Understanding Hormonal Imbalances

It is important that dermatologists possess comprehensive knowledge and strategies for managing hormone-related aspects to enhance overall patient well-being and appearance, reports Shriyal Sethumadhavan.

Hormonal fluctuations wield significant influence over dermatological concerns in the realms of skin health, weight management, and hair vitality. These intricate hormonal dynamics link with dermatology. Hormonal imbalances can contribute to skin issues such as acne, dryness, and premature ageing by affecting sebum production and collagen levels. In addition, they play a pivotal role in metabolic processes, influencing body weight and the challenges of weight management. The influence extends to hair health, resulting in concerns like hair loss, thinning, and alterations in texture. Dermatologists should be well-versed in managing these hormone-related aspects to optimise patients’ overall well-being and appearance.

Impact on skin, weight, and hair

Hormonal imbalances, such as increased androgens (male hormones) or fluctuations in estrogen levels, can stimulate the sebaceous glands to produce excess oil. “This can lead to clogged pores and acne breakouts, particularly along the jawline and chin,” says Dr Sudha Vani Damarla, Consultant Dermatology & Founder, Sri Skin & Cosmetology Centre, Hyderabad. “Hormones can influence the skin’s moisture balance. For example, lower estrogen levels during menopause can lead to drier skin, while increased androgens can make the skin oilier.”

She further adds that hormones also affect collagen production, which can impact skin elasticity and contribute to wrinkles and sagging over time. “Hormonal fluctuations can influence body fat distribution. For example, higher cortisol levels (due to stress) can lead to fat storage, especially around the abdomen. Insulin resistance, often associated with hormonal imbalances, can make it more challenging to maintain a healthy weight. Hormones like ghrelin and leptin regulate hunger and satiety, and hormonal imbalances can influence appetite and cravings.”

What’s more, hormonal imbalances, such as elevated androgens, can cause hair thinning and lead to conditions like hirsutism (excessive facial and body hair) or male-pattern baldness, says Dr Damarla. Whereas hormones like estrogen

promote shinier and thicker hair, hence any imbalances can affect hair texture and appearance. Hormonal fluctuations during the menstrual cycle, pregnancy, and menopause can impact breast size and tenderness. Estrogen and progesterone play key roles in these changes.

Dr Damarla goes on to add that hormones can influence melanin production, affecting skin pigmentation. “Conditions like melasma, often exacerbated by hormonal changes, result in dark patches on the skin, especially on the face. Hormonal imbalances can lead to changes in nail growth, strength, and appearance. For example, brittle nails are sometimes associated with thyroid disorders.

Dr Akanksha Singh Cornuit, Founder, PromMed Aesthetics, Bengaluru, says, “Hormonal fluctuations can have significant effects on skin health, weight management, and hair health and different life stages can trigger hormonal changes that bring up on these changes. Making diet and lifestyle changes can help manage those fluctuations. Hormones do not just control how you feel, it may impact the following, she elaborates:

For skin health

• Acne: Hormonal changes, such as those during puberty, menstruation, or pregnancy, can lead to increased oil production in the skin, which may result in acne breakouts.

• Ageing: Declining hormone levels as you age can contribute to a loss of skin elasticity and hydration, leading to wrinkles and dryness.

Weight Management:

• Metabolism: Hormones like insulin, thyroid hormones, and cortisol play a role in regulating metabolism and body weight. Imbalances can affect weight control.

• Appetite: Leptin and ghrelin are hormones that regulate hunger and satiety. Fluctuations can lead to overeating or reduced appetite.

Hair Health:

• Androgens: Hormones like testosterone and dihydrotestosterone (DHT) can impact hair follicles. Increased levels can lead to hair loss, particularly in conditions like androgenetic alopecia.

• Thyroid hormones: An underactive or overactive thyroid can lead to hair thinning or loss.

On her part, Dr Indu Balani, Clinical and Aesthetic Dermatologist, New Delhi, says, “Hormonal shifts, such as those during puberty, pregnancy, and menopause, can lead to increased oil production and acne. Elevated androgens can stimulate the sebaceous glands, resulting in clogged pores and breakouts. During menopause, declining estrogen levels can lead to reduced collagen production, contributing to thinning skin and wrinkles.” She mentions that it is crucial to tailor your skincare routines to accommodate these hormonal changes. Regarding weight management, Dr Indu adds, “Hormones play a pivotal role in regulating appetite, metabolism, and fat storage. Hormones like insulin, cortisol, and leptin are key players in these factors. Fluctuations in these hormones can lead to weight gain or, in cases of hyperthyroidism, even weight loss and hair loss. Androgens, particularly Dihydrotestosterone, have a significant influence on the hair growth cycle.” In conditions like androgenic alopecia or female pattern baldness, hair follicles become sensitive to DHT, leading to the miniaturisation of hair follicles and characteristic male pattern baldness. Hormonal fluctuations during pregnancy and menopause can also affect hair density, resulting in hair growth during pregnancy and hair fall during lactation. These fluctuations significantly impact hair and skin health.

