Estrogen Cream for the Face: What the Science Says About Anti-Aging, Collagen, and Hormones

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0:42Gemini and Chrome is here for it. Ready to make anything online make sense? There's no place like Chrome. Check responses set up required. Compatibility and availability varies 18+. is estrogen face cream the new holy grail of anti-aging well here's the truth it's not new but we're going to talk about it today we're going to dive into the topic that is on a lot of women's minds especially after age 35 when their skin starts changing in ways that sort of feel really sudden and sometimes really unfair if we're being honest losing collagen is not fair So we're talking about estrogen face cream. Is it real?

1:21Does it work? Is it safe? Who can prescribe it? And is it true that estriol is the gentler option while estradiol is more potent but riskier? We're going to walk through the science, what studies actually show, who's a candidate, how to use it, and where I sit on this as a board-certified naturopathic endocrinologist. So with that said, let's get into it. First off, let's talk about why your skin responds to estrogen. So your skin is one of the most estrogen-responsive organs in your entire body. We have estrogen receptors throughout the skin. In fact, we have estrogen receptors throughout our entire body.

2:03So it's not just about baby making. So we see these estrogen receptors can be in our hair follicles, in our sebaceous glands where we produce oil, in the cells that produce keratin, and collagen-producing cells as well. And this is why women see such a profound change in their skin during perimenopause, where it gets drier, it starts to lose elasticity, it seems like it's sagging, it might feel more crepey. as estrogen declines, studies show that collagen drops by one to two percent per year. Super lame. I hate to be the one to break it to you. And what I'm going to say next is kind of even worse.

2:41That is that we lose about 30 percent of our collagen in our skin in the first five years after menopause. So that is 12 consecutive months, no period. Five years after that, there goes the dive in our collagen. That's why we see wrinkle depth increases. Hydration drops due to reduced hyaluronic acid synthesis. And I want you to understand, this isn't like some cosmetic coincidence or conspiracy coming after you. This is the biology of hormones and how them shifting affects your skin. So when we are applying estrogen topically, we're essentially targeting that organ, your skin, that's designed to respond to it.

3:26and I think in the future we're going to see research showing that using topical estrogen on the skin may also help with skin inflammation or the inflammation that can happen with aging skin. Now if you're a nerd like I'm a nerd let's talk about what the research says about topical estrogen. Let's start with what we know from actual clinical trials. So firstly collagen and elasticity improvements can happen with estrogen therapy. So a trial using 0.01 % of estradiol and 0.3 % of estriol found significant improvements. What they found was skin elasticity, firmness, wrinkle depth, and hydration all improved after six months of use.

4:13And then they looked at systemic absorption and they concluded that estriol, that's E3, that's our weakest estrogen, that showed minimal to no systemic estrogenic activity. Okay, that's important because if you're not wanting estrogen to go systemic, estriol is your best bet. Now, there was another study on estriol cream and that was applied daily for 12 weeks, so roughly three months again. And what they found was improved elasticity, reduced wrinkle depth, increased collagen production. Is this sounding familiar to you? Yes. So all of the negative effects of losing your estrogen were mitigated by using topical estrogen.

4:58And it's these studies in part where the conversation about estriol being safer comes in because estriol is not going systemic in the same way that estradiol is. It's binding weekly to estrogen receptors and it does not meaningfully raise systemic estrogen levels in most women, which is why it's not the estrogen of choice. If you have hot flashes, cognitive changes, the run-of-the-mill kind of symptoms that we think of with perimenopause. Estradiol, that's E2, that does absorb more readily, but when used in a low-dose topical facial formulations, systemic levels generally remain within the postmenopausal ranges.

5:43However, this is why estradiol definitely requires more clinical oversight. And I will share with you that in my practice, estriol is the one that I prefer to use on the skin until a woman has entered into menopause or she's in the late phase perimenopause. Then we start looking at estradiol because she needs her estrogen levels up anyways. And we can use this low dose, which isn't going to have like a huge systemic effect, but those changes are going to be more pronounced. So in early perimenopause, so let's say you're like 38, 42, that's when I would use estriol. Now you're 48 to 52, that's when I would move over to estradiol.

