The Skin-Hormone Connection: Balancing Hormones & Healing the Skin-Together
TREVOR CATES, ND
As our body’s largest and most visible organ, skin gives us outer clues about what’s happening inside the body. This includes hormonal imbalances. Acknowledging and working with the skin-hormone connection can not only help alleviate your patients’ symptoms of hormonal imbalances, but it can also relieve related skin issues.
Anyone who has treated patients with skin conditions like acne, rosacea, atopic dermatitis, or psoriasis – or experienced them personally – knows how debilitating these can be. It’s a rewarding path to help patients overcome these and other skin problems. As a child, I experienced atopic and contact dermatitis along with seasonal allergies; my struggles ultimately put me on the path to become a naturopathic physician. Therefore, I’ve always had an inside understanding of the challenges – not just the discomfort and embarrassment that comes from skin issues, but the unwanted side effects from conventional treatments as well.
Patients with skin challenges want to hide but often can’t. When you help patients clear up their skin issues, it has a profound effect on their self-esteem; they show up to school or work with more confidence and feel more secure in their relationships. But when you address the root causes behind skin conditions – nutritional deficiencies, microbiome issues and hormonal imbalances – you can also help improve their health in many other ways.
Hormonal imbalances hold a complex yet common connection with skin issues. Surprisingly, though, they’re often overlooked or treated separately. I do not know a woman in the Western world over 30 years of age who has not faced skin issues and hormonal imbalances during her lifetime. The connection between these goes deep, yet many doctors still address them independently of each other.
Throughout your practice, you will likely see patients experiencing some of these hormonal imbalances at the same time. And when you address these imbalances, your patients will be grateful for how well they feel as well as the results they see on their skin. Keep in mind, however, that the answers to hormonal balance and restoring healthy skin often go beyond a few dietary changes and some supplements. Instead of treating hormonal imbalances and skin separately, consider a more holistic approach.
Here are some of the ways low and high hormone levels impact skin and some natural medicine recommendations for each:
When estrogen is low, skin tends to be drier, less elastic, and more fragile. Eating certain phytoestrogens such as flaxseeds, sesame seeds, and non-GMO soy may help support estrogen levels naturally.1 Chronic stress tends to suppress estrogen production, including in young women, so stress management is important.2 Certain supplements like vitamin D3 have been shown to increase estrogen production.3
High estrogen (such as during pregnancy or when on birth control pills) makes women more prone to melasma. Supporting estrogen metabolism is key in these cases. Supplementation with maca (Lepidium meyenii) may help balance estrogen and progesterone, particularly in perimenopausal and postmenopausal women.
Testosterone stimulates sebaceous glands, which are important for protecting skin with natural oils, but overproduction can lead to acne. Age-related hormonal changes, such as those experienced during puberty and menopause, may affect testosterone production and metabolism, leading to oily or breakout-prone skin. Supplements with saw palmetto (Serenoa repens), zinc, and vitamin D may help balance androgen levels. Chromium also appears to help lower free testosterone and is known to help balance blood sugar, actions that are beneficial for women with polycystic ovary syndrome.4
Low androgens can lead to thinning, dry skin as well as loss of muscle in the face, contributing to sagging skin. Patients with low levels of DHEA and testosterone may benefit from supplements and bioidentical hormone replacement therapy.
An underactive thyroid can lead to a dry, coarse complexion and a reduced ability to perspire. In contrast, those with an overactive thyroid may experience oilier and more acne-prone skin. We can provide thyroid support with supplements like zinc, selenium, and iodine.5 For hypothyroid symptoms, consider natural desiccated thyroid or other thyroid medication, but monitor levels; if an individual receives too much supplementation, they may swing the other direction and experience oily skin.
High levels of cortisol may increase inflammation and sebum production, triggering acne, atopic dermatitis, rosacea, and other skin issues. Patients may find relief by engaging in stress management practices. Potentially helpful supplements include phosphatidylserine, L-theanine, L-tyrosine, Korean ginseng (Panax ginseng), ashwagandha (Withania somnifera), and/or rhodiola (Rhodiola rosea).
A Focus on Acne
According to the American Academy of Dermatology, acne is the most common skin condition in the United States, impacting close to 50 million Americans every year.6 Almost all American children experience acne at some point. However, in other parts of the world, like Papua New Guinea and Paraguay, acne doesn’t seem to exist. We know the standard American diet plays a role in acne, yet many of our patients seem to eat healthy diets and still struggle with acne. In addition to diet, we want to pay attention to other factors in a person’s environment that may trigger acne and contribute to hormonal imbalances.
