Dr Nedic’s opinion about how hormones affect the way you look & feel featured in Longevity magazine
Hormones are chemical messengers produced by organs and glands that co-ordinate and control a multitude of functions in the body, explains Dr Ela Manga, an integrative doctor based in Johannesburg. “Some hormones have specific target sites, while others act more generally on the whole body. “Your hormones are involved in a number of different bodily functions, such as growth, immunity, reproduction and metabolism, as well as hunger and stress. “There are certain hormones that have a huge role to play in the way we look and feel specifically, as they have receptor sites inmost cells,” says Manga. These hormones include thyroid hormones and steroid hormones such as DHEA, cortisol and oestrogen, progesterone and testosterone. Your hormones affect a wide range of biological activities on the skin, as your skin cells are rich in receptor sites. Dr Sly Nedic, an anti-aging physician and founder of 8th Sense, who specialises in aesthetics, adds that hormonal imbalance (either deficiency or excess) can affect any age group. “Symptoms depend on the particular function of the hormone during a certain time of life. What has been considered by conventional medicine a physiological decline of hormones during aging is categorised by anti-aging medicine as a crucial modifiable factor to diminish, or possibly reverse, aging.”
Hormones, she says, affect our physical appearance, mental health, energy levels, sleeping patterns, social behaviour, sexual activity, food intake, and almost every other function in the body. “Symptoms of hormonal imbalance often overlap one another. For example, insomnia could be caused by a low growth hormone, low progesterone or low melatonin. Depression and anxiety could by caused by low oestrogen, thyroid hormone, growth hormone or testosterone.
“Some physical features can be affected by multifactorial hormonal imbalance, such as belly fat: excess insulin, excess cortisol, low growth hormone; sagging arms can be caused by low growth hormone, low testosterone, low oestrogen, etc. Patients usually have excellent insight that hormonal imbalance might be a problem, when almost every organ and function is randomly affected.”
Manga expands: “When there is a drop or fluctuation in hormonal levels due to illness, or as part of the aging process, it can affect brain function, energy levels and the efficiency of our organs. Changes will also inevitably be reflected in the skin, which is the largest organ in the body and the most visible. Skin changes are therefore the first indication that something is out of balance in the endocrine system.”
Menopause is a natural process that women go through as the body begins to age. Dr Noori Moti- Joosub, a dermatologist at Laserderm, Dunkeld, explains: “It is triggered when ovaries begin to release eggs more infrequently. When a woman stops having her monthly period, and her ovaries no longer release eggs, she is in menopause. This process can take up to 10 years before a woman truly is in menopause.” Moti-Joosub adds that as a woman goes through menopause, her ovaries gradually stop producing oestrogen and progesterone. Both of these hormones influence the release of the hormone insulin (which can increase the risk of developing diabetes). According to Nedic, the dermal changes of menopause are caused by reduced oestrogen activity on beta receptors situated in certain structures in the skin, such as keratinocytes, fibroblasts, sweat glands, hair follicles and blood vessels. This results in wrinkles, dry skin, loss of firmness, smoker’s lines and pale skin. “The same receptors are involved in the promoter region of antioxidant enzymes, making menopausal skin more prone to UV-light damage and oxidative damage from free radicals.” The up-regulation of transcription factors, especially MMPS that happens when these beta receptors are not stimulated, is hugely responsible for degradation of collagen. “However, knowing this also opens a space for potential use of stimulators, like resveratrol, to counteract this effect.”
In addition, diminished ceramides, fatty acids and cholesterol in the skin barrier during menopause can cause excessive dryness, dullness and roughness, as well as accelerated skin aging. “Glycosaminoglycans (GAGs) attract and absorb water, and their concentration directly affects the water content of your skin, as well as supporting collagen, elastin and turgidity in the cellular spaces. During menopause, due to intrinsic aging, this amount decreases
tremendously,” Nedic adds. All of these skin-aging concerns are exacerbated by the decline of the human growth hormone (HGH). What makes the skin-aging process even more complicated, she says, is that menopausal skin aging happens in conjunction with other intrinsic aging factors. “One of these is the formation of advanced glycation end-products (AGEs) that further break down collagen and elastin fibres in your skin.”
MENOPAUSE AT A GLANCE:
Dr Noori Moti-Joosub indicates that menopause, and the reduction in the production of essential hormones, affects your:
Hair: INCREASING DRYNESS AND BRITTLENESS. THERE CAN ALSO BE HAIR LOSS, AS THE FEMALE SEX HORMONES USUALLY PROTECT AGAINST THIS.
Skin: CAUSING THINNING OF SKIN, DECREASED ELASTICITY AND DRYNESS. IT CAN ALSO AFFECT MUCOUS MEMBRANES, AND THE VAGINAL SKIN CAN BECOME THIN AND DRY, INCREASING THE RISK OF URINARY TRACT AND YEAST INFECTIONS.
Body: MAKING YOU MORE AT RISK OF DEVELOPING DIABETES, HEART DISEASE, BONE BREAKDOWN AND OSTEOPOROSIS.
COMMON HORMONE DEFICIENCIES
Dr Ela Manga explains what happens to your body when you are deficient in a particular hormone.
LACK OF PROGESTERONE: You may experience hot flushes, irregular periods and fatigue. This also has an effect on the function of other hormones.
LACK OF OESTROGEN: It increases your risk of bone mass loss, decreased libido, vaginal dryness, poor memory and a general loss of motivation.
LACK OF TESTOSTERONE: It results in decreased memory, loss of libido, increased abdominal fat and an increase in muscle mass.
