Hormones, Skin & Hair - Structural Changes During Menopause

00:00:00.320 and hair today and many of you who know

00:00:02.960 me will know that I have a very dear

00:00:05.600 friend and an esteemed colleague um who

00:00:08.080 I’ve known for many years actually and

00:00:10.320 um Saj Rajpar is a general dermatologist

00:00:14.000 so a skin specialist but he’s had a lot

00:00:16.400 of training in the whole body as well

00:00:19.359 more and more there are lots of skin

00:00:21.279 specialists that are popping up who are

00:00:23.279 just looking at the skin on our face

00:00:25.119 trying to make us look younger and not

00:00:28.320 thinking about the skin as an organ. So,

00:00:31.199 I always have loads of questions about

00:00:33.280 skin and hair. So, I thought I would

00:00:35.600 invite him on a Sunday to um ask him

00:00:39.520 more. So, I’ve had quite a few questions

00:00:41.600 on my Instagram already. And if you’ve

00:00:44.079 got questions that you want to ask, you

00:00:45.840 can put them in the chat and um I will

00:00:48.719 quiz him. But I just thought I’d start

00:00:50.879 firstly s by saying thank you and thank

00:00:53.039 you for all your work that you do.

00:00:55.280 Pleasure. Pleasure. I’m looking forward

00:00:56.960 to being quizzed.

00:00:59.039 So, it’s very interesting about skin,

00:01:01.359 and I know I talk about this quite a

00:01:03.039 lot, and I’ve talked to you about it

00:01:04.319 before. Lots of people think skin equals

00:01:07.439 a woman’s face equals vanity. Now,

00:01:11.760 recently some um guidelines came out um

00:01:14.720 and there was this sort of consensus

00:01:16.159 statement with the International

00:01:17.600 Menopause Society, and they were saying

00:01:19.360 that we should absolutely never use HRT

00:01:22.640 just to improve skin and hair. And I

00:01:25.600 sort of felt a bit annoyed in some ways

00:01:28.320 because it was almost dissing skin, like

00:01:30.560 skin doesn’t really matter. Now, if I

00:01:33.280 was only taking HRT to try and look

00:01:36.360 younger, okay, we can talk about that.

00:01:39.280 You know, there’s some social issues or

00:01:40.960 whatever ethical issues with that, but

00:01:42.880 in my mind, the skin is an organ and we

00:01:46.320 you can explain more about that. But if

00:01:48.640 I’m taking HRT to improve my skin, i.e.

00:01:51.840 have less dry skin, have less thinning

00:01:54.880 of my skin, have less risk of ulcers um

00:01:58.159 like Venus ulcers and um if I had

00:02:02.000 psoriasis or eczema to improve the

00:02:04.159 quality of my skin as well, surely

00:02:06.799 that’s still quite important. Like why

00:02:09.280 do we think the skin is just like

00:02:11.280 something that covers a body or in a

00:02:13.200 woman it’s just the face? And I think

00:02:15.599 Louise, I entirely agree. It is so much

00:02:17.680 more than just facial aesthetics. And in

00:02:20.160 fact, I have a slide that says, "Skin is

00:02:23.040 more than facial aesthetics. Please can

00:02:25.040 we move away from this concept that um

00:02:28.239 reducing your facial lines means your

00:02:30.319 skin is healthy or that you are

00:02:32.160 healthy?" That’s completely not the

00:02:34.160 case. And I think it’s really important

00:02:35.519 to appreciate that 70% of women around

00:02:39.040 the permenopause and menopause have

00:02:41.120 symptoms arising from their skin. And

00:02:44.000 the skin, as you said, is a really

00:02:45.920 important organ. It’s one of the biggest

00:02:48.640 organs in the body and has important

00:02:51.920 structure and functional aspects to it.

00:02:55.280 So it’s not just the aesthetics, it’s

00:02:57.519 the structure of skin that matters. We

00:02:59.200 need integrity in our skin that’s

00:03:01.200 resistant to tearing and heals well when

00:03:04.239 there’s an injury. And we need the skin

00:03:06.560 to function properly because of course

00:03:08.319 it’s the first and foremost barrier. It

00:03:11.360 keeps the outside out and the inside in.