6:29Now I mentioned the dry filling and I mentioned hyaluronic acid earlier on, estrogen also increases the skin's natural hyaluronic acid production. In fact, one study showed there was an increase in hyaluronic acid content when using topical estrogen treatment. And this is why women will often say that their skin will feel plumper or bouncier within weeks of initiating estrogen therapy. Now, there's also been safety studies and across multiple trials, topical estriol hasn't changed LH or FSH. It didn't thicken the endometrial lining and it didn't significantly raise estradiol levels. I feel like I keep saying that over and over, but it's important to highlight.

7:14Estradiol E2 can, in some cases, slightly elevate serum levels. Usually not enough to be clinically meaningful to help manage your menopausal symptoms because we're using such a small dose on a small area. So a small dose on the face alone. But again, this is why we monitor and we personalize things. You know, as I'm talking about this, I realized we need to spend a little time breaking down estriol versus estradiol because the differences matter and we don't often talk about the different forms of estrogen. So E3 is estriol. That's our weaker estrogen. It activates ER beta, if you care about that nerdy stuff.

7:58It's minimally systemically absorbed and it is excellent. We use it most commonly for vaginal dryness, pain with sex, vaginal atrophy, repeat UTIs, pelvic floor, issues like urinary incontinence. But on the face, What it may help do is improve fine lines, improve surface texture, improve hydration, improve barrier repair, and that is the best form for women who want cosmetic benefit without altering systemic hormones. And the good news is studies overwhelmingly support its safety. This is why many menopause dermatologists prefer estriol. Now, I want to talk about estradiol, but before I do, can you leave me a review?

8:47Can you jump over into wherever you're listening to this right now? Leave me a quick review. You can just click the five stars and call it a day. It helps this podcast get out to everyone who needs it and your support is what helps center women's voices in topics of women's medicine. Okay, so estradiol E2, much stronger estrogen, much more bioactive, higher systemic absorption when we use it on the skin, but it is better for deeper wrinkles and significant collagen loss. That's why, again, I will switch to that in that later perimenopause into the menopausal years. It's not appropriate for pregnancy, breastfeeding, and you shouldn't use it if you've had a hormone sensitive cancer without talking to your doctor first.

9:33And most prescribers are going to start with estriol unless there is a compelling reason to switch to estradiol. Like, hey, your estrogen levels are changing as it is because your ovaries are in retirement. You're now post-monopausal. Now we should consider getting those levels up. And again, you know, with estradiol, it's not going to be enough to put it on your face and raise your levels significantly. But if we are already going to be using hormone therapy to raise your estradiol levels, we can bring in the topical as well on the face. Now, I'm going to move into how to use estrogen face cream safely.

10:08However, I'm a doctor. I'm not your doctor. You need to meet with your doctor. You need to have an individualized conversation with them. But let's walk through some practical steps because I know I've got a lot of doctors and clinicians who do listen to this show. So where do we apply it? So crow's feet, around the eyes. If you're on YouTube, you can see me right now. Cheeks, jawline, upper lip or around the lips, areas that are thinning or have fine lines. Some women will use it on their neck, on their chest, on their forehead as well. And sometimes clinicians will say, you know, dab it just right underneath your eyes, not rubbing it all over the eyelids.

10:50We also don't put it on our lips. We don't want to be eating it. And I want to say that sometimes Coupling estrogen therapy with like laser therapy, microneedling, doing near-infrared light therapy, that can really help enhance the effects that you're getting. Now, typically, I gave you the dosages early on, so what we're distributing is about a pea-sized amount. It's typically enough for the entire face. So what I tell people to do, put a pea-sized amount and dab it on your face where you're going to distribute it and then go ahead and rub it in. Typically, we're going to use this three to five nights per week.

11:27And when we start, it's usually three nights per week. And then we start to increase to maybe five to seven nights per week. However, if you're using retinols, then we're going to alternate the times that you're using it. And your dermatologist should be able to advise you on this. Now, the good news about Estriol cream is that if you're using something like vitamin C, hyaluronic acid, moisturizers in the morning, not going to be a problem. You can also put it on and then put a moisturizer over it. What I would caution you against is not using retinol and estradiol or estriol creams the same night.

