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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Dr. Siobhan Deshauer tells us what our hands say about our health—she’s not practicing palmistry though; she’s a rheumatologist, and everything here is about clinical signs of health/disease.

The signs include…

“Spider fingers” (which your writer here has; I always look like I’m ready to cast a spell of some kind), and that’s really the medical name, or arachnodactyly for those who like to get Greek about it. It’s about elongated digits. Elongated other bones too, typically, but the hands are where it’s most noticeable.

The tests:

• Make a fist with your thumb inside (the way you were told never to punch); does your thumb poke out the side notably past the edge of your hand, unassisted (i.e., don’t poke it, just let it rest where it goes to naturally)?
• Take hold of one of your wrists with the fingers of the other hand, wrapping them around. If they reach, that’s normal; if there’s a notable overlap, we’re in Spidey-territory now.

If both of those are positive results for you, Dr. Deshauer recommends getting a genetic test to see if you have Marfan syndrome, because…

Arachnodactyly often comes from a genetic condition called Marfan syndrome, and as well as the elongated digits of arachnodactyly, Marfan syndrome affects the elastic fibers of the body, and comes with the trade-off of an increased risk of assorted kinds of sudden death (if something goes “ping” where it shouldn’t, like the heart or lungs).

But it can also come from Ehlers-Danlos Syndrome!

EDS is characterized by hypermobility of joints, meaning that they are easily flexed past the normal human limit, and/but also easily dislocated.

The tests:

• Put your hand flat on a surface, and using your other hand, see how far back your fingers will bend (without discomfort, please); do they go further than 90°?
• Can you touch your thumb to your wrist* (on the same side?)

*She says “wrist”; for this arachnodactylic writer here it’s halfway down my forearm, but you get the idea

For many people this is a mere quirk and inconvenience, for others it can be more serious and a cause of eventual chronic pain, and for a few, it can be very serious and come with cardiovascular problems (similar to the Marfan syndrome issues above). This latter is usually diagnosed early in life, though, such as when a child comes in with an aneurysm, or there’s a family history of it. Another thing to watch out for!

Check out the video for more information on these, as well as what our fingerprints can mean, indicators of diabetes (specifically, a test for diabetic cheiroarthropathy that you can do at home, like the tests above), carpal tunnel syndrome, Raynaud phenomenon, and more!

She covers 10 main medical conditions in total:

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Want to read more?

• We Are Such Stuff As Fish Are Made Of ← because collagen comes up a lot in the video
• How To Really Look After Your Joints

Take care!