Our skin is often a reflection of what’s going on inside our bodies. As our largest organ, the skin creates a layer of protection from the environment and is “intimately connected” to our brain, says board-certified dermatologist Dr. Keira Barr, MD.
While your hormones influence your skin, your skin can also influence your hormones. As a receptor and effector of hormones, your skin is more than a barrier between your internal organs and the outside world. It has its own connection to the hypothalamus gland, the master hormone control center of the brain that produces hormones and sends signals — from dewy skin to dry patches — to give us a heads up on things that might be wrong.
A good example of how the skin influences your hormones: sun exposure. Let’s say one sunny day you go to the beach and come home with a tan. Exposure to UV light causes the skin to produce beta-endorphins as well as proopiomelanocortin (POMC), the hormone responsible for triggering pigmentation.
Another example of how the skin influences your hormones: that moment you look in the mirror, see a rude flare-up of acne, and instantly get stressed out. While that flare-up may originally be a result of your sex hormones fluctuating, the increase in cortisol (your stress hormone), continues the vicious cycle by suppressing the immune system.
As Dr. Barr says, “Your skin isn’t trying to sabotage you. It needs you to pay attention to how you’re living.”
Which hormones impact your skin health?
Yes, it’s hormones — plural — that impact your skin health. Most notable are the hormones estrogen, progesterone, and androgens, but these sex hormones aren’t the only hormones influenced or involved with your skin health. A few others that also impact skin health include cortisol, melatonin, and insulin. Hormonal imbalance (of these and other hormones) can lead to skin issues — commonly acne — and other symptoms.
Here’s a quick breakdown of the hormones that affect skin and what they do:
Estrogen keeps our skin hydrated and helps with its elasticity and oil production. It appears in all humans but at higher levels in people with vaginas.
Progesterone is a hormone necessary for the entire reproductive process. It improves circulation, decreases inflammation, and develops the maternal immune response. In coordination with estrogen and androgens, fluctuations of progesterone can lead to acne, dermatitis, and pigmentation. But the exact correlation of progesterone to acne is unclear.
Androgens are “male” hormones, like testosterone, that affect hair growth, voice change, libido, and sebum production (which locks in moisture and prevents your skin from becoming dry). Though they appear at higher levels in people with testes, androgens are present in all humans.
Cortisol controls our stress levels. High levels of cortisol suppress our immune system, causing “an imbalance in other hormones like androgens,” according to Dr. Barr. An imbalance in androgens can lead to acne.
Melatonin is the sleep hormone and is “one of the body's most potent antioxidants,” according to Dr. Barr. It repairs skin cell damage from external factors such as air pollution and sun exposure as well as stimulates hair follicles.
- Skin tags
- Acanthosis nigricans (velvety patches of hyperpigmented skin)
- Androgenetic alopecia (thinning hair)
- Hirsutism (dark, coarse hair growth in people with vaginas)
Skin health at different phases of your life
Hormone changes happen to everyone throughout our lives, and they impact our skin health in different ways. But people with vaginas tend to experience greater hormone fluctuations because of the menstrual cycle.
Your skin health during puberty
During puberty, a wave of hormones floods the body: The follicle-stimulating hormone (FSH) increases the production of estrogen by the ovaries. An increase in androgens like testosterone are responsible for acne, hair growth, and body odor.
Testosterone also increases levels of insulin and growth hormone (GH), which helps promote regular bone and tissue growth.
While the hormones of people with testes begin to stabilize as they mature into adults, the hormones of people with vaginas continue to fluctuate.
Your skin health throughout your menstrual cycle
During your menstrual cycle, you have a whole lot of hormones floating around your body. The follicular phase begins with menstrual bleeding (aka your period). Your brain sends the two hormones — FSH and luteinizing hormone (LH) to your ovaries, triggering the production of estrogen. The ovulation phase involves high levels of estrogen telling the brain to create more LH so that the ovary can release an egg to potentially be fertilized (read: ovulation). This continues until the luteal phase, where the ruptured follicle turns into the corpus luteum, producing high levels of both estrogen and progesterone that thickens the uterine lining.
If pregnancy occurs, the corpus luteum will continue producing progesterone and the embryo produces human chorionic gonadotropin (hCG) which is what pregnancy tests use to determine early pregnancy. Otherwise, the uterine lining sheds, the corpus luteum decays, and you end up back in the menstrual bleeding phase.
“It’s really in that week or two before your period where you see the worst of your acne show up,” says Eva Luo, OB-GYN and medical advisor to Modern Fertility. As your body sheds its uterine lining and you transition from the luteal phase to your period, levels of progesterone decrease while levels of estrogen and androgens increase. You see the worst of your acne in the first week or so before your period because the progesterone is no longer suppressing the sebum-producing androgens that your skin can receive.