Managing hormonal fluctuations often involves a combination of lifestyle changes, medication, and, in some cases, consultation with a dermatologist may be required.

Interplay between hormones and aesthetic concerns Hormones play a significant role in various aesthetic concerns, and hormonal imbalances can exacerbate these issues. As recommended by Dr Akanksha, here’s how hormones are interconnected with common aesthetic concerns:

• Acne: Hormones like androgens (eg: testosterone) can stimulate the sebaceous glands to produce more oil, leading to acne. Hormonal imbalances, such as those occurring during puberty, the menstrual cycle, or due to polycystic ovary syndrome (PCOS), can contribute to acne breakouts.

• Hair Loss: Hormonal imbalances, particularly elevated levels of dihydrotestosterone (DHT), can contribute to hair loss, especially in conditions like androgenetic alopecia. Hormonal changes during pregnancy or menopause can also affect hair thickness and growth.

• Weight Gain: Hormonal imbalances can impact body weight and body composition.

• Thyroid Hormones: An underactive thyroid can slow metabolism, which leads to weight gain and difficulty in losing weight.

• Cortisol: Chronic stress can lead to elevated cortisol levels, which may result in fat accumulation, particularly in the abdominal area.

• Aging of skin-Hormonal changes during menopause, such as a decline in estrogen, leads to a loss of skin elasticity and hydration, contributing to wrinkles and sagging skin.

• Hyperpigmentation: Hormonal fluctuations, such as those during pregnancy or due to hormonal contraceptives, can trigger the overproduction of melanin, leading to conditions like melasma or chloasma, causing uneven skin tone.

• Cellulite: Hormonal factors may influence the development of cellulite by affecting fat distribution and connective tissue. Estrogen, in particular, plays a role in the appearance of cellulite.

Addressing these hormonal imbalances through medical treatments, lifestyle changes, or hormone therapy, when appropriate, can help manage these aesthetic concerns.

Dr Sudha says, “Hormones play a significant role in the maintenance of normal skin physiology and can impact aesthetic concerns. For instance, hormonal imbalances can exacerbate certain dermatologic conditions.” She shares her list:

• Acne: Hormonal changes, particularly an increase in androgens, can stimulate sebum production in the skin, leading to acne breakouts.

• Excess Hair Growth (Hirsutism): Hormonal imbalances, such as elevated levels of androgens, can result in excessive hair growth in areas typically associated with male-pattern hair growth in women.

• Alopecia: Androgenetic alopecia, or pattern hair loss, is influenced by hormonal factors. In some cases, hormone imbalances can contribute to hair thinning or loss.

• Rosacea: While the precise cause of rosacea is not fully understood, hormonal factors are considered potential triggers, and hormonal therapies may exacerbate the condition.

Hormonal imbalances, such as those caused by certain contraceptive methods or hormonal therapies, can further worsen these aesthetic concerns, says Dr Sudha. “Progesteroneonly methods, like hormonal intrauterine devices (IUDs) and implants, have been associated with triggering or worsening conditions such as acne, hirsutism, alopecia, and rosacea. Hormonal contraceptives, particularly combined oral contraceptives (COCs) and vaginal rings, have shown potential in effectively treating acne and hirsutism.

Above are only some of the conditions influenced by hormonal imbalance.

Impact of aesthetic treatments

Aesthetic medicine treatments can effectively address issues related to hormonal changes in several ways. These treatments focus on improving the appearance and overall wellness of individuals during hormonal transitions. makeup can be used to conceal hair loss or thinning.

• Breast augmentation or reduction: These surgeries can address changes in breast size and shape due to hormonal fluctuations.

• Skin pigmentation: Laser treatments can target and reduce pigmentation issues like melasma.

• Topical treatments: Topical lightening agents or retinoids for hyperpigmentation.

• Aesthetic treatments: Chemical peels and microdermabrasion can help improve skin texture, reduce acne, and minimise the appearance of fine lines and age spots. Dermal fillers and botulinum toxin injections can restore lost volume, smoothen wrinkles, and enhance facial contours, providing a more youthful appearance.”

Dr Akanksha agrees that aesthetic medicine treatments are very effective in addressing various aesthetic concerns associated with hormonal changes. Here is how they can help:

For acne management

• Topical treatments: Retinoids, benzoyl peroxide, or topical antibiotics to control acne breakouts.

• Chemical peels: They can help exfoliate the skin, unclog pores, and improve skin texture, reducing acne and PIH.

For hair restoration

• Minoxidil and prescription medications like finasteride can slow hair loss and promote hair regrowth or procedures like PRP and lasers also help in gaining the lost hair.