00:03:15.519 And we often call or refer to the

00:03:18.560 outside out being kept out as the skin

00:03:21.120 barrier. And it’s really important to

00:03:23.040 understand that hormones affect the skin

00:03:24.959 barrier and that is a basic function of

00:03:27.440 the skin. So really we need to move

00:03:29.319 towards functional improvement of the

00:03:31.920 skin, symptomatic improvement of the

00:03:34.000 skin, structural improvement of the skin

00:03:36.080 and yeah if your skin also looks better

00:03:38.560 for it that’s a bonus but that would not

00:03:41.440 be the primary aim. No, it’s very

00:03:44.319 interesting. I actually if you know I

00:03:46.319 wanted to do dermatology at some I was

00:03:49.440 yeah so it was I was going to do I

00:03:52.080 wanted to do oncology so cancer medicine

00:03:54.640 and then when I did my um member of the

00:03:57.360 Royal College of Physicians and I was

00:03:59.760 deciding on my

00:04:01.319 specialty I realized oncology wasn’t for

00:04:03.840 me it wasn’t quite holistic enough

00:04:05.840 because a lot of oncology is about

00:04:08.319 studies and trials and sometimes people

00:04:11.920 are forgetting the bigger picture and I

00:04:13.360 like using my general medicine. So then

00:04:15.519 I actually thought well skin is

00:04:17.918 something that’s everywhere obviously

00:04:20.000 and it has a really important effect and

00:04:22.720 my pathology degree I spent um a lot of

00:04:26.000 time looking at skin for women with

00:04:29.040 dysmic sclerosis um looking at the type

00:04:32.080 of collagen called type four collagen

00:04:34.080 and how it changes in these women uh

00:04:36.639 mainly um and their skin and I so I did

00:04:40.000 a lot of biopsies a lot of analyzing um

00:04:42.960 with molecular bi technology techniques.

00:04:45.120 And it was then like looking down the

00:04:47.040 microscope at skin, realizing how it can

00:04:50.320 change at a molecular level, thinking

00:04:53.040 how dynamic it is and how it can really

00:04:56.639 transform someone’s life if they haven’t

00:04:59.919 got a skin issue. Um, and it just made

00:05:03.360 me think differently. But then I

00:05:04.240 thought, well, I don’t know. I can’t

00:05:05.600 pronounce half the Latin names that skin

00:05:08.080 conditions are called, and I thought,

00:05:09.840 I’m not sure that that’s right for me.

00:05:12.080 So then I uh applied for a job in

00:05:14.720 Manchester, but Manchester skin

00:05:16.320 department’s really really popular. I

00:05:18.720 didn’t get shortlisted. I think it was

00:05:20.400 the first time. I’d never been

00:05:21.440 shortlisted for a job and I thought,

00:05:22.800 "Oh, this is the sign." Um and then I

00:05:25.199 went into general practice. But Louise,

00:05:27.360 I did not know that before. I did not

00:05:29.759 know that you are a collagen expert and

00:05:31.919 really I should be directing all my

00:05:33.680 collagen questions to you.

00:05:36.880 Interesting, isn’t it? So, but you know

00:05:39.759 the skin is is the largest organ in the

00:05:42.400 body, isn’t it? Well, yes, that is said

00:05:45.440 often, but actually probably by surface

00:05:48.960 area, the lungs are the largest organ.

00:05:51.600 I’d like to think the skin is number one

00:05:53.120 at everything, but the lungs have the

00:05:54.800 largest surface area and the muscular

00:05:56.479 sceal system has the largest weight, but

00:05:59.840 nonetheless, the skin is an extremely

00:06:02.160 important organ. And it’s interesting

00:06:04.639 that you mentioned that you know we need

00:06:06.880 to look at skin holistically. If we just

00:06:08.960 take itch for example, there are so many

00:06:12.639 causes of itch. And if you haven’t got

00:06:14.639 your training in general internal

00:06:16.479 medicine and you haven’t treated

00:06:19.280 patients on the hematology ward, on the

00:06:21.199 infectious diseases wards, you might

00:06:23.199 miss several causes of itch. That could

00:06:25.639 include problems with the kidneys,

00:06:28.479 problems with the liver. Certain forms

00:06:30.880 of cancer like lymphoma can present with

00:06:32.960 itch, certain forms of infection can

00:06:34.880 present with itch. And that’s all sort

00:06:37.440 of the internal health system or your

00:06:41.280 wellness showing on your skin. So

00:06:42.960 sometimes the skin and often the skin is

00:06:44.880 actually an insight into somebody’s

00:06:47.440 well-being and how fit and well that

00:06:49.280 they are. And that’s really one of the

00:06:50.720 most interesting things that I find

00:06:51.919 about skin which is that we get an

00:06:53.840 insight into somebody’s general health

00:06:56.479 status you know without even asking a

00:06:58.319 question. Yeah. And you know what

00:07:00.960 permenopause and menopause itchy dry

00:07:03.759 skin is so common and I shudder when I

00:07:07.280 think about women I see saw as a GP and

00:07:10.319 like you I did a lot of medical

00:07:12.400 training. So people with itchy skin

00:07:14.560 often waking them up at night really

00:07:16.560 awful come and see me with scratch marks

00:07:18.400 down their back. I would make sure they

00:07:20.479 didn’t have kidney disease, liver

00:07:22.160 disease, or lymphoma, all of these

00:07:24.240 things. And then I was often stuck. And

00:07:26.800 do you know what s I never once thought

00:07:28.479 about their hormones. And I thinking

00:07:30.080 back, they were all women in their 50s,

00:07:31.919 60s, 70s. And I did them such a

00:07:34.800 disservice because I did not think about

00:07:36.560 it at all. And now I see women obviously

00:07:39.199 they don’t come only with dry, itchy

00:07:41.520 skin. But it’s one of the things that

00:07:43.199 often melts away when they have their

00:07:45.520 hormones balanced properly. Um but but

00:07:48.639 the skin is a window really. I’m very

00:07:51.280 interested as you are preventing

00:07:53.599 disease. We want to be kept as healthy

00:07:55.919 as possible. We don’t really want to be

00:07:57.759 seeing doctors. Um but when our skin

00:08:02.000 generally, so I’m talking about our

00:08:03.919 general

00:08:05.160 skin ages fast, then it can affect it.

