Is DHEA Beneficial to Aging Skin?

Is DHEA Beneficial to Aging Skin?

Written by Michelle Violi, PharmD – Women’s International Pharmacy

Dehydroepiandrosterone (DHEA) is one of the most abundant circulating steroid hormones in humans, with concentrations typically peaking between the ages of 25 and 35 and then gradually declining with age. It is released mostly from the adrenal glands as a precursor to androgens and estrogens, but it may have its own effects on the body as well. A plethora of benefits has been associated with DHEA, from immune system support to improved sexual satisfaction. Some have called DHEA a “super hormone” and an “anti-aging panacea;” this article examines whether this bold reputation extends to the skin.

Skin Treatments with DHEA

The positive effects of DHEA on the skin have been supported by a number of studies, including both systemic (total body) and localized treatment methods. In 2000, Dr. Étienne-Émile Baulieu et al. conducted a study where 280 women and men, ages 60-79 years old, were given 50mg of DHEA by mouth daily for one year. A number of different outcomes were evaluated. With regard to skin, the results showed improvements in:

  • Sebum production
  • Skin surface hydration
  • Skin pigmentation
  • Epidermal thickness

The researchers concluded “a lack of harmful consequences” for the 50mg per day dose. However, like any other sex hormone, DHEA can have symptoms of excess if the dose is too high, such as:

  • Excessively oily skin
  • Acne
  • Increased facial or body hair
  • Breast tenderness

It is important to watch for these symptoms in order to adjust dosing levels.

Another study, conducted by Dr. Stephanie Nouveau et al., went the topical route, which allowed for a more directed approach and a lower dose of DHEA. Over the course of four months, 20 postmenopausal women applied a DHEA 1% (10mg/gm) cream to the skin on their face and hands. When compared to a group of 20 postmenopausal women who applied a cream with no active ingredient, Dr. Nouveau et al. found the topical DHEA tended to improve skin brightness and to counteract epidermal atrophy (a characteristic feature of hormone-related skin aging) as well as the papery appearance of aging skin.

DHEA and Vaginal Tissues

Vaginal atrophy is a common condition in postmenopausal women that often occurs with urinary symptoms and causes considerable discomfort. Typically, women with vaginal atrophy experience:

  • Dryness
  • Itching
  • Irritation
  • Burning of the vaginal and/or vulvar tissues
  • Painful sexual intercourse

Traditional treatments for these symptoms have included vaginal lubricants/moisturizers and vaginal estrogens. More recently, however, DHEA has also been shown to improve symptoms of atrophy. In a 12-week study by Dr. Fernand Labrie et al., involving almost 500 menopausal women, 6.5mg of DHEA was administered vaginally on a daily basis. The results of this study showed the following benefits:

  • Improvements in vaginal pH (which is important in preventing infections)
  • Improved skin thickness and color
  • Increased vaginal secretions
  • Reduced pain during sexual activity
  • Reduced vaginal dryness

DHEA blood levels remained well within the normal postmenopausal values. 


As with all hormones, the key to optimizing DHEA is balance. While supplementing DHEA deficiency can have manifold benefits, it’s equally important to watch for symptoms of excess and to adjust dosage levels to fit individual needs. The studies discussed in this article—along with many others—indicate that, with the guidance of a healthcare practitioner, DHEA may be used to optimize skin health, particularly in inhibiting or even reversing the effects of aging.

© 2019 Women’s International Pharmacy

Edited by Carol Petersen, RPh, CNP; Women’s International Pharmacy

Is DHEA Beneficial to Aging Skin?2019-07-19T09:31:15-05:00

DHEA and Healing Skin Wounds

DHEA and Healing Skin Wounds

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

DHEA may improve skin's ability to healDehydroepiandrosterone (DHEA) is produced primarily by the adrenal glands and is the most abundant of all the steroidal hormones. The quantity of DHEA in the body drops significantly during the aging process. This is so predictable that DHEA levels could be regarded as an aging biomarker.

One of the problems of aging is that it impairs the rate of wound healing in the skin. Many people begin to notice that cuts take longer to heal as they age. Ulcerations may develop which become chronic.

