Dr. Nicole Sundene
Hormones and Dermatology are very interconnected in my mind as a Women's Health doctor. From hormonal acne, and dry menopausal skin to perimenopausal “Allergic Skin” that causes eczema, psoriasis, cystic acne, Seborrheic Dermatitis, Dyshidrotic Eczema, and hives, all of these skin changes in women are actually an important alert that hormone imbalance may be the “Root Cause.” Women have fluctuating hormones throughout each month and decade of life.
While most people are aware that testosterone causes acne and hypothyroidism causes dry skin, we will discuss hormones and Dermatology in greater depth than that today to understand exactly what is happening to a woman as she move through her teens and twenties and battles hormonal acne as I once did.
I often see my patients experiencing perimenopausal or menopausal skin changes. Many Dermatologists send me their patients when they cannot resolve their patients symptoms with standard treatments or have noticed a hormonal pattern.
Women over forty in perimenopause and menopause often tell me they feel like they “Rapidly aged ten years overnight,” and ask why their skin has suddenly become so thin, saggy, has lost elasticity, and no longer has a healthy glow. We reminisce about the healthy glowing skin they once had when full of hormones during pregnancy as I fill out a lab slip to evaluate the hormones that are "off" with menopause.
WHAT IS THE CONNECTION BETWEEN HORMONES AND DERMATOLOGY?
As a Naturopathic Hormone Doctor that has treated a lot of women over the years, I do see women's skin changing as they transition through perimenopause and menopause. Generally the skin goes from oily to dry or from already dry to super dry and now having massive issues. Women commonly report new allergic skin conditions they never had before like eczema, psoriasis, hives, seborrheic dermatitis, or dyshidrotic eczema.
While we all tend to associate vaginal dryness with menopause, really the entire body is drying out along with the vagina. So today in this hormone blog I will be discussing exactly what women need to do.
In my mind as a “Holistic Dermatologist,” the main underlying issue is the change in the woman’s hormones. Especially when new skin condition’s pop up in a women’s forties and fifties the first thing we should be thinking about is hormone imbalance rather than reaching for that easy steroid cream to apply. The steroid cream basically is just slapping a band-aid on the Dermatology issue and not addressing it at the “Root Cause.”
Every woman nearing menopause wants to know why their skin is rapidly aging, thinning, and has lost its turgor and elasticity. So today we will be discussing the link between female hormones and skin aging.
ESTROGEN HORMONE AND SKIN HEALTH
Estrogen is responsible for helping keep our skin hydrated as well as builds the layer of collagen behind the skin. Loss of estrogen is why women suddenly notice their skin lacks elasticity, and has become very thin. Thin skin is more likely to bruise because there is less cushion to protect the blood vessels below it and with this women notice that cuts take longer to heal. Women that also bruise easily are those that tend to be low in progesterone which we will discuss next. Easy bruising can also be a sign of anemia from heavy bleeding in perimenopause.
Often women cannot rebuild enough iron stores with just food sources when they have had heavy periods prior to menopause. After the ferritin level is above >75 menopausal women generally do not need to supplement with iron as they are no longer losing blood each month.
Estrogen is the last hormone that women lose when women become officially menopausal. Most women in their late thirties and forties are dealing with low progesterone and low or high testosterone impacting their skin.
The sudden loss of estrogen in menopause though, is when women suddenly notice Hot Flashes along with new Dermatology complaints, or tell me that they have “Aged ten years overnight,” and think to seek me out. As a hormone doctor, I want women to be aware of the shifts to their hormones and skin ahead of time so we can prevent this "rapid aging syndrome" at menopause.
By checking hormones when women turn forty or sooner, we do not need to work to reverse rapidly aged menopausal skin! We can watch for trends and changes and be prepared and treat as needed. Prevention is the queen of Anti-Aging Dermatology!