00:08:09.360 It’s sort of like a window into our

00:08:11.039 internal organs, isn’t it? Yeah,

00:08:13.440 absolutely. I think you know one really

00:08:16.160 important observation is when your skin

00:08:20.440 thins it is likely to predict if you’re

00:08:23.520 perry and

00:08:25.000 postmenopausal that your bones are also

00:08:27.560 thinning. And this is this observation

00:08:30.720 is you know decades centuries old that

00:08:35.120 women who had translucent skin were much

00:08:38.640 more likely to have bone fractures. And

00:08:41.440 this is where your skin is giving an

00:08:43.679 insight into what’s happening on the

00:08:45.839 inside. And it’s no surprise because

00:08:48.320 skin is about 80% type one collagen and

00:08:52.399 bone is 90% type 1 collagen. In the

00:08:56.080 bone, we have osteoblasts that build

00:08:58.720 bone. In the skin, we have fibroblasts

00:09:01.760 that build skin and build collagen and

00:09:04.160 both have estrogen receptors. And of

00:09:07.040 course, if we’ve got an estrogen

00:09:08.680 deficiency, then we’re going to have

00:09:10.640 thinning in both organs almost in a

00:09:13.600 linear fashion. And so, this is a

00:09:16.080 classic example of where your skin gives

00:09:19.040 an insight into what’s going on inside.

