bio identical hormone therapyHow Do Bio-Identical Hormones Make You Look Younger?

You know, sagging cheeks, wrinkles and frown lines? The surprising answer is that you have more control over facial aging than you think.

Factors such as divorce, smoking, and the use of anti-depressants dramatically accelerate facial aging.

So what is beneficial in making women’s faces look more youthful?

Hormone replacement therapy. Yes, a Case Western Plastic surgery study found that hormone replacement therapy made a big difference by reducing the aging process.

Aging, especially in the skin seems to accelerate after menopause in women.

Aging faster with wrinkles spreading rapidly, skin quickly loses elasticity and smoothness are common features in postmenopausal women not receiving hormone replacement therapy.

The basis for the use of topical estrogen therapy stems from the documented evidence of reducing diseases of aging, including heart disease, osteoporosis and cancer but also in the estrogen depleted chronological aging of our skin.

To a large degree the features of aging skin seem to result from the decline in estrogen levels after the menopause. Of all hormones that decline with age, estrogens have the most dramatic effect on the skin. Estrogens are known to protect women from heart disease, and now it seems that they also slow down skin aging.

Several studies indicate that postmenopausal women on estrogen replacement therapy develop less wrinkles and have better skin texture and elasticity than those not taking estrogens.

Studies in postmenopausal women have demonstrated significant decrease skin thickness with marked thinning of the epidermis (outer skin layer), loss of critical collagen resulting in deterioration of skin structures, deepening of wrinkles and widening of skin pores.

The more rapid the collagen loss, which occurs in the first two years after menopause, the more dramatic the appearance of aging in these women.

Studies have shown up to a 30% loss of skin collagen immediately after menopause and the loss continues if there is no estrogen replacement received.

This British Medical Journal study amazingly showed that women who then received topical estrogen therapy experienced an increase in skin collagen content 48 % higher than those who did not received hormone replacement therapy.

Proper bioidentical hormone replacement with estrogen, progesterone and testosterone replacement is a complex decision requiring the analysis of one’s medical history and a physician who has the knowledge to expertly balance a women’s hormones.

Women after menopause have been shown to have improved skin benefits using estrogen topical preparations.

A University of Vienna study in postmenopausal women demonstrated a marked improvement in skin elasticity and firmness after only six months of therapy; wrinkle depth and pore size decreased by over sixty percent in both estradiol and estriol groups. Skin moisture and collagen synthesis increased significantly.

I believe that estrogen creams could also improve the signs of aging in premenopausal women as well although further studies are needed to confirm that. The Plastic and Reconstructive Surgery article showed that hormone replacement therapy dramatically reduced the appearance of facial aging in women.

So not only does hormone replacement reduce your risk of heart disease, cancer , and osteoporosis, but it also makes you look younger.

So now you have European and American studies that support the benefits of Hormone Replacement therapy on the skin.

The benefits of Hormone replacement therapy on the heart, bones, memory and cancer are being clearly documented in the medical literature. So, it’s about time we took the fear out of HRT and provide women with a safe and healthy approach to wellness. Now that sounds like a great idea to me.


Treating women and men for the past 26 years, I’ve noticed that estrogen in women is restorative to skin, hair, nails. Without estrogen, it seems that women struggle to maintain the viability of their skin. And that means not just the skin on your face, but the fragile thinning skin on your arms and hands as well.

The more estrogen, the better skin, hair and nails, but this finding and the inaccurate believes surrounding estrogen have created a dilemma for women and their physicians. The effectiveness of systemic estrogen replacement in reversing skin aging has by now been well validated by research.

Unfortunately women have been repeatedly told how bad estrogen can be. But all estrogens aren’t the same. 

There is Estrone, or E1, that has breakdown products that cause cancer. I DON’T LIKE THIS ONE AND DO EVERYTHING TO KEEP THIS LOWER IN ALL WOMEN. This same hormone, Estrone, made primarily in fat tissue, is the one that causes women to gain at least 20 pounds with menopause.

