Successful and healthy ageing is one of the most important needs of our fast ageing population. Patients’ frequent concern to their dermatologist is how to overcome the effect of this natural process on their skin. With ageing, there is a decrease in the level of hormones. Bio-identical Hormone Replacement Therapy (BHRT) is a new and innovative field which bridges the gap between aesthetically and functional anti-ageing medicine.

What Is BHRT?

The Endocrine Society defines bio-identical hormones as “compounds derived from plants that have exactly the same chemical and molecular structure as hormones that are produced in the human body.” They are most often used as people age and hormone levels drop. BHRT supplies your body with adequate levels of key hormones like Estrogen, Progesterone, Dehdoepiandrosterone (DHEA) and Growth hormones (GH).
Anti-ageing clinics administer BHRT in the following forms:
Creams (Dermal or vaginal)
An advantage of BHRT is that the dosage can be tailored to each individual patient.

What Hormonal Therapies Are Popular And Effective In Delaying Skin Ageing?

“ Growth hormone and IGF-1 are both given as daily subcutaneous injections: can markedly reverse the thinness and lack of elasticity of the skin. These therapies may also substantially reduce wrinkles and uplift sagging cheeks.
Vasopressin therapy (as its’ synthetically derivative desmopressin), provided orally, sublingually or intranasal twice daily: reverses the small skinfolds due to dehydration of the skin of the face by keeping the water in the skin.
Thyroid treatment: taken as oral pills, makes the skin less dry by stimulating sweat glands . thyroid hormones also heat the skin more, providing the skin a better flush due to a increase of blood flow in the skin.
Estrogen therapy in women is best taken as transdermal estradiol (always associated it with a protective oral or vaginal progesterone capsule!): It makes the skin less dry, prevents facial hair from appearing on the face of women, and can slightly thicken the skin
Testosterone therapy is best taken by women as daily transdermal gel to rub in  on inner lower arm or as a  once-a-month. intramuscular injection: It makes the skin less dry and stronger (less risk of bruising). However, in excess or in absence of sufficient estradiol in women may facilitate acne
Cortisol therapy takes “age spots” and dark circles under the eyes” away that are in fact pigment spots due to Addison’s disease, adrenal failure that – when cortisol is lacking – triggers an oversecretion of ACTH, the pituitary hormone that stimulates the adrenal glands to make more cortisol. ACTH has as an additional effect to darken the skin. In case of cortisol deficiency, ACTH stimulates the appearance of irregular hyperpigmented spots that re-disappear when adequate amounts of cortisol is taken. However, cortisol should not be given without an equivalent dose of another adrenal hormone DHEA that prevents any excessive catabolism (tissue-wasting) by cortisol.
Melatonin therapy stimulates the proliferation of keratinocytes of the skin, improving skin thickness and reduces skin inflammation and may also reduce skin pigment spots. Topical application is recommended for efficacy”
~ Dr. Thierry Hertoghe

What Effect Does Hormone Deficiency Have On The Skin?

Hormones play a key role in skin health which is made evident when hormonal disorders present symptoms in the skin and hair.

A big hormonal player in skin health is estrogen. Menopause is due to estrogen deficiency and causes accelerated collagen breakdown, decreased elastin, dehydration and impaired wound healing. The lack of collagen reduces skin tone and recoil when stretched. Also, there is decreased water retaining capacity of skin tissues. The skin is more itchy and fragile, resulting in the appearance of more wrinkles. One study found that 2 out 5 women self-report more sensitive skin around the time of menstruation, which researchers suspect could be due to low levels of estrogen during this phase.

Clinical observations and analysis conducted in animal experimental models at a molecular level have shown the important role played by the GH system in the development, maintenance and repair of the skin. In GH deficiency such as in the condition Sheehan’s Syndrome, patients present with dry, thin and pale skin. Similarly, DHEA deficiency presents as dry, flaky skin. [H4] How Does Anti -Ageing Hormonal Therapy Work?
“They build up the body by:
Stimulating anabolic processes, which consists mainly of assembling new proteins from amino acids.
Reducing any excess inflammation, taking the excess fire out of the body causing a reduction of CRP, interleukins-1beta, -6, -8, CRP, TNF-alpha and many other inflammatory moleculres.
Increasing energy by stimulating the mitochondria to increase the production of ATP, the energy molecule.
Protecting the body against infection by thickening skin and respiratory and intestinal mucosa so that microbes (pathogens) do not or do less easily penetrate. Many hormone therapies also stimulate the immune system so that the body overcomes infection quickly.”
~Dr Thierry Hertoghe

What Are The Benefits Of BHRT?

BHRT improves quality of life, well being, and contributes to slowing of the ageing process. There has been an increasing number of studies that recommend hormones as viable therapies to treat the symptomatic effects of ageing such as dry, itchy, thin and fragile skin. These hormones reduce skin atrophy and increase skin hydration, according to a review published in the Dermatology online Journal, January 2019.

Recent studies have confirmed that only two weeks of topical estrogen increases epidermal thickness, skin hydration and keratinocyte proliferation in the skin of elderly males and females. To read more about the effect of estrogen on skin ageing, click here.

Growth hormone firms and tightens the skin on the eyelid, nose and cheek. It also reduces oedema and tissue enlargement. GH can reduce wrinkles, tighten saggy skin, decrease body fat, increase lean muscle mass, boost energy, rev up sex drive, and make you look and feel decades younger.

DHEA therapy has shown positive effects of increasing sebum production which improves skin surface hydration, brightness roughness. A randomised control trial found that skin atrophy suddenly decreased in postmenopausal women by DHEA supplementation at a dosage of 50mg daily for 365 days may refined the physical appearance of ageing skin. DHEA therapy provides a safe and effective skin care regiment.

“ Psychologically, patients have clearly a better quality of life and feel better, have often much more energy, sleep better, are more positive, much less risk of depression, etc. Physically, hormone -treated patients age less quickly depending if sex hormones and growth hormone and IGF-1 therapies are also given. In this case, they seem the first years to continuously rejuvenate up to 5-10 years younger. Thereafter ageing restarts but at a slower pace, possibly twice less quickly than the average untreated person.”
~ Dr. Thierry Hertoghe