00:09:22.640 It’s really important because I know

00:09:24.000 when you were talking at the conference

00:09:25.519 that we um organized in March, you had

00:09:28.080 pictures of people with sort of more

00:09:30.720 wrinkles, sagging of their skin and

00:09:32.320 saying which of these people are more

00:09:33.760 likely going to have

00:09:35.160 osteoporosis. Um and this is really

00:09:38.640 important actually because one of the

00:09:41.120 reasons I take HRT is to keep my bones

00:09:43.600 strong. I’m really I just got this I’m

00:09:46.240 so scared about osteoporosis especially

00:09:47.920 of my spine actually. So anything I can

00:09:50.480 do and of course I eat healthy, of

00:09:52.320 course I do weightbearing exercises, but

00:09:54.959 actually anything to build like you say

00:09:57.360 get those osteoblasts working really

00:09:59.200 well, build the collagen, build the

00:10:02.080 structure of my bones, but again

00:10:03.920 structure of skin is is really important

00:10:06.240 and um I know when I was

00:10:08.760 permenopausal my skin really changed and

00:10:12.240 I I remember often looking in the mirror

00:10:14.560 as cleaning my teeth in the evening and

00:10:16.399 just thinking, "Oh, it just like it just

00:10:18.720 didn’t have the

00:10:20.360 same texture and it felt very sort of

00:10:24.240 dry but also quite lifeless almost like

00:10:27.279 the blood wasn’t getting to the skin in

00:10:29.440 the same way so like probably felt

00:10:32.399 almost like I wasn’t getting enough

00:10:34.880 oxygenated blood to the skin but also

00:10:37.279 not enough Venus return as well and it’s

00:10:39.839 it’s a weird thing when you think well I

00:10:42.160 haven’t changed anything my diet hasn’t

00:10:44.399 changed my exercise hasn’t changed like

00:10:46.880 it’s but that’s quite common isn’t when

00:10:49.200 we don’t have hormones. Yeah. I think

00:10:51.760 it’s it’s down to the fact that I think

00:10:54.320 virtually every single type of cell in

00:10:56.880 the skin has got receptors for

00:11:00.360 estrogen. And without uh estrogen levels

00:11:04.320 being at their optimum, the skin does

00:11:07.200 change. And it’s not uncommon for people

00:11:09.120 to come into the clinic saying they feel

00:11:10.880 they’ve got dull skin, that they’ve got

00:11:13.279 sagging of the skin, that they’ve got

00:11:14.959 dry skin, and that the appearance of the

00:11:16.959 skin has changed significantly in a

00:11:18.800 short period of time. We actually know

00:11:21.600 from studies looking at women who have

00:11:24.160 had um surgical removal of their ovaries

00:11:27.519 that the skin changes can develop within

00:11:31.120 six months of a surgical menopause. So

00:11:33.920 it does not take long for the skin to

00:11:37.519 react adversely from being void of

00:11:40.760 estrogen. We also know that we may

00:11:43.839 potentially women may potentially lose

00:11:46.519 30% of their collagen in the first 5

00:11:49.519 years after menopause. So there is a

00:11:52.640 rapid change and that’s why people

00:11:54.640 describe this change so rapidly. So

00:11:57.040 that’s the collagen where the structure

00:11:58.800 of the skin but also the function of the

00:12:00.720 skin. So our our skin produces its own

00:12:04.480 natural moisturizing factors. This

00:12:07.200 includes things like sebum which is like

00:12:09.440 a greasy substance that keeps the skin

00:12:11.680 well

00:12:12.440 hydrated. Ceramides which are like the

00:12:15.440 cement between cells that keeps the cell

00:12:18.000 barriers really watertight and stops

00:12:20.720 soaps and pollution and other things

00:12:23.040 penetrating the skin. and also our own

00:12:26.079 hyaluronic acid which is a substance

00:12:28.320 that just holds water and keeps your

00:12:30.880 skin plump and all these three three

00:12:34.079 things will decline in many women around

00:12:37.440 the permenopause and menopause. So it’s

00:12:39.440 not uncommon that their skin feels

00:12:41.839 different that it feels drier that it’s

00:12:43.839 reflecting light differently because the

00:12:46.200 composition of the skin has changed and

00:12:48.800 that’s where perhaps the appearance of

00:12:50.480 dullness may arise when nothing else has

00:12:52.560 changed. So yeah, there there are

00:12:54.880 actually many many profound changes both

00:12:57.680 at the cellular level, at the molecular

00:12:59.839 level. Um there are also changes in the

00:13:03.040 the hair follicles as well. And we also

00:13:05.200 know that around 40% of women will have

00:13:08.399 problems with hair loss around the

00:13:11.120 permenopause and menopause. So yeah,

00:13:13.120 it’s a vast uh and important topic and

00:13:16.480 it’s really important it’s that we don’t

00:13:18.399 think just of estradile because the

00:13:20.959 other hormones are really important as

00:13:22.560 well and lots of people are really

00:13:24.560 worried about testosterone and think

00:13:26.240 testosterone will will cause hair loss.

00:13:29.839 But actually for most women when they

00:13:32.079 have a normal female physiological range

00:13:35.360 of testosterone, hair growth can improve

00:13:39.040 um and skin can improve as well. A lot

00:13:41.360 of people think their skin’s going to

00:13:42.720 become spotty and oily. Um but actually

00:13:45.839 a lot of people find that their skin

00:13:48.079 texture um improves with lowd dose

00:13:50.880 testosterone as well. Yeah, this is

00:13:52.959 indeed the case and there’s actually

00:13:54.160 published data to suggest that if your

00:13:56.880 testosterone levels are very low.

00:13:58.560 Remember testosterone is anabolic that

00:14:00.639 means it stimulates growth and that

00:14:04.480 includes growth within the hair follicle

00:14:07.120 structures. So if both in men and women

00:14:10.560 in fact if your testosterone levels are

00:14:13.320 zero, both men and women will find that

00:14:16.160 the hair quality and quantity goes down

00:14:18.800 both on the scalp and on the body. And a

00:14:21.920 study showed that replenishing women

00:14:24.800 with very low levels of testosterone

00:14:27.279 back to sort of normal levels,

00:14:29.600 physiologic levels as you mentioned,

00:14:31.760 actually stimulated hair growth rather

00:14:34.639 than caused hair growth. Now I would

00:14:36.880 just say there are a small number of

00:14:39.199 women for whom they might be sensitive

00:14:41.440 to testosterone and it is actually

00:14:43.760 sometimes hard to get somebody bang in

00:14:45.600 the physiological range isn’t there?