The research supporting what is termed the gut-skin axis is perpetually developing. And the evidence strongly suggests that from the inside out, our gut microbiome appears to impact the skin microbiome. 7 Because of this, we want to support a healthy skin microbiome not just from the outside, but also from within the gut.
The skin microbiome promotes the natural lipid barrier and skin immune system, which helps restore and promote healthy blemish-free skin. Astoundingly diverse, the skin microbiome consists of trillions of bacteria, fungi, protozoa, and viruses. This includes a thousand different species of bacteria8 and almost 130 different species of fungi.9 An estimated 1 billion bacteria inhabit each square centimeter of our skin.10 Remarkably, the makeup of these bacteria varies not just from person to person, but even by skin region.
The surface of human skin has a natural pH level of about 4.0 to 4.5, making it mildly acidic.11 This level helps keep the skin microbiome in balance; a more alkaline pH kills or disrupts that balance. Even water, at a neutral pH of 7.0, is too alkaline for optimal skin health. After rinsing with water, rebalancing the pH to a mildly acidic level is important. Many common skincare products, including cleansers, serums, moisturizers, and over-the-counter topical medications have a pH of 5.5 and higher, which can dry out skin and make it more prone to breakouts and premature aging.12 The ideal pH of a skin care product is between 4.6 and 5.4, and the ingredients that go into the product determine this value.
Birth control has changed women’s lives in a very profound way, not just in helping with family planning, but as it has turned out, in treating health issues. Doctors commonly prescribe hormone-based birth control for acne in women – even women who are not sexually active. But this frequently comes with side effects and does not address the true underlying cause. Hormonal birth control contains synthetic, not natural, forms of estrogen and progesterone. Moreover, it suppresses testosterone levels,13 depletes women of certain nutrients,14 and disrupts the gut microbiota.15 And it comes with several potential side effects, including an increased risk for blood clots, stroke, certain types of cancer (including breast, cervical, and uterine), and hormonal imbalances (such as thyroid abnormalities).
Another major factor in hormone disruption can be found in the ingredient lists of over-the-counter skin care products. Patients with acne often use these products topically. Many of them contain endocrine-disrupting chemicals (EDCs), which are absorbed through the skin into the bloodstream and can potentially wreak havoc on the endocrine system. For example, oxybenzone, a common component in chemical sunscreens, is a well-known EDC. Parabens and synthetic fragrances, too, have been linked to hormone disruption. It is critical to reduce exposure to EDCs by avoiding them in skincare products.
In the United States today, we’re exposed to numerous EDCs and other toxic chemicals in our personal care products and in our food, water, and air. This exposure disturbs our hormone balance and our skin microbiome. To restore hormonal harmony, we must support the gut microbiome and detoxification pathways while nourishing the body. In the process, we can clear up acne and restore skin health, all while hormonal balance returns. To illustrate this, here is a case study.
Karen was a 24-year-old female who came in to see me with acne vulgaris on her face and back, hypothyroidism, and dysmenorrhea. Her acne started at age 12. At that time, she saw a dermatologist who prescribed topical retinoids and oral antibiotics. This helped some, but in high school, she developed cystic acne and subsequent scarring.
At the time of her appointment, she was taking desiccated thyroid medication for hypothyroidism. Her skin was oily, and she was breaking out in acne on her face and back. For skincare, she was using a popular cleanser from the health food store plus a natural body scrub.
At this initial appointment, I ordered lab work and put her on an oral probiotic, chaste tree berry (Vitex agnus-castus), evening primrose oil (Oenothera biennis), and a supplement with skin, hair, and nail nutritional support (containing a combination of nutrients including vitamin A, B vitamins, zinc, methylsulfonylmethane, and green tea extract). I also counseled her to avoid trigger foods including sugar and dairy, and to increase her intake of fiber, healthy fats and proteins, and phytonutrients. My goal was to balance her hormones naturally while simultaneously supporting her gut health and providing nutrients for skin repair. Finally, I encouraged her to change her skincare regimen to a mildly acidic natural 4-step skincare system to support her skin microbiome externally.
A month later, after looking at her lab results, I switched her thyroid medication to a different brand of desiccated thyroid and lowered the dosage. I also changed her probiotic and added 5000 IUs of vitamin D3 daily. Topically, I recommended liquid African black soap for her back and recommended she remain on her supplements. My treatment approach with this follow up was to continue supporting her hormonal, nutritional, and microbiomal balance.