PROGESTERONE HORMONE AND SKIN HEALTH
Progesterone levels are high in pregnancy which causes our capillaries to increase blood flow aka "vasodilation." This is why pregnant women have that amazing glowing skin everyone comments about, “Look at how she is just glowing!” As progesterone levels decline the blood vessels naturally narrow which is why menopausal women suddenly get High Blood Pressure and heart problems like palpitations, and PVC's that they never had before. The arteries of the cardiovascular system have smooth muscle in them that relaxes arteries, stomach, and lungs. When women develop asthma in middle age, they should consider progesterone deficiency as a "Root Cause" since progesterone is a natural bronchodilator.
However, when progesterone begins to naturally decline around the age of 35 and dwindles down to zero by forty or fifty, this is when women complain to me that their hair, nails, and skin looks sallow, dull, dry, and lacks any form of that “healthy glow.”
Progesterone is also important for vaginal hydration, dry eyes, and irritable bladder. Painful intercourse described often as “Having sex with sandpaper,” is not just caused by lack of estrogen but also lack of progesterone and testosterone. The 90's method of giving women with hysterectomies estrogen only with the new research we now have on progesterone is simply cruel.
For years doctors have argued that because "she has no uterus, she doesn't need progesterone," this gross scientific misnomer should be drop kicked straight back to the 1900's where it belongs. Estrogen monotherapy should be put out to pasture permanently with "Horsey Hormones" aka Premarin for the safety and sanity of women everywhere. Women need progesterone for their eyes, skin, vaginal health, blood pressure, hormonal acne, weight loss, and mental health. Women without progesterone often have troubled sleep riddled with night sweats, anxiety and insomnia.
TESTOSTERONE HORMONE AND SKIN HEALTH
Testosterone is oftentimes viewed as the “Most Evil Hormone” in Dermatology for causing Hormonal Acne, Rage, Oily Skin, and Cystic Acne in my PCOS patients. I worked for three Dermatologists over an eight year period that were constantly trying to battle the evil testosterone with spironolactone and birth control pills with some wins and losses because testosterone is not always the cause of the hormonal acne. Testosterone blocking treatments fail when another hormone such as estrogen, progesterone, thyroid hormone, or adrenal hormones like DHEA are out of balance.
While testosterone is sometimes to blame in hormonal acne, women do need some testosterone in their systems as this is the primary reason why “men age better than women.” Because they have testosterone levels of 800 while women are at 8 if not zero in menopause. Plus I see fantastic results treating my Chronic Fatigue, Chronic Pain, Depression, Anxiety, Mental Health, and Osteoporosis patients with testosterone!
Testosterone is why men don't generally get Osteoporosis unless they have low testosterone levels. Ironically, once I began to see benefits on my patients DEXA's and started to look into the research for Osteoporosis and testosterone, the only research study I found of course was done on men with low testosterone. The good news though, is that bone was built from supplementing with testosterone in the study! A minor women's health victory!
Since both my grandma's had severe Osteoporosis I want all women to know this stuff now so they can prevent painful debilitating fractures that may not ever be able to heal in their "Golden Years." I am excited about testosterone not just for avoiding wrinkles but also for bone health. I have seen testosterone build bone in the past decade of my practice faster than in the first half of my career when we just gave women premarin or natural estrogen aka estradiol for their bones.
Today, my patients that use a cocktail of estrogen, progesterone, and testosterone and eat the mineral rich foods on my Osteoporosis blog along with supplements to ingest the correct 1000 mg of calcium I recommend women intake daily for prevention, and combine all of that with weight bearing exercises at least twenty minutes three times a week, are able to reverse their T scores on their DEXA's.
Now I have revealed on my women's health blog that men age better and have better bone density than women, but we will never admit this out loud! This is a 100% private portal page for women on the internet right? 😉
But I bring this testosterone issue up because if you have ever seen a man wash his face with a bar of dial soap and use no moisturizer afterwards, you know exactly what I am talking about. Men make so much testosterone that their skin is naturally hydrated from within at it’s base and they generally do not need to apply lotion on top. The testosterone stimulates sebaceous gland oil production. Meanwhile women with low testosterone are applying nineteen different products and serums to their skin twice daily.