00:14:46.959 There’s a period where you know people

00:14:48.959 are stabilizing and there are a you know

00:14:51.760 a small number of women where

00:14:53.120 potentially they might be sensitive to

00:14:55.320 androgens both on their scalp and their

00:14:58.240 skin. But it is unanimously the case

00:15:00.240 when I see patients who say look

00:15:02.000 actually I do think that this is you

00:15:04.480 know the testosterone is flaring my acne

00:15:06.240 and there are some women for whom this

00:15:07.600 is okay none of them wants to come off

00:15:09.920 it because of all the other positive

00:15:13.360 benefits of testosterone that they are

00:15:16.079 experiencing and it’s often the case

00:15:18.240 that when their levels are physiologic

00:15:20.639 and they are having some skin or hair

00:15:22.240 symptoms we can usually manage those

00:15:24.560 with skin directed and hair directed

00:15:26.480 treatment. So there’s no reason why

00:15:28.399 somebody can’t still benefit even if

00:15:31.279 they are in that minority that seems to

00:15:33.120 be sensitive. But for the majority of

00:15:34.639 people, there are generally positive

00:15:35.920 benefits. And testosterone is a potent

00:15:39.440 stimulator of sebum secretion. Sebum is

00:15:42.800 important not just on your face. We

00:15:44.160 always think about sebum and acne on the

00:15:46.639 face in teenagers. It’s actually an

00:15:49.360 important molecule all over the body. We

00:15:52.639 create sebum all over the body and that

00:15:55.040 helps lubricate the skin and protects it

00:15:57.519 from getting dry. It’s your own

00:15:59.320 moisturizer. And when your sebum levels

00:16:01.759 go down, your skin becomes more dry. And

00:16:04.480 this is why many women on testosterone

00:16:06.480 will actually experience better quality

00:16:09.040 skin in terms of hydration and also dry

00:16:11.040 eyes. You know how many women will

00:16:13.279 mention, you know what, my skin and my

00:16:15.440 eyes feel less dry because in the eyes

00:16:17.839 you’ve got sebaceous glands that are

00:16:19.839 specialist for the eyes called mimonium

00:16:21.759 glands and they also stimulate are

00:16:24.880 stimulated by testosterone and produce a

00:16:26.800 similar you know oily substance that

00:16:28.959 lubricates the surface of the eye and

00:16:30.720 reduces surface eye disease. Yeah, dry

00:16:33.920 eyes is so common and actually some

00:16:36.800 people get watery eyes because their

00:16:39.360 eyes are dry. So they go out to the cold

00:16:41.199 environment and their eyes are streaming

00:16:43.040 but they still have dry eyes and it can

00:16:45.600 be very very common umly associated with

00:16:48.240 testosterone deficiency more than the

00:16:50.560 other two hormones actually. It’s well

00:16:52.399 recognized and well discussed in the

00:16:54.880 literature about testosterone and dry

00:16:57.040 eyes. Um I mean there are lots of

00:16:59.199 reasons why people can get skin changes.

00:17:01.120 There’s lots of reasons why people can

00:17:02.720 get hair changes, but the sort of dry

00:17:06.000 skin and and and dry hair, hair loss,

00:17:09.520 the texture of hair can really change

00:17:12.319 when people don’t have hormones and any

00:17:15.359 changes to hair can take several months.

00:17:19.199 So if you started a treatment or didn’t

00:17:22.240 have so say if you had iron deficiency

00:17:25.119 and then started iron it can take a

00:17:27.280 while concept for your hair to change

00:17:29.679 and show. So Louise this is so important

00:17:33.160 because understandably people are really

00:17:35.840 impatient and they think if they don’t

00:17:37.679 see a change straight away that that

00:17:40.160 can’t have been the case and that

00:17:41.360 they’re still going to have more hair

00:17:43.600 loss even though it was the correct

00:17:45.280 treatment. I always tell my patients

00:17:47.760 that it’s going to take 8 to 12 months

00:17:51.440 to begin to see recovery

00:17:55.440 from reversing a potential cause. And

00:17:57.919 that includes genetic causes as well.

00:18:00.640 And don’t forget hair is growing what at

00:18:02.559 a rate of a centimeter a month or

00:18:04.160 something like that. So, if you’ve got

00:18:05.919 long hair and you’re assessing, you

00:18:07.919 know, your ponytail width, then that’s

00:18:10.640 going to take even another year or two

00:18:12.520 potentially before you’re actually going

00:18:14.480 to be able to visibly feel that. But

00:18:16.960 what we see under regular followup is

00:18:20.080 the starts of hair growth, the

00:18:22.080 beginnings of hair growth. And using a

00:18:24.240 magnifying glass and a damatoscope and a

00:18:26.160 tricoscope, we can monitor, you know,

00:18:28.000 that somebody is going in the right

00:18:29.679 direction, but really for them to see it

00:18:32.080 can take months. And that’s entirely the

00:18:33.840 case.

00:18:35.280 So patience is a virtue but it is this

00:18:37.840 is really difficult because there there

00:18:39.679 are so many things that affect our hair

00:18:42.320 growth and um you know I know myself a

00:18:45.120 few months ago my hair felt thinner and

00:18:47.360 then I had my estradile level done and

00:18:49.600 it was actually quite low and despite

00:18:51.600 using higher than licensed doses of

00:18:54.799 patches just because I don’t absorb

00:18:56.799 through this great barrier that my skin

00:18:58.880 is um I must have I know when I started

00:19:01.840 my HRT I was permenopausal and I’m sure

00:19:04.720 age 54. I’m menopausal now. So, I

00:19:08.080 naturally just needed a little bit more

00:19:09.919 estrogen. And I I think the last few

00:19:12.160 months my hair’s got better again. And

00:19:13.840 and it’s the only thing I’ve changed.

