HRT for anti-aging: The hormones and the benefits

Dr. Moy

Beverly Hills, Calif., dermatologist Ronald Moy, M.D., says skin and other concerns often come up when he talks with female patients in their 40s, 50s, 60s and beyond who are preparing to have skin rejuvenation procedures. They’ll share a laundry list of typical perimenopausal and menopausal symptoms, from dry skin to lack of sleep, he says.

So, for the last decade, Dr. Moy has added a bioidentical hormone treatment component to his practice. Bioidentical hormone treatment might start with the goal of tightening and thickening aging skin, but also offers a host of other benefits, including better mood, improved sleep and much more, he says.

“A good part of my practice is doing this. I have more happy patients doing this than regular dermatology. It’s an unmet need. Patients tell me their lives have been changed with bioidentical hormones,” Dr. Moy says. “The three reasons to do bioidentical hormones are for disease prevention, to look better and feel better.”

POLL: Do you offer hormone replacement therapy in your practice?

Diet and exercise play an important role, obviously.  However, there is no treatment or regimen that will improve health, wellness, aesthetics and overall wellbeing as well as replacing and optimizing hormones that decline with age.

Bioidentical Hormones and Skin

Several studies suggest there are benefits from using bioidentical hormones to alleviate symptoms from dry, itchy, thin and fragile skin, as these hormone treatments can increase skin hydration and reduce skin atrophy, according to a review published January 2019 in the Dermatology Online Journal.¹

Dr. Moy says there are a number of hormones that tighten and thicken skin. As one ages, collagen is lost in the skin, which affects skin thickness, texture and hydration. Dehydroepiandrosterone (DHEA), testosterone, estradiol (estrogen) and the thyroid all affect the integrity and health of skin.

DHEA. DHEA, which patients can buy in topical or oral form over the counter, has been shown in studies to thicken and tighten skin and in a case report in the Journal of the American Academy of Dermatology to help prevent tears in atopic skin, according to Dr. Moy.²

“Usually the DHEA dosage is about 10 mg for women and 25 to 50 mg for men,” he says.

However, this is where the expertise of the clinician comes into play, as Dr. Moy will adjust doses of the pharmaceutical hormones based on serum levels, symptoms and personal desires.

Testosterone. Testosterone, in cream or pill form, is by prescription and can improve skin health and appearance, according to Dr. Moy.

“Testosterone cream improves skin tightening and skin elasticity. It also not only thickens skin but increases [the ability to develop] muscles. But it can result in acne at high doses,” Dr. Moy cautions.

Testosterone is a tissue building, fat melting and aesthetic hormone. It is the best hormone for maintaining that youthful appearance. It also provides the best effect of maintaining strength and energy. Without testosterone, exercise will show little benefit on maintaining muscle and metabolism. Add testosterone to the mix and that is where the fat burning aesthetic benefits of exercise are maximized.

“People who are on testosterone always feel better,” says Dr. Moy. “Their moods are better. Testosterone also helps decrease osteoporosis risk.”

Related: The health benefits of hormone replacement

Estrogen. Estrogen influences skin also. And applying estrogen cream improves wrinkles, according to Dr. Moy. The dermatologic literature is full of studies demonstrating benefits of estrogen on skin thickness, hydration, laxity and hydration. As women go through menopause, they all notice changes in their skin that were previously not evident. Dr. Moy emphasizes the need for maintaining adequate estradiol (estrogen) levels for maintaining youthful skin.

Although most women have normal thyroid levels, the levels of the thyroid hormone decrease with age.
Thyroid hormone deficiency can cause dry skin and hair loss and getting patients to levels in the high-normal (optimal) range can improve skin and hair, as well as lower weight, according to Dr. Moy.

Thyroid. The thyroid also affects the skin, but its biggest benefit is as a metabolic hormone that improves metabolism and burns fat. As a woman’s thyroid levels fall with age, she experiences that increase in visceral and subcutaneous fat that is difficult to remove.

Progesterone. Progesterone can improve skin, sleep and anxiety, according to Dr. Moy.

“Progesterone is also important to women’s health. It is synergistic with estrogen,” he says.

Dr. Moy makes sure that women understand that progesterone can be beneficial and safe and the bioidentical hormones available today are not the synthetic hormone (Provera) that was used in the past.

Other Hormones. At times, Dr. Moy will recommend other hormones, including melatonin to help with sleep. Vitamin D is also a hormone and can improve immunity and skin. Pregnenolone, he says, helps with cognition. Dr. Moy might use metformin for weight reduction, but it also has a positive effect on high blood pressure and high cholesterol.

“In my practice, patients take most hormones as pills, which is especially good for preventing disease,” he says.

Dr. Moy trained under Neal Rouzier, M.D., who offers bioidentical hormone treatment courses for physicians and wrote a book on the topic. Worldlink hormone training courses can be viewed at WorldlinkMedical.com.

References:

• Hunt PJ, Gurnell EM, Huppert FA, et al. Improvement in mood and fatigue after dehydroepiandrosterone replacement in Addison's disease in a randomized, double blind trial. J Clin Endocrinol Metab. 2000;85(12):4650-6.

• Daniell HW. Oral dehydroepiandrosterone might prevent frequent tears in atrophic skin: A case report. JAAD Case Rep. 2017;3(6):534-535.