While biostimulators like PLLA and high-molecular-weight hyaluronic acid are trusted tools in aesthetic medicine, results can vary widely. One often-overlooked reason? Hormones. In this article, Dr Juanri Jonck explores how estradiol and testosterone play a pivotal role in skin quality, and what that means for treatment outcomes.
Estradiol’s role in skin quality
Estradiol (E2), the most potent form of oestrogen, plays a critical role in maintaining youthful, hydrated, and resilient skin. It stimulates fibroblasts to produce collagen and promotes glycosaminoglycan production, including hyaluronic acid, which supports skin elasticity and hydration.
Collagen provides the structural backbone of the skin, and estradiol is one of its primary regulators. Research shows that women can lose up to 30% of skin collagen within the first five years of menopause, primarily due to the sharp decline in estradiol levels. The resulting skin thinning and fragility may explain why some postmenopausal patients do not respond as robustly to biostimulators such as PLLA (poly-l-lactic acid).
In women with healthy oestrogen levels, skin regenerates more efficiently and responds better to treatments. By contrast, those with declining oestrogen may require additional support to achieve similar outcomes. In selected cases, hormone replacement therapy (HRT) can help restore estradiol levels, improving not only the skin’s response to treatment but also broader markers of well-being.
The testosterone advantage
Often overlooked in aesthetic settings, testosterone is equally important in maintaining skin health for both men and women. It promotes dermal thickness, enhances collagen turnover, and supports sebum production, which is crucial for hydration and barrier protection.
Men typically have thicker dermal layers and higher baseline collagen density, which can make their response to biostimulators more pronounced. This is likely due in part to testosterone’s effect on the skin matrix.
As testosterone levels decline with age, the skin becomes thinner and less elastic, with reduced sebum production. Addressing this decline through lifestyle interventions or, where appropriate, HRT, may complement the benefits of biostimulatory treatments, especially in older patients or those experiencing symptoms of hormonal imbalance.
Why HRT matters in aesthetics
Optimising hormonal health isn’t just about enhancing treatment results; it’s also about supporting patients’ general well-being. Estradiol, for instance, has been shown to reduce the risk of conditions such as cardiovascular disease, osteoporosis, dementia, and even breast cancer. Testosterone contributes to muscle mass, cognitive function, libido, bone health, and metabolic support.
For years, practitioners avoided prescribing HRT due to concerns raised by the early 2000s Women’s Health Initiative (WHI) study. However, long-term follow-up published in 2021 has clarified many of these concerns, showing that estradiol therapy can reduce the risk of breast cancer and improve overall health in postmenopausal women.
Rethinking aesthetic care
With this growing body of evidence, aesthetic practitioners are uniquely positioned to adopt a more comprehensive approach to patient care. By considering hormonal health when designing treatment plans, clinicians can achieve not only superior skin results but also improve quality of life.
This shift towards integrative aesthetic medicine allows practitioners to move beyond surface-level concerns and begin addressing the full spectrum of patient needs. From alleviating menopausal symptoms to enhancing confidence through more consistent results, the future of aesthetics may be as much about internal balance as it is about external rejuvenation.
Final thoughts
Hormones like estradiol and testosterone influence the skin at every level – from collagen production to hydration and elasticity. Understanding their impact helps practitioners predict treatment outcomes more accurately and personalise protocols for improved efficacy.
By addressing underlying hormonal imbalances, aesthetic doctors can offer their patients more predictable, durable, and satisfying results. When we treat the whole person, not just their face, everybody benefits.
References
- Brincat, M. (2000). The effects of oestrogens on the skin. Menopause International.
- Fisher, G. J., et al. (1996). Molecular basis of sun-induced premature skin ageing and retinoid antagonism. Nature.
- Thornton, M. J. (2002). The biological actions of oestrogens on skin. Experimental Dermatology.
- Lähteenmäki, L., et al. (2003). Effects of hormone therapy on skin. Climacteric.
- Zouboulis, C. C., et al. (2007). The human skin as a hormone target and an endocrine gland. Hormone Research.
- Pincelli, C. (2009). Androgens and skin aging. Dermato-Endocrinology.
- Kanda, N., et al. (2004). Testosterone enhances glucocorticoid-induced skin atrophy. Endocrinology.
- Manson, J. E., et al. (2021). Estrogen therapy and breast cancer incidence. WHI Study.
- Breastcancer.org. (2021). Long-term follow-up of WHI hormone trials.
- Dubois, L., et al. (2020). Testosterone and its effects on cardiovascular health. Journal of Endocrinology.
- Perring, A. (2019). Hormones and aging: A practical approach. Clinical Endocrinology.
About the author
MBChB (Pret)
Dr Juanri Jonck is a medical doctor based at lifeLAB in Pretoria and serves as a medical advisor for BST Global Aesthetic Connection. She is dedicated to enhancing natural beauty and restoring confidence through a holistic, individualised approach to patient care. Her primary focus lies in orthomolecular medicine and the importance of health optimisation through nutraceuticals, not only to prevent but also to treat certain pathological processes. She has a special interest in Aesthetic Medicine, Hormone Optimisation, IV Nutrient Therapy, and Lifestyle Improvement. Dr Jonck believes that anti-ageing begins from within, and that a natural, refreshed appearance is best achieved through internal balance. By evaluating and optimising hormone and nutrient levels, she helps patients function at their optimum health level and achieve sustainable, long-term wellbeing.