Weight management

• Aesthetic treatments like liposuction, coolSculpting, or laser fat reduction can help contour the body by reducing localised fat deposits.

Dr Sudha offers some of the remedial methods for the issues faced by the hormonal imbalance:

• “Body contouring: Procedures like liposuction or noninvasive treatments like CoolSculpting can help target stubborn fat deposits.

• Hormone therapy: In some cases, hormone replacement therapy may be recommended to address hormonal imbalances affecting weight.

• Hair health and appearance and restoration: Options include hair transplant surgery, low-level laser therapy, and topical medications like minoxidil.

• Cosmetic camouflage: Hairstyles, hair products, and

• Nutrition and exercise plans: An in-house nutritionist can provide guidance on nutrition and exercise regimens to support healthy weight management.

Skin rejuvenation

• Dermal fillers: Injectable dermal fillers can restore volume, reduce the appearance of wrinkles, and improve facial contours.

• Laser and IPL therapy: These treatments can target skin irregularities, pigmentation issues, and stimulate collagen production for a more youthful appearance.

• Microneedling: This procedure can improve skin texture and promote collagen production.

Hyperpigmentation treatment

• Chemical peels: Chemical peels can help reduce hyperpigmentation by removing the top layer of skin with excess pigment.

• Topical lightening agents: Dermatologists may recommend topical products containing ingredients like hydroquinone or kojic acid to lighten dark spots.

• Cellulite treatments: Various treatments, such as radiofrequency, acoustic wave therapy, and laser therapy, can improve the appearance of cellulite by targeting fat cells and collagen.

While these aesthetic treatments can be effective, they may not address the underlying hormonal imbalances causing these issues. Hence a comprehensive approach often involves a combination of both the aesthetic and hormonal aspects of these concerns. Personalised treatment plans should be tailored to the individual’s specific needs and goals.

A holistic approach

Taking a holistic approach in aesthetic medicine can contribute to better patient outcomes.

A holistic approach to skin and hair health considers the interconnected factors that influence these aspects of wellbeing, contributing to better patient outcomes in several ways, as listed by Dr Sudha.

• Identifying underlying causes: Considering a patient’s overall health, lifestyle, and diet to identify potential underlying causes of skin and hair issues that can lead to the discovery of hormonal imbalances, nutritional deficiencies, or other health problems that may be contributing to the condition.

• Personalised treatment plans: Every individual is unique. By tailoring treatment plans to address a patient’s specific needs, including dietary adjustments, supplements, and lifestyle changes for more effective and sustainable results.

• Stress reduction: Techniques like meditation, mindfulness, and relaxation exercises. Lowering stress levels can positively impact skin and hair health, as stress is known to exacerbate conditions like acne and hair loss.

• Nutritional support: Proper dietary changes or supplements to address nutritional deficiencies that can affect the appearance and condition of the skin and hair.

• Lifestyle modifications: Regular exercise, adequate sleep, and the avoidance of harmful habits like smoking and excessive alcohol consumption. These lifestyle changes can promote better skin and hair health.

• Preventive care: Holistic healthcare focuses on preventing problems before they occur. This can include regular skin and hair assessments, early detection of issues, and proactive measures to maintain their health.

A holistic approach to skin and hair health takes into account the interconnected factors that influence these aspects of appearance and well-being. By addressing underlying causes, promoting overall health, and offering personalised care, it can lead to better patient outcomes, healthier skin, and improved hair condition.

Dr Akanksha agrees, “A holistic approach in the field of aesthetic medicine considers not only the physical aspects of a patient but also their overall well-being and emotional state.” She elaborates on how this approach can contribute to better patient outcomes:

• “Comprehensive assessment: By assessing not only the aesthetic concerns but also the patient’s overall health, lifestyle, and emotional state, practitioners can develop a more complete understanding of the patient’s needs and goals.

• Personalised treatment plans: Holistic practitioners tailor treatments to address the individual patient’s unique circumstances, which can lead to more effective and satisfying results.

• Emotional well-being: Aesthetic procedures can have a significant impact on a patient’s self-esteem and confidence. Holistic care considers the emotional aspects, ensuring patients feel supported throughout their journey.

• Long-term results: Holistic approaches often emphasise lifestyle factors like nutrition, exercise, and stress management. These elements can contribute to sustained results and overall health improvements.

• Safety: By considering the patient’s overall health, potential risks and complications can be minimised, leading to safer treatments.

• Preventative care: Holistic practitioners may focus on preventive measures and education, helping patients make choices that promote long-term health and aesthetics.

• Psychological benefits: A holistic approach can reduce anxiety and stress associated with aesthetic procedures, fostering a positive patient experience.”

Overall, a holistic approach in aesthetic medicine aims to optimise not only the physical appearance but also the patient’s mental and emotional well-being, potentially leading to more successful and fulfilling outcomes.