It is the most abundant form of estrogen after menopause, and I believe the reason why 80% of the breast cancers occur postmenopausally, a time in a woman’s life, when her estrogen levels are as low as when she was a 10 year old girl.

Estradiol is the primary hormone of youthful women that disappears at the time of menopause. Estradiol or E2 reduces heart disease, provides a sharp mind and memory, helps reduce inflammation, and maintains bone health.

Restoring Estradiol postmenopausally, I believe is the reason why bioidentical topical hormones, actually reduced breast cancer in a European study by 24%. It will reduce the Estrone, or E1 in the fat tissue, the same one that is related to breast cancer and is often 1000 x higher in a women’s breast than circulating in her blood stream.

By the way, the use of oral estrogens or Premarin will dramatically increase the dangerous Estrone levels as well, but not the topical creams applied to the skin. I never recommend the use of oral estrogens for the management of menopausal symptoms.

The final Estrogen is Estriol, or E3. This one is associated with a dramatically lower lifetime risk for breast cancer. Some authors consider it protective for breast cancer, and that is my philosophy as well. Estriol is an amazing cure for vaginal dryness, urinary incontinence and recurrent urinary tract infections, and the data is now accumulating which supports the amazing dermal or skin benefits for Estriol.

Unfortunately, inaccurate reports in magazines create fear and dread for Estrogen. Ill-informed, but presumably good intentioned writers and individuals paid off by the big drug companies propagate these fears in the lay press that Estrogen is bad and that is why women need to become their own advocates and diligently search out the real truth.

And the truth is that hormone replacement, done correctly is safe and will protect your heart, reduce cancer, maintain healthy bones, reduce weight, and maintain a sharp memory.

My patients are very educated about the benefits of Estrogen. They often know much more than their gynecologist about the issues of Estrogen metabolism.

Recent reports have demonstrated the benefits of Estrogen on the skin and my patients know that using Estriol topically is so very beneficial for their entire body, but will it work locally to manage the wrinkles and the aging skin process? Is there any way to obtain the dermal benefits of estrogens locally?

And does it reach systemic levels for women who are Estrogen dominant between their 40’s and 50’s, have had breast cancer and told to avoid Estrogen, or women who are afraid or not sure if using Estrogen is safe?

The short answer is yes, women can benefit locally from the amazing skin improvements, and won’t increase systemic levels significantly. Let’s summarize these studies and the dramatic dermal benefits demonstrated in these numerous studies.

  1. Greater epidermal and dermal thickness because of increased collagen production.
  2. Wrinkles disappear as they become filled in with healthy skin.
  3. Better structure and order to the elastin fiber matrix. (aging will cause a “disorderly” deposition of the elastin fibers, thus resulting in uneven texture.)
  4. Greater vascularization (i.e. more blood vessels allow better oxygen and nutrient delivery to the skin).
  5. Higher levels of hyaluronic acid (primary substance in expensive fillers like Restylane) and mucopolysaccharides, which all result in increased dermal hydration.
  6. Inhibition of excessive sebum (skin oil) production, thus better control of acne.
  7. Diminished facial hair in both texture, color and quantity. So essentially less facial hair, and the hair is less masculine in type being less coarse and dark.
  8. Antioxidant action, essential for healthy skin and therefore protects the skin against free radical damage.

There is a big difference between estrogens provided topically or orally as a pill. I will not ever use an oral estrogen as they increase inflammation, increase weight gain, increase gall bladder problems and dramatically increase Estrone levels, the estrogen that causes breast cancer and needs to be reduced.

However topical Estrogens, Progesterone, and testosterone will interact with your body, just as if they were your own hormones when you were 20 years old. So what about the effects of estrogens applied topically in the form of a cream?

Two studies by Dr. Jolanda Schmidt, a small pilot and a larger follow-up, have finally provided some answers.

