cream, which can help alleviate skin dryness and increase skin strength, won’t give the systemic benefits (incl. to bones, heart, brain, etc) that only systemic HRT can yield.
• Plant-based phytoestrogens, which are not well-evidenced, but may be better than nothing if nothing is your only other option. However, if you are taking anything other form of estrogen, don’t use phytoestrogens as well, or they will compete for estrogen receptors, and do the job not nearly so well while impeding the bioidentical estrogen from doing its much better job.

And for all at any age, sunscreen continues to be one of the best things to put on one’s skin for general skin health, and this is even more true if running low on estrogen.

For more on all of this, enjoy:

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Take care!