00:19:15.520 So, it probably is related, but you have

00:19:17.440 to wait until you really know whether

00:19:19.520 it’s made a difference or not. Yeah. And

00:19:21.600 there’s some interesting data to suggest

00:19:23.600 that it might be that it’s actually the

00:19:26.320 skin of the scalp that the estrogen is

00:19:28.480 really improving the quality of. And

00:19:30.400 that you know and when you mentioned the

00:19:32.000 blood vessels you know we’ve got tiny

00:19:34.480 little blood vessels what’s the

00:19:35.840 microvasculare

00:19:38.080 and in fact some of the treatments for

00:19:40.080 hair loss actually dilate the blood

00:19:41.919 vessels and improve hair growth that

00:19:43.440 way. But there is some data to suggest

00:19:46.000 that actually it’s the improvement of

00:19:48.240 the skin surrounding the hair follicles

00:19:51.440 that is responsible when you when you

00:19:54.559 correct somebody. Yeah. It’s it’s like

00:19:56.720 getting the soil right. If you get the

00:19:58.480 soil right, then your grass will grow

00:20:00.480 better. You feed the soil. So, we don’t

00:20:03.440 really need to be buying menopause

00:20:06.320 labeled shampoos or face creams, do we?

00:20:08.960 See? I I hate nothing more than

00:20:13.960 the surplus of menopause branded

00:20:17.520 products on the shelves and online and

00:20:20.320 on social media adverts that promise to

00:20:25.360 restore estrogen deficiency or restore

00:20:27.919 the signs of estrogen deficiency.

00:20:30.880 And you know there is no no way that

00:20:33.840 these products are able to do that you

00:20:36.080 know and I looked at you know there was

00:20:38.159 a period where I actually assessed

00:20:39.760 several products and you know I checked

00:20:42.880 all the ingredients really carefully and

00:20:46.320 determined what the active ingredients

00:20:48.320 were and what those ingredients would

00:20:51.000 do. And it was fair to say that they

00:20:53.919 were all reasonable products. They would

00:20:55.919 all help skin. They might be good

00:20:58.120 moisturizers or they might have, you

00:21:00.880 know, minor anti-aging benefits, but

00:21:04.240 there was not one product that would

00:21:07.520 only be specific for per or

00:21:09.840 post-menopausal skin. Those products

00:21:11.600 would equally work well in a man or a

00:21:15.039 premenopausal woman. There was nothing

00:21:16.640 unique in them. There was certainly

00:21:17.840 nothing specific for the menopause. So,

00:21:20.000 it’s all a marketing game. The only way

00:21:23.600 to treat the signs of estrogen

00:21:25.440 deficiency is with estrogen. It’s in the

00:21:28.480 name, isn’t it? So, you know, it kind of

00:21:31.120 it tell the only way to treat the signs

00:21:33.039 of thyroid deficiency, by the way, is

00:21:35.200 with thyroid hormone. And I don’t see,

00:21:37.679 you know, the only way to treat iron

00:21:38.880 deficiency with iron. So kind of we’ve

00:21:41.440 got to be really really transparent that

00:21:43.919 you know these products I do think

00:21:45.520 mislead and it’s a it’s a really

00:21:48.000 vulnerable bunch of you know group of

00:21:49.520 women where you you’re experiencing

00:21:51.679 symptoms you’ve got the hair loss you

00:21:53.039 think right I need to take those

00:21:54.240 supplements that collagen supplement

00:21:56.400 that multi-vitamin product that promises

00:21:59.840 you know immediate hair growth and you

00:22:02.000 know I see patients who spend hundreds

00:22:04.400 of pounds a month so hundreds on Yeah.

00:22:08.159 Yeah. and it and it shouldn’t happen.

00:22:10.080 So, we’ve got a few minutes left. I’ve

00:22:12.320 got loads of questions that came through

00:22:13.919 today on my Instagram. So, I’m just

00:22:15.679 going to quickfire you some questions if

00:22:17.840 that’s okay. Let’s let’s do it. Um so,

00:22:21.600 uh why is my skin so itchy? So, you have

00:22:24.880 mentioned that itchiness is very common.

00:22:27.440 Yeah. So, a few causes of itching. It

00:22:29.679 could be because you’re dry because of

00:22:31.120 the sebum and ceramide reduction. So,

00:22:33.280 you could do with moisturizers and

00:22:34.720 avoiding soaps. It could be um because

00:22:38.640 of the nerve endings. You know,

00:22:40.640 sometimes the nerve endings transmit

00:22:43.600 abnormal signals and give you the

00:22:45.280 sensation of itch or the sensation of

00:22:48.000 insects on your skin which is known as

00:22:49.679 formication and all these strange and

00:22:51.919 weird burning symptoms, pins and

00:22:53.520 needles, tingles, itch. So, sometimes

00:22:56.000 it’s the nerve dysfunction from estrogen

00:22:58.080 deficiency as well. And another not

00:23:01.200 uncommon cause of itching is too much

00:23:03.840 histamine in the skin. And sometimes,

00:23:06.240 you know, taking an antihistamine can

00:23:08.320 calm the histamine in the skin. So

00:23:09.600 there’s at least three causes to look

00:23:11.440 at. But again, you know, there we said

00:23:13.280 there’s so many causes for itch, aren’t

00:23:14.880 there? Liver, kidney, absolutely spiral.

