Hormones and Skin Health: Oestrogen and Progesterone

While testosterone is often associated with oil production and androgen-driven skin changes, other hormones play equally important roles in shaping the skin’s structure and behavior.

In Part 2 of this series, we examine how oestrogen and progesterone affect skin physiology and how these shifts may present in clinical skin practice.

Oestrogens

Oestrogens are a group of steroid based female sex hormones that are most commonly recognized for their role in female sexual characteristics and development and regulation of the female reproductive system. Like testosterone, everyone produces oestrogens but in greater quantities in females. Produced in ovaries, testes and adrenal glands, oestrogen is also manufactured in fat cells.

There are three primary oestrogens -

Oestradiol - Produced by both biological sexes and is the most common type of oestrogen in females during their reproductive years.

Estrone - A weaker form of oestrogen manufactured post menopause.

Estriol - The oestrogen that rises during pregnancy promoting uterus growth and preparing the body for delivery.

Beyond female characteristics and reproduction oestrogens are necessary for bone development and maintenance and have been demonstrated to have an impact on libido, mood and cognitive function.

In skin oestrogens impact collagen density, decrease sebum production, reduce growth of facial and body hair, promote epidermal thickness, and stimulate melanin production.

The use of oestrogen based oral contraceptives sees hyperpigmentation as a common side effect. This usually presents on the upper lip, and then in the typical butterfly pattern. Darkening of the linear nigra is often evident.

The absence of oestrogen post menopause sees a significant change in skin density and dryness. Accelerated loss of collagen leads to more fragile skin, and the skin also loses its natural turgidity and radiance as hydration levels deplete both internally and at the surface.

Gender affirming treatment for transfeminine persons may include oestrogen and anti-androgen therapy. As a result, hyperpigmentation issues can develop as oestrogens drive melanocyte activity. Skin may also become drier with the sebum regulating and sebocyte reducing action of oestrogen.

It is worth noting that oestrogen and anti-androgen treatments are not generally successful at making significant reduction to existing facial or body hair. There is usually a requirement to implement alternate hair reduction treatments to address hirsutism. For these clients pseudofolliculitis barbae can be another frustrating result of attempting to address excess hair growth and will require interventions to reduce inflammation and impaction of the hair.

Progesterone

Progesterone is part of a group of steroid hormones released by the ovaries. It supports implantation of a fertilized ovum and maintains pregnancy. Fluctuations in progesterone levels can contribute to abnormal menstrual periods and menopausal symptoms.

Clients may take progesterone to address amenorrhea, treat the symptoms of premenstrual syndrome, or regulate abnormal uterine bleeding associated with hormonal imbalance. Progesterone is also used in combination with oestrogen to reduce cancer risk as part of hormone replacement therapy.

Women produce more sebum in the week before their menstrual period, when progesterone levels are higher and oestrogen levels are lower. Since progesterone counters the sebum reducing and regulating action of oestrogen, contraceptives with high levels of progesterone (mini pills) also can trigger acne breakouts.

Progesterone is the contraceptive hormone of choice in non-binary and transgender men. Progesterone does not impact gender affirming testosterone therapy and as such can be used during and after treatment.

Oestrogen and progesterone illustrate how hormonal balance directly influences the structural integrity, hydration, and pigment activity of the skin. These shifts can be seen throughout many stages of life, from menstrual cycles and pregnancy to menopause and hormone therapy.

However, hormonal influence on the skin does not end there. In Part 3, we will explore what happens when hormone therapy is paused or discontinued, and how changing hormone levels can temporarily affect skin stability, hydration, and oil production.