In the UK, Stuart J. Mills and colleagues at Manchester University investigated the role of DHEA in aging skin. This group had already demonstrated that estrogens have a positive effect on skin healing whether used directly on the wound or throughout the body. They wondered if DHEA would have a similar effect, since it is an immediate precursor of both estrogen and testosterone. Understanding that DHEA has many positive effects on the immune system, the researchers also wanted to establish whether DHEA would work directly, or whether it had to be converted into estrogen or testosterone to be effective in healing skin wounds.

First, they compared two groups of human subjects. Those suffering from ulcerations or other signs of slow wound healing were compared with healthy individuals with normal healing. The researchers were able to demonstrate that those with slow skin healing had significantly lower DHEA levels in their blood than the healthy group.

Next, they procured estrogen-deficient mice. Unlike humans, mice do not produce DHEA but they do have the necessary enzymes in their skin to convert DHEA to estrogen or testosterone. After producing superficial wounds, the researchers gave these mice DHEA throughout their bodies. This did not produce any noticeable effect on healing. However, a marked increase in healing did occur when DHEA was applied directly to the damaged skin area.

Finally, in order to determine whether DHEA was working directly or whether the metabolites of estrogen or testosterone were the key to improved healing, the researchers used substances that blocked the conversion enzymes for estrogen and testosterone. Healing and inflammation relief did not occur when estrogen production was blocked. With only testosterone blocked, however, the benefits of the DHEA treatments remained. Mills et al. concluded that DHEA could be effective for targeted treatment of damaged skin, and that the effectiveness depended on the conversion to estrogen and its local action on estrogen receptors.

  • Mills SJ, et al. The Sex Steroid Precursor DHEA Accelerates Cutaneous Wound Healing Via the Estrogen Receptors. J Invest Dermatol. 125: 1053-1062 2005.

© 2018 Women’s International Pharmacy

Edited by Michelle Violi, PharmD; Women’s International Pharmacy

For any questions about this article, please e-mail

Carol Petersen at

DHEA and Healing Skin Wounds2018-11-05T13:27:54-05:00

Skin Deep Look At Hormones

Skin Deep Look At Hormones

Written by Michelle Violi, PharmD – Women’s International Pharmacy

There is no doubt that hormones affect the skin, but do different hormones affect the skin differently? Let’s take a closer look.


  • Estrogen appears to affect the skin and its appearance in a number of ways: It supports collagen production, it maintains skin moisture by increasing certain skin components called mucopolysaccarides and hyaluronic acid, and it may assist in maintaining barrier function of the stratum corneum (the outermost layer of the skin).
  • A study using topical estriol 0.3% cream or estradiol 0.01% cream showed markedly improved elasticity and firmness of the skin as well as decreased wrinkle depth and pore sizes in both groups.
  • A study using topical or oral estradiol with or without progesterone showed improvement in skin surface lipids, epidermal skin hydration, skin elasticity, and skin thickness after six months.


  • A study using topical progesterone 2% cream showed an increase of elastic skin properties and firmness, and a decrease in wrinkle number and depth.


  • Thyroid affects the skin through a number of different mechanisms. Thyroid hormones have a direct action on the skin itself, the skin can manifest symptoms based on thyroid hormone actions (or lack thereof) on other tissues, and the thyroid and skin can both be affected by the body’s autoimmune response.
  • Skin-related symptoms of low thyroid function include:
    • Rough, thin, scaly skin
    • Edema, or swelling of the skin
    • Puffiness of hands, face and eyelids
    • Pale skin
    • Cold skin
    • Dry skin
    • Decreased sweating
    • Rash of purple spots
  • Skin-related symptoms of excess thyroid function include:
    • Smooth, thin skin
    • Warm skin
    • Increased sweating
    • Reddening of skin
  • Skin-related symptoms of autoimmune related thyroid disorders such as Graves’ disease or Hashimoto’s thyroiditis include:
    • Eczema
    • Hives
    • Vitiligo, loss of skin pigment


  • Stress conditions can increase cortisol production in the