00:23:17.280 It’s really important to see someone who

00:23:19.039 understands. So see somebody who

00:23:20.400 understands and wants to check you over

00:23:22.080 properly. So perorbital dermatitis,

00:23:25.280 never had it before. Could it be hormone

00:23:26.880 related?

00:23:28.480 Indeed. You know, one in seven of us is

00:23:30.880 born with the genes that predisposes us

00:23:32.880 to

00:23:33.640 dermatitis. And dermatitis, by the way,

00:23:36.159 guys, is another word for eczema. And

00:23:38.880 potentially, if you’re prone and you’re

00:23:41.120 potentially parmenopausal and it’s

00:23:43.200 drying your skin out, then the thin

00:23:45.200 eyelid skin may be the first to show

00:23:47.360 this because it’s very much more prone

00:23:50.000 to irritation, especially because we’re

00:23:52.400 using skinincare products on that area,

00:23:54.480 potentially makeup products on that

00:23:56.000 area. And when we shampoo ourselves and

00:23:57.760 wash our faces, we might get little

00:23:59.440 collection of that sort of shampoo

00:24:01.280 product in that area. So it may it may

00:24:04.720 not. So not all changes at the

00:24:06.320 permenopause or menopause are going to

00:24:08.000 be from that. But it is worth being

00:24:10.480 evaluated for sure. Yeah. And 24 year

00:24:14.000 old. She’s on the contraceptive pill for

00:24:15.840 six years, but her hair is frizzing,

00:24:17.679 starting to curl, odd gray hair. So this

00:24:21.279 is interesting, isn’t it? Because

00:24:22.720 contraception, I’ve spoken about before

00:24:25.120 is actually all artificial hormones,

00:24:27.440 synthetic hormones. So, they will block

00:24:29.520 the action of estradile and progesterone

00:24:32.880 and testosterone. Um, and I see a lot of

00:24:35.840 people with mental health symptoms, mood

00:24:38.720 changes, but also dry, itchy skin when

00:24:41.360 they’ve had an implant in especially,

00:24:43.679 but hair changes too. So, it could be

00:24:46.080 related, couldn’t it? I indeed believe

00:24:48.320 this. I absolutely hate synthetic

00:24:50.400 hormones. I have to say the number of

00:24:52.919 women who come with acne from various

00:24:58.000 combinations of synthetic hormones, you

00:25:00.240 know, either progesterone only or even

00:25:02.480 combined. Um, and it is entirely

00:25:05.600 feasible that, you know, there could be

00:25:08.080 changes in the hair that’s related. Um,

00:25:11.120 sometimes there are other causes for

00:25:12.880 hair loss and change in hair quality.

00:25:14.480 And I think it is worth getting checked

00:25:16.000 over if you’ve got a strong family

00:25:17.520 history of hair loss. um you know it is

00:25:21.200 worth just being checked over for even

00:25:22.880 hereditary type changes as well but

00:25:24.559 indeed hormones could be responsible

00:25:26.320 too. Yeah. I did a podcast with Sophie

00:25:28.960 who you know my middle daughter that

00:25:30.400 came out a few weeks ago and she was

00:25:32.320 saying so many of her friends go on

00:25:34.080 birth control so contraception for their

00:25:37.039 skin but often it doesn’t help. No it

00:25:41.120 the success rate is around 50%. So it

00:25:44.720 definitely does not help 50% and I I

00:25:47.600 think a handful of those actually really

00:25:49.440 get worse from it. Yeah. And and then

00:25:51.679 there’s potentials for side effects,

00:25:53.279 isn’t there? It’s the it’s the weight

00:25:54.720 gain, the mood changes and all the other

00:25:56.799 side effects. It’s a it’s a quite a

00:25:58.720 heavy dose of estrogen or estro

00:26:00.799 synthetic estrogen as well, isn’t it?

00:26:02.720 Absolutely. So increasingly we give

00:26:04.640 women natural hormones um even when

00:26:07.360 they’re young because they can use other

00:26:08.880 forms of contraception and then have

00:26:10.559 natural hormones. Um, what about

00:26:12.720 collagen supplements? Are they Oh, don’t

00:26:15.039 get me started. Please don’t get me

00:26:17.360 started. I’m going to give you a very

00:26:18.559 short answer on this one and say at the

00:26:20.400 current time, I’m saying no. Yeah. Well,

00:26:23.200 we haven’t seen good evidence and it

00:26:24.640 sort of doesn’t make sense anyway. And

00:26:26.400 you want to treat the underlying cause.