The following month, she said that her skin was less oily since starting the new thyroid prescription and skincare regimen, but much of the cystic acne continued. I called in a topical prescription for her to the local compounding pharmacy for daily use on her face: potassium azeloyl diglycinate with 5% niacinamide. Besides her skin, her menses were no longer painful, and her fatigue had diminished.
At the end of the third month, she reported that her skin was neither oily nor dry. The texture of her skin had improved significantly; even her esthetician said her skin was the best it had ever looked. After this appointment, she started a series of platelet-rich plasma facials to help with the acne scarring. And after 5 years, my patient continues to be a very happy and fervent advocate for natural medicine.
Our patients often present with complex layers of root causes, and it’s our job to help peel back those layers. The messages skin provides can help us know if we’re heading in the right direction. Whether we see acne clearing up, dry skin appearing more hydrated, premature wrinkles slowing, itches diminishing, or eruptions disappearing, the skin will give you signs of progress. And when your patients are on the path to becoming symptom-free on the inside and vibrantly healthy on the outside, they will be eternally grateful. I still am thankful – 38 years later – for the holistic practitioner who helped clear up my skin issues.[REFS]
- Wu WH, Kang YP, Wang NH, et al. Sesame ingestion affects sex hormones, antioxidant status, and blood lipids in postmenopausal women. J Nutr. 2006;136(5):1270-1275.
- Roney JR, Simmons ZL. Elevated psychological stress predicts reduced estradiol concentrations in young women. Adapt Human Behav Physiol. 2014;1(1): 30-40.
- Irani M, Merhi Z. Role of vitamin D in ovarian physiology and its implication in reproduction: a systematic review. Fertil Steril. 2014;102(2):460-468.e3.
- Fazelian S, Rouhani MH, Bank SS, et al. Chromium supplementation and polycystic ovary syndrome: A systematic review and meta-analysis. J Trace Elem Med Biol. 2017;42:92-96.
- Triggiani V, Tafaro E, Giagulli VA, et al. Role of iodine, selenium and other micronutrients in thyroid function and disorders. Endocr Metab Immune Disord Drug Targets. 2009;9(3):277-294.
- Skin conditions by the numbers. American Academy of Dermatology. (n.d.). Retrieved April 29, 2022, from https://www.aad.org/media/stats-numbers
- Salem I, Ramser A, Isham N, et al. The Gut Microbiome as a Major Regulator of the Gut-Skin Axis. Front Microbiol. 2018;9:1459.
- Eisenstein M. The skin microbiome. Nature. 2020;588(7838):S209.
- Findley K, Oh J, Yang J, et al. Topographic diversity of fungal and bacterial communities in human skin. Nature. 2013;498(7454):367-370.
- Kong HH, Segre JA. Skin microbiome: looking back to move forward. J Invest Dermatol. 2012;132(3 Pt 2):933-939.
- Lambers H, Piessens S, Bloem A, et al. Natural skin surface pH is on average below 5, which is beneficial for its resident flora. Int J Cosmet Sci. 2006;28(5):359-370.
- Jung YC, Kim EJ, Cho JC, et al. Effect of skin pH for wrinkle formation on Asian: Korean, Vietnamese and Singaporean. J Eur Acad Dermatol Venereol. 2013;27(3):e328-e332.
- Zimmerman Y, Eijkemans MJ, Coelingh Bennink HJ, et al. The effect of combined oral contraception on testosterone levels in healthy women: a systematic review and meta-analysis. Hum Reprod Update. 2014;20(1):76-105.
- Palmery M, Saraceno A, Vaiarelli A, et al. Oral contraceptives and changes in nutritional requirements. Eur Rev Med Pharmacol Sci. 2013;17(13):1804-1813.
- Mihajlovic J, Leutner M, Hausmann B, et al. Combined hormonal contraceptives are associated with minor changes in composition and diversity in gut microbiota of healthy women. Environ Microbiol. 2021;23(6):3037-3047.
Trevor Cates, ND, a 2000 graduate of the National University of Natural Medicine, was the first woman licensed as a naturopathic doctor in the state of California. She wrote the bestselling book Clean Skin From Within and founded The Spa Dr., a pH-balanced natural skincare line. Dr. Cates is host of the Hormones, Health, and Harmony Docuseries (May 10, 2022), The Woman’s Doctor Podcast, and the public television special Younger Skin From Within. Her next book, Natural Beauty Reset: The 7-Day Program to Harmonize Hormones and Restore Radiance, is available for preorders on Amazon and hits bookstores in September 2022.