THYROID DEFICIENCY: This creates brain fog, fatigue, weight gain, dryness of skin and hair, constipation and depression.
SKIN AND HORMONE DEFICIENCIES
The skin serves as a mirror of what is going on in our body internally. “This is why any hormonal imbalance will be reflected on the skin, especially the face,” says Nedic.
LOW MELATONIN: Skin appears prematurely aged.
LOW GROWTH HORMONE: Skin appears thinner and drier; cheeks are more prone to sagging.
LOW THYROID: Dry skin, swollen eyelids and a puffy face.
LOW CORTISOL: Dark circles under the eyes, hyperpigmented spots on the face. You are more prone to a yellow-brown facial skin discoloration.
LOW OESTROGEN: Wrinkles, dry, pale skin and increased facial hair.
LOW TESTOSTERONE: Loss of facial muscle tone, which contributes to a sagging appearance, more wrinkles and a slack face.
Stress impacts on menopausal symptoms. “Many symptoms of adrenalin surge and adrenal fatigue overlap with menopausal symptoms to a degree,” Nedic says. Sometimes hot flushes improve only once the adrenals are treated. “Mood swings, irritability, excessive emotions, an outburst of anger, anxiety, panic attacks,are all mental and emotional characteristics of cortisol deficiency, seen after prolonged stress, and actually could also be symptoms of oestrogen/progesterone deficiency seen in menopause.”
She says a menopausal woman who has good testosterone levels will have less severe symptoms of adrenal fatigue (due to ongoing stress), as testosterone is a strong cortisol stimulator. Similarly, a number of women who are experiencing severe stress with adrenal fatigue, and are going through menopause, could exacerbate their symptoms if they are put on oestrogenonly HRT. “Oestrogen inhibits cortisol activity in a similar manner as HGH.” To simplify, Nedic says, treating a woman who is in menopause and is experiencing underlying stress will need a more complex approach in balancing her hormones, rather than prescribing HRT monotherapy only.
IMPACT OF STRESS ON YOUR SKIN
Prolonged stress causes high cortisol levels that can affect the skin in many ways, one of which is a degradation of collagen, which increases skin sagging, explains Nedic. “At the same time, our body is responding to the stress through inflammatory pathways, which can exacerbate many skin issues.” Suppressed immunity caused by high cortisol levels can worsen pre-existing skin conditions such as psoriasis, rosacea and eczema. Additionally, the skin barrier lipid content is affected, which can lead to skin dryness and predisposition to easier microbial penetration. “There is a higher incidence of acne, and this condition is more refractory to treatments. Skin cell renewal is also diminished, leading to dehydration.” In addition, says Nedic, we tend to eat more sugar during stress, which creates AGEs, and this contributes to further collagen degradation. When we are under stress, our skincare routine in compromised, further adding to our skin issues.
BEST ANTI-AGING INGREDIENTS:
According to Nedic, beta oestrogen receptor agonists, such as resveratrol, or skin HRT containing predominantly oestriol, are novelty treatments to target menopausal skin changes,working on beta oestrogen receptors. She recommends increasing the oxidative capacity of the skin by adding good-quality antioxidants to your diet, such as vitamin C, alpha-Tocopherol (vitamin E) and ferulic acid. These will help to keep free radicals at bay. Free radicals tend to form at a much higher level in menopausal skin.
“Skin-barrier enhancers, such as cholesterol, ceramides and fatty acids, will keep the skin barrier function intact, reducing dryness, roughness, and increasing skin barrier cell renewal.”
She adds that cell renewal and new collagen production can be improved with the addition of retinol, although this does not enhance elastin production.
“Inhibiting glycation of collagen and elastin protein fibres to stop production of AGEs is an important tool for menopausal skin. GAGs should also be part of a targeted skincare regime, as they promote the ability of collagen and elastin to retain moisture.”
Manga concurs, adding that to soothe skin caused by increased inflammation, look for anti-inflammatory ingredients such as pycnogenol, resveratrol and grape seed extract. “Ginkgo biloba and white and green tea extracts further protect the skin from oxidative damage.”
WHAT YOU CAN DO:
Moti-Joosub recommends that you:
- Consult a gynaecologist, particularly regarding advice on hormone-replacement therapy.
- Maintain a healthy diet, and be mindful that you may require additional calcium and vitamin D supplementation – particularly during or post-menopause.
- Exercise regularly and attempt to add weight-bearing exercises into your exercise routine.
- Have your blood pressure, cholesterol and fasting glucose levels checked.
- Use a water-based lubricant or vaginal oestrogen creams to help with vaginal discomfort.
- As your skin will lean towards dehydration, moisturise more often, or consider changing your moisturiser to a richer, thicker option.
- Get regular pelvic examinations, breast examinations, pap smears and mammograms done.
- Check for skin cancer, colon and rectal cancer on a more regular basis.
- Avoid smoking; it’s never too late to stop.
ANTI-AGING AT A GLANCE
- Moti-Joosub offers these tips for delaying the signs of aging:
- Wear sunscreen daily (even in winter).
- Choose cleansers that contain alpha and beta-hydroxy acids, as these allow for gentle exfoliation to remove dead skin cells.
- Retinol, in the form of Retacnyl, is a proven effective anti-aging agent for limited use (three months only).
- Antioxidants are beneficial in your anti-aging regime, but try to obtain the purest forms possible.
- Botox and fillers can reduce unwanted lines and soften creases.
- Photodynamic therapy can be used to treat all pre-cancerous skin lesions; it offers a wonderful cosmetic result too.
- Fractionated laser (Fraxel) plumps up collagen and assists in anti-aging.