00:26:28.000 So, if the cause is a hormonal

00:26:30.000 deficiency causing the collagen loss,

00:26:32.000 you’re better off having hormones

00:26:33.120 really, aren’t you? And just one quick

00:26:35.120 addition here, you know, make sure that

00:26:36.799 your diet’s rich in protein. you know

00:26:39.279 that you’re getting enough of the

00:26:41.120 natural collagen or nutritional

00:26:43.880 Absolutely. values. Yeah. Um quite a few

00:26:48.080 questions about acne flares, rosaceia.

00:26:51.520 Um could that be related to hormonal

00:26:54.159 changes? Definitely. Yeah. Um 10% of

00:26:57.080 permenopausal and early menopausal women

00:27:00.480 will report an acne flare. So, you know,

00:27:03.520 a very simple explanation might be that

00:27:06.159 the estrogen level has dropped more than

00:27:08.400 the relative testosterone level.

00:27:10.080 Therefore, the hair follicles are seeing

00:27:11.520 more androgen. But it’s it’s far more

00:27:14.000 complex than that. And I think just sort

00:27:16.159 of swings in hormones upset sebaceous

00:27:20.000 structures and hair follicles. And it

00:27:22.360 often more often than not actually women

00:27:25.039 who get permenopausal acne also had acne

00:27:28.880 as a teenager may also have had a

00:27:31.440 history of PCOS. So have a history of

00:27:34.279 something related to hormonal acne. So

00:27:37.039 yeah, not uncommon actually. Really not

00:27:39.039 uncommon. Yeah. And the other thing that

00:27:41.440 happens often during permenopause and

00:27:43.440 menopause is there’s an imbalance of

00:27:45.279 hormones. So often there’s more

00:27:47.600 testosterone relative to estradile. So

00:27:50.640 although testosterone tends to reduce as

00:27:53.600 we age, estradile reduces very quickly

00:27:56.720 after menopause. So people think that

00:27:59.039 they’ve got too much testosterone

00:28:00.720 because of the skin changes. And often

00:28:04.000 rather than blocking testosterone,

00:28:06.159 giving them estradile

00:28:08.399 and they might even need some

00:28:10.080 testosterone once the estradiles in um

00:28:12.960 can make a real difference, can’t it?

00:28:14.960 Yeah. Yeah. If you’ve got your estrogen

00:28:16.559 back to baseline, then that allows you

00:28:18.399 to bring the ratio back. But yeah,

00:28:21.520 absolutely, it is a common problem and

00:28:23.760 it can happen quite quickly. I’ve seen

00:28:25.760 women, you know, who who have developed

00:28:29.039 quite moderate to severe acne in a

00:28:31.760 period of 3 to four months.

00:28:36.399 So, I’m going to end there. We have done

00:28:39.600 quite a few podcasts before and we’ve

00:28:41.679 got articles on my website as well about

00:28:44.159 skin and hair. One of the things that

00:28:46.960 just to leave on a negative thought

00:28:48.960 really is that there’s incredibly little

00:28:51.520 research about skin changes, hair

00:28:54.240 changes, and hormones. A lot of it is

00:28:56.799 using synthetic hormones. We haven’t got

00:28:58.880 any upto-date studies really that are

00:29:01.600 going on at the minute. And there’s a

00:29:03.520 lot we can learn. as a I’d love to be

00:29:05.760 looking more about the different types

00:29:07.039 of collagen for example in skin and

00:29:09.039 their their effects s and I found an

00:29:11.600 article many years ago showing that

00:29:13.679 women who have venus ulcers really

00:29:16.760 reduces the incidence of venus ulcers if

00:29:20.240 people take hormones now just looking at

00:29:22.559 that itself it’s millions and millions

00:29:25.440 of nurses time dressing time NHS time

00:29:30.159 you know um dressing these ulcers in

00:29:32.399 these women and it’s painful They reduce

00:29:34.919 more. They reduce motility and mobility.

00:29:39.200 Um, you know, and they’re so much more

00:29:41.760 common in women, of course, aren’t they?

00:29:44.080 Yes. So, we we need to be thinking more

00:29:46.960 about the skin

00:29:49.799 as an organ that’s really important for

00:29:52.399 us, not just a cosmetic

00:29:54.799 um sort of device almost.

00:29:58.320 Yeah, absolutely. You know, if we’ve got

00:30:00.320 an intervention here that could reduce

00:30:03.039 Venus legos in women by a third, why

00:30:06.159 aren’t we using it? What else could that

00:30:08.960 intervention do? And it’s it’s going

00:30:11.200 back to can we improve the structure and

00:30:13.520 function of the skin? And it is apparent

00:30:15.760 that we can. So, yeah, we definitely

00:30:18.080 need to do some more research.

00:30:20.480 Yeah, there’s loads we need to do. Um,

00:30:23.360 thank you very much S for joining today

00:30:25.600 and um hope you all enjoy the rest of

00:30:28.320 your time. But go on to the website,

00:30:29.919 have a look at what what else we’ve got

00:30:31.760 over there, and um enjoy the rest of

00:30:34.480 your your day. Thank you.