Hormones and Skin Health: Understanding the Role of Testosterone

For skin professionals, understanding how individual hormones affect the skin helps provide context for many of the changes clients experience at different life stages. In this three-part series, we will explore the major hormones that influence skin structure and function. This knowledge underpins effective consultation and skin assessment, and can facilitate more holistic conversations with clients when their skin condition fluctuates.

In Part 1, we overview the broader impact of hormones and begin with unpacking testosterone, an androgenic hormone that plays a significant role in skin density, sebum production, and hair growth. Its effects are relevant across the gender spectrum and are particularly important to understand in the context of adult acne, androgen sensitivity, and gender-affirming hormone therapy.

Hormones play a fundamental role in driving and regulating body functions and processes, and as such are a primary influence in how our skin behaves.

Whether we are teenagers maturing into adults, progressing through a pregnancy, experiencing the changes associated with the menopause, or undergoing gender transition, specific hormones will shift the skin balance and can lead to skin changes and challenges.

Since every individual is unique, hormone levels can vary from person to person. And whilst a person’s individual hormone levels might fall within the expected range when tested, there is also increasing evidence that our cellular response can be elevated or reduced in different individuals, leading to greater nuance in how skin might behave.  Along with genetic biological drivers to altered hormone levels, there are factors in our exposome that can also affect which hormones are raised and dominant. These might include suffering acute or chronic periods of stress, diet, and medications, along with the more direct influence of artificial hormones for contraceptives or hormone replacement therapy (HRT).

Hormones impact how much sebum the skin produces, cell turnover rate (the rate of cell production and desquamation), hydration levels, protein production (including collagen, elastin and melanin) and barrier function. The result is variances in skin colour, density and resilience, softness and texture, degree of oiliness or dryness, and sensitivity.

As we investigate the role of each hormone we can start to unravel some of the potential consequences of hormone fluctuation on skin condition and evolve our consultative conversations to shape more realistic expectations for clients.

That brings us to the first hormone under discussion – testosterone.

Testosterone

Testosterone is produced in the testes and ovaries, with a proportion being produced in the adrenal gland. Conversion of testosterone to the highly potent dihydrotestosterone happens in a variety of tissues including, most significantly, the skin.

Testosterone is an androgenic and anabolic hormone. Androgenic refers to its impact on male sexual characteristics and anabolic to its tissue building function.

It is responsible for increased muscle mass, increased bone density, and increased skin density with higher collagen levels in the reticular dermis. Typically, males have 20-25% more testosterone than females, but the impact of this hormone has relevance across the gender spectrum and will affect physical characteristics.

Approximately 10% of testosterone is converted to dihydrotestosterone when it reacts with the enzyme 5-alpha reductase in the skin. This triggers sebocyte proliferation and subsequently increases sebum production. Dihydrotestosterone is linked to male pattern hair loss, but increases face and body hair.

In women, 50% of testosterone is produced by the ovaries and adrenal glands and released directly into the blood stream. The other 50% is made from conversion of the adrenal androgens to testosterone in other parts of the body including the skin.

This direct biological action in the skin along with increased androgen sensitivity with age, are major factors in the development of both adult acne and terminal hair growth for women. The jaw area is a primary region for increased androgen sensitivity.

For transmasculine persons on gender affirming testosterone therapy the effects of treatment include increase in sebum production, increase in face and body hair, decreased density of scalp hair and a redistribution of body fat. The impact of the treatment usually becomes evident in the skin within a month of initiating hormone therapy and will peak around the two-year mark.

In line with the increased sebum production there is a high incidence of developing acne. Some studies have seen as many as 94% of the trial group experience facial acne. Whilst severity can vary, the condition may peak around six months. Some find the condition regulates after the first year but in others it can be persistent and an ongoing struggle.

Since the period of transition can be stressful in itself, new or additional skin challenges such as acne can increase anxiety and affect mental health. These clients need support with focussed skin care strategies that can facilitate daily management. In addition, medical interventions are not precluded and should be considered where necessary to address more severe grades of acne.

Androgenetic alopecia, commonly referred to as male pattern hair loss, has a significant prevalence in long term testosterone therapy for transmasculine persons.

Testosterone demonstrates how profoundly hormones can shape the behavior and characteristics of the skin. From increased sebum production and acne development to changes in hair growth and skin density, androgen activity plays a central role in many common skin concerns.

In Part 2, we will explore oestrogen and progesterone, two hormones that influence collagen density, hydration levels, pigmentation, and cyclical changes in the skin. Understanding these hormonal shifts can provide further insight into how skin evolves throughout different life stages.