Because of the relationship between hormone changes and acne, doctors often prescribe oral contraceptive pills (OCPs) as treatment. “OCPs suppress ovulation and provide you with a steady state of hormones from week to week, avoiding this fluctuation,” explains Dr. Luo. How effective are OCPs at treating acne? In one review of 31 clinical trials with 12,579 participants, nine placebo-controlled trials had data available for analysis. All of the nine trials found that combined oral contraceptives (which include both estrogen and progesterone) reduced not only the number of pimples, but also the self-assessed perception of acne severity as compared to the placebo.
In addition to that pimple on your chin that only shows up right before you start your period, some other skin issues you may experience as the levels of progesterone, estrogen, and androgens fluctuate include:
- Atopic eczema
- Oily skin
- Skin sensitivity
Your skin health during pregnancy
The body goes through many hormonal changes that influence the organs (your skin included!) during pregnancy and the time leading up to it.
“Women who are trying to get pregnant have often recently discontinued birth control and can develop hormonal acne as a result,” says board-certified dermatologist Dr. Lavanya Krishnan, MD.
Every hormonal change you experience during this time is to nourish and develop the fetus. When you're pregnant, you start producing higher levels of estradiol and progesterone to prep the uterine lining (the endometrium) to help the embryo in its initial stages. Some endometrial cells later develop into the placenta meant to nourish the fetus throughout the pregnancy. One study shows that over 90% of pregnant people experience some kind of significant skin change that’s either a result of the pregnancy or exacerbated by it.
A handful of significant skin changes you may experience during (or before) pregnancy:
- Melasma ("mask of pregnancy")
- Brittle nails
- Thicker and denser scalp hair
- Spider angioma
- Stretch marks
Many of these changes will resolve after pregnancy and do not affect the growing fetus.
Your skin health postpartum
Since you experience what Dr. Luo calls a “crash in hormones” after giving birth, many of the skin changes during pregnancy often go away on their own. One new issue, however, might be hair loss (in medical-speak: telogen effluvium) 6-16 weeks postpartum. Recovering your normal hair thickness could take months, but scalp hair density may never be as dense as it was prior to pregnancy.
Your skin health during menopause
The average age of menopause is 51 but Dr. Barr says that “women can be in this period starting in their early 30s or the day after 12 months have passed without a period.”
As we get older and go through perimenopause and menopause, our fertility hormone levels drop. While this happens to all fertility hormones, the rate at which estrogen lowers can have a big impact on our skin.
Since estrogen is in charge of keeping our skin hydrated and supple with collagen and elasticity, skin issues we may experience around menopause include:
- Poor healing
We’re not just talking about facial skin — vaginal dryness is a very common issue during perimenopause and menopause.
What your skin type has to do with your skin health
Fitzpatrick skin phototypes take skin color and reaction to sun exposure into account to predict when skin might burn. Much more familiar, however, is labeling skin type as oily, combination, or dry. That said, there's more to our skin type than sun reactivity and sebum production. (Reminder: Sebum is a yellow, oily substance that locks in moisture and prevents skin from becoming dry).
Our skin has a microbiome of its own as well as its own pH balance. According to Dr. Barr, “As the pH of the skin changes, the lipid formation changes, and different areas of the skin are less or more receptive” to our hormones.
Oily skin typically indicates increased sebum production caused by higher levels of testosterone and lower levels of estrogen — whereas dry skin, known as xerosis, typically indicates decreased sebum production.
Combination skin is a little of both skin types: Different parts of the skin are more or less receptive to oil production.
The pH of our skin can change because of a myriad of factors:
- The environment
- Our mood
- The products we use
- What we eat
- How old we are
Ways to nourish your skin in the event of hormonal imbalance or other issues
Now that you know how your hormones impact skin health, it's time to learn how to take care of your skin — regardless of skin type. These are all examples of ways you can listen to your skin:
- Develop a skincare routine that works for you
- Discover what triggers your skin and take note
- Stay hydrated
- Research different skincare product types (serums versus lotions)
- Use clean products, when you can
- Get a good night’s sleep
- Find ways to relax (meditation works!)
- Be conscious of how what you eat impacts your skin
Bottom line — your hormones impact a whole lot more than your mood. Though our skin is our largest (most visible) organ, it’s easy to forget it needs our love and attention, too. Don’t get discouraged if you don’t see immediate results from these insights. New treatment plans and routines take patience.
This article was medically reviewed by Dr. Eva Marie Luo, an OB-GYN at Beth Israel Deaconess Medical Center and a Health Policy and Management Fellow at Harvard Medical Faculty Physicians, the physicians organization affiliated with the Beth Israel-Lahey Health System.