I just want women educated and understanding why neglecting their hormone imbalance is neglecting their skin, and yet again how unfair it is to be female versus male. Plus now you have medical proof to substantiate to your husband that you do need to buy all of those anti-aging serums and he is totally fine without any!
Testosterone naturally begins to decline around the age of 35. This is when women notice not just dry skin, but that their skin lacks any form of oil or hydration, and their hair is also suddenly dry and coarse. Perimenopause is also when female hair loss begins.
Women generally report lack of stamina, chronic fatigue, depression, and that they are not bouncing back as quickly from their workouts and their muscles and joints feel inflamed and in pain for several days after a workout. Suddenly it becomes exhausting to try to exercise two days in a row if not impossible.
Keep in mind that men with "low testosterone" of 300 complain of joint pain and muscle aches while many of my female patients are at zero. So men are tired and in pain at a level of testosterone 30 times higher than what most women have in menopause, and many of us will never be at that level, nor should we be.
Testosterone helps our joints and muscles heal and repair, so if you notice you are in chronic pain, more tired than normal after a workout this is generally one of the the very first early warning signs of perimenopause for most of my patients, and a sign you need to get on my SCHEDULE to have your hormones checked! Especially if you are having night sweats or beginning to feel overheated at night.
Testosterone has always been the villain in Dermatology because it stimulates the oil glands in our skin causing acne. However, we do need some testosterone as women or our skin looks dry and lacks any form of protective oil that provides shine to our faces. While we don’t need our complexions dripping with visible oil, we do need some oil to prevent rapidly aging skin in menopause!
WHAT IS THE TREATMENT FOR MENOPAUSAL HORMONE CHANGES TO THE SKIN?
Hormonal Acne, and Menopausal Hormone changes to the skin require a physician skilled in both Dermatology and Hormones. The first step is for a Female Hormone Specialist (please not your Family Doctor, Endocrinologist, or Obgyn) to check your full set of female hormones, adrenals, and thyroid as these are ALL equally important in my mind. Oftentimes I sadly receive new patients that think that they have “already had all their hormones checked,” only to receive one test or a one page report that they proudly hand me. A TSH is not a full hormone panel, it is not even a full thyroid panel. An FSH/LH to confirm you are menopausal is almost utterly useless. Why????
Occasionally the correct tests are ordered but the doctor ordering the test does not know how to properly interpret them because the hormones fluctuate in different parts of a woman's menstrual cycle and have to be tested at the right time. We also need to look at what is optimal and not just look for things in bold that are clearly abnormal when it comes to chronic skin conditions and Dermatology.
This is where I see a lot of women fail with having their hormones checked with perimenopause, PCOS, and hormonal acne. Testing hormones in the wrong part of the cycle, and/or not testing the correct hormones is totally ineffective for solving women's skin conditions.
Lets instead test all the nutrition and hormonal metrics related to skin health to properly address Dermatology conditions, especially in menopausal women and those with PCOS, thyroid conditions, and perimenopause.
My initial hormone test report is four pages long at minimum. Most insurance covers hormone testing for women unless it is of course government funded. Only the government could care less about your hormones! But they are still very important for proper skin health, which is why I have written this blog about how they impact women during different stages of their lives in my Holistic Dermatology practice.
So if you have not had hormones properly checked, and are struggling with skin rashes, hormonal acne, eczema, or psoriasis, simply visit my SCHEDULE page to treat yourself to a Naturopathic Hormone visit!
In my experience of fifteen years working as a “Holistic Dermatologist,” very few skin conditions in Women's Health are not hormonal.
Dr. Nicole Sundene
Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Specialist in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause, Thyroid, Hashimotos, PMS, Perimenopause, Autoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology , Acne, Psoriasis, Eczema and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 22 years of experience in both Prescription and Natural women's health and hormones she presents to women the best integrated health solutions for their Chronic Disease. She has been an Herbalist for over 27 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on Instagram, Twitter and Facebook for more tips on Women's Health, Female Hormones and Naturopathy!