Dr. Schmidt compared the effects of two types of cream: .01% estradiol cream (that’s 0.1mg/g) and 0.3% Estriol cream (3mg E3/gr) on the skin of 58 women between the ages of 44 and 66. None used HRT.

All subjects were instructed to use the same cleansing and cosmetic regimen, and to apply 1g of cream to the face once a day. Measurements of skin elasticity, moisture content, vascularization, wrinkle depth, and pore size were done at baseline and after 6 months of treatment. There was no “vehicle only” control group, but a previous study using a control group had already confirmed a considerable physiological impact of estriol on the skin.

Results: there was a dramatic improvement on all measures in both the estradiol and the estriol group. The estriol group showed the improvement faster. The chief advantage of estriol, however, turned out to be lack of side effects. Only one woman in the estriol group reported a possible side effect, namely itching.

In the estradiol group, one subject complained of reddening of the face, and three noticed increased pigmentation. Serum levels of estradiol and estriol were unaffected by the facial treatment. Vaginal smear remained atrophic, confirming the absence of systemic effects.

The post-study pictures of the improvement of the depth of wrinkles using the 0.3% estriol cream was impressive. We see age spots fading in color with properly balanced bioidentical topical therapies. Part of estriol’s beneficial effects on the skin may be not just its stimulation of growth factors, but also its antioxidant properties. Estriol and its metabolites are surprisingly potent antioxidants.

Dr. Schmidt concludes: “Estriol, a biologically weaker estrogen, shows predominantly epidermotropic effects or healthy skin appearance with the formation of new skin tissue. Also there is a lack of any systemic side effects with the topical therapies. These promising local effects after topical external use only, suggests that Estriol should gain importance in topical use in dermatology in the future, although the fear factor still has to be overcome for some patients.

For my patients who have read extensively, are extremely knowledgeable and devoted to optimizing their health using bioidentical hormone therapies, the addition of Estriol as a topical to improve and promote healthy youthful skin is an exciting safe addition to achieving a youthful appearance.

To my knowledge, there is no commercial interest in developing estriol products, but we routinely recommend them for use in patients suffering with vaginal dryness. Hoyes Pharmacy in Tampa, Florida has spearheaded an ingenious effort to offer Estriol now as an adjunct to healthy youthful skin.

Note that peri-menopausal women can use the Estriol cream without worrying about raising their serum estrogen levels. But note also that those women who use the classic extremely weakest or best formula that contains only .125mg of estradiol have their answer of why it hasn’t done anything for their vaginal dryness or their memory loss.

I usually start at Estradiol/Estriol topical cream with a 6-8 mg , 60:40 ratio of Estriol:Estradiol, which translates into 3.2 mg of Estradiol versus the often extremely low levels used of .125 mg. My patients see results in weeks, not months.

One of the amazing results from the studies is the dramatic topical effect of using Estriol cream and the filling in of wrinkles on the neck area. That, together with the fading of keratoses and repair of sun damage and sunspots means a healthy appearing face and neck and it is not just an appearance, the skin is so much more healthy.

Other hormones have also been shown clinical to improve the appearance of the facial and neck skin. The effects of topical progesterone, pregnenolone, with Estriol may show even better improvements in the quality of the skin, and the reduction of acne and facial hair growth.


So far there is anecdotal evidence that the use of testosterone cream on the face provides a fabulous facelift. Testosterone is known to promote collagen production even more effectively than estrogens, so it would come as no surprise if a future study should discover that for men a T cream is the best cosmetic.

But such a study is yet to be performed.

For now it is obvious that the use of T cream or gel in a manner that raises serum T level, in other words testosterone replacement, does have a very quick, positive impact on men’s skin. Within ten days or so, one can see greater freshness and rosiness, and deeper color of the lips. The rejuvenating effects of testosterone replacement on aging male skin are unmistakable, and begin to happen enviably fast.

To learn more about bio-identical hormone replacement therapy, phone Dr. Robert Carlson (941) 955-1815.