12:04I wouldn't use any exfoliating agents like BHAs with your estrogen cream. I wouldn't use strong peptides with your estrogen cream. It's a treatment in its own. And so if you're like, I'm on strong peptides, I do an exfoliant, I do retinol, then you're going to want to alternate those through the week. Now, in terms of results, that's what everybody always wants to know. One, will I get results? Hydration, usually within two weeks. Seeing the texture change, usually within two months. Seeing collagen changes in firmness, three months, sometimes four months. The full results, that's going to be more like a year and a half to two years.

12:47This is slow, science-based approach to rebuilding your skin. It's not filler. It's not Botox. It's not a quick fix. You can use filler. You can use Botox with it. If that's your jam, you can totally do that. However, I think it's always important to set up realistic expectations because so many times, and I listen, I'm not someone to hate on influencers on the internet. But like, you know, like all people, like, right, there's problematic doctors, problematic plumbers, problematic mechanics, and problematic influencers. And they'll be like, I am earning a commission on this. Therefore, I will tell you that Estriol cream will change everything in two weeks.

13:28And honestly, you're going to see everything change. Take a photo. I always tell you, take a photo before you start. You will notice gradual improvements, like I outlined. You will notice big changes, two years of consistent use. And I think that's fantastic because what we typically see is five years after menopause, we notice big changes that are not in the direction we typically want them to be. And I want to be really clear in this episode that this is something that I've been asked a lot about. I personally use Estriol cream on my face, okay? And I don't necessarily use it just because I want to look younger, stay younger forever.

14:09And And I think that's what always people take is like, oh, you're just trying to like never age. I'm going to age. It's going to happen. My face is going to get older. This is the reality. However, what we know is, is that when the barrier starts to break down, when the collagen starts to degrade, we see inflammation rises. I actually had a PhD researcher in skin health that I will link her episode to talking all about how they've measured systemic inflammation coming from the skin. Your skin can raise systemic inflammation. Systemic inflammation can lead to mood changes, can lead to cognitive changes we don't want, cardiovascular changes we don't want.

14:52And so when I look at what I'm doing for my skin, do I want to feel confident? Do I want to feel beautiful? Heck yes, I'll check that off. I want that. And I want to make sure that my barrier is working for me so my skin is protected, so I don't get injured so easily and that I'm regulating inflammation to the best of my ability. And I think the latter is a lot more important. However, my ego sometimes just perks up and says, hey, I want to feel good too. Now, another thing that's important, I think everyone should know, but definitely for my prescribers who are listening to the show right now, this is when you shouldn't use estrogen face cream.

15:28Firstly, pregnancy. You got enough estrogen going on, you ought to be just fine. Breastfeeding, I don't recommend it. A lot of experts don't recommend it. Anything that can go a little bit systemic can affect the baby. And we don't want to mess with breastfeeding hormones if that's the route a woman has chosen to go. If you have unexplained vaginal bleeding, all hormone therapy is a no until we figure out what the heck is going on because that is cancer until proven otherwise. One thing I hear from women all the time is that they're struggling with symptoms like hot flashes, sleep disruptions, and brain fog, but aren't sure where to turn to for help.

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16:53Plus, you'll get$20 off your first order today. That's M-Y-A-L-L-O-Y dot com, code Dr. Brighton. If there's a history of estrogen receptor positive breast cancer, you cannot use estradiol unless you're cleared by an oncologist. Estriol is typically considered safe. However, I always make sure the oncologist is on board because that's their wheelhouse, that's their expertise. If someone has an active skin infection, this should be common sense, but just in case it's not, don't put estrogen cream on an active skin infection. Now, who can you get estrogen cream from? Not every clinician is comfortable prescribing topical estrogens for cosmetic use.

17:38That doesn't mean it's unsafe, okay? It just means they're not trained in hormone responsive dermatology. They're not trained in hormone replacement therapy or menopause hormone therapy, and that's great that they know their limitations and they can refer you. So who else can you see or who can you refer to? Menopause specialists. So physicians who are certified by the Menopause Society, formerly NAMS, which is the North American Menopause Society. I'm one of those clinicians who's certified through them. I actually was prescribing hormones far before I even knew NAMS existed. But these providers tend to understand topical and local hormone therapy.

18:19dermatologists who have training in menopause dermatology. There are more and more dermatologists now incorporating estriol and low-dose estradiol into anti-aging protocols, and they can advise you on like the full gamut of how to take care of your skin. We love dermatologists. Functional and integrative medicine clinicians, many of them are comfortable with low-dose hormonal topicals, especially estriol. And if you're still having a hard time, call compounding pharmacy. They can't prescribe, okay? But they are the fastest way to locate clinicians in your region who do prescribe. And before I give you questions to ask your provider, I do want to say this about compounding pharmacies.

19:03Compounding pharmacies use FDA-approved hormones. What they do that makes their products not FDA-proofed, the actual prescription given is they modify it for your needs. The FDA's role is to monitor medications and give them approval that are going to go out to everyone. Those are the medications that the compounding pharmacists use. We look at something like progesterone, Prometrium. You're going to do 100 milligrams to 200 milligrams and that's all you're going to get. You might have progesterone intolerance. You might be someone who's just super sensitive to progesterone and we need to do things differently for you.

19:42If I prescribe you 50 milligrams, that is not going to be FDA approved because the FDA doesn't care about what you as the individual is doing in terms of the dosage as much as they care about are the medications being used actually FDA approved. There are clinicians willfully, purposely spreading disinformation to dissuade women from using compounding pharmacies. as someone who is neurodivergent, works with a lot of neurodivergent women who do not always tolerate the cookie cutter protocol and the standards that are being used, or women who have a lot of sensitivities, autoimmune disease, it's quite ableist for a provider to try to dissuade people from using a very well-regulated pharmacy in order to get the exact type of medication that they need.

20:31I find that very problematic. Now, I'm a big fan of like, Can we just use what your insurance will cover and get it for you as cheap as possible? Yes. But when we can't, that's what compounding pharmacies are there for. And anybody who is very well versed in hormone therapy knows how to work with a compounding pharmacy. If they are not working with a compounding pharmacy, it is because they've been taught the cookie cutter model. That's what they know how to apply. And if that works for you, I love that because that's super easy. And we love that. But if it doesn't, you may need to see someone else.

21:01and myself and all of the providers that I respect have at one point worked with a compounding pharmacy because we listen to our patients and we know that this one size fits all doesn't in fact fit all. Okay, so let's talk about what to ask your prescriber. So here are the questions I'd say are good to ask your provider. One is do you prescribe topical estriol or estradiol for facial use? You know the difference now and if you don't remember, just go back and listen to the episode again. I would also ask, what dose do you typically start with? How do you monitor systemic absorption? If they say, well, estriol doesn't have systemic absorption, totally fair, right answer.

21:42What results should I expect? I think having a clinician who's honest about results is very important. How do we adjust if I'm sensitive to those hormones? And if somebody dismisses topical estrogen outright as dangerous, listen, that's not a provider who's keeping up with the literature, or if they just tell you, like, I wouldn't know what to do, or no one's ever had a problem with the prescriptions before, that's not comforting. And I would say, they say no one's ever had a problem, but if we come to that line and we have to cross it, then we'll do that together. Okay, great answer. So to wrap all this up for you, topical estrogen, especially E3, estriol has legitimate scientific support.

22:25It can help improve collagen, hydration, elasticity, fine lines. It also appears safe for most non-pregnant women when used under medical supervision. But keep in mind, it is a hormone therapy. So even in small doses, you need to be monitored by a prescriber. The key here is using the right formulation, the right dose, and making sure you have a provider that you can partner with. if you are someone who has noticed skin changes after age 35 and nothing topical is touching it your retinol is not getting you the results you want anymore then maybe it's time to consider estrogen cream it is an evidence-based option and if you haven't tried it yet it might be worth trying but keep in mind it can take a couple years before you see the full benefits but in most people they're going to notice like things are a little plumper a little more hydrated in just a couple of weeks.

23:21As always, thank you so much for being here. If this episode's helped you, please share it with someone. Leave me a comment. Let me know what was most helpful. This helps guide me so that I know as I create episodes going forward what kind of information actually impacts your life, helps you have better results with your clinician, better results with your health altogether. And if there's ever anything you're curious about, I'm always happy to do an episode or find the expert who can, I can interview who can do that episode for us. So I will see you next time. Your call has been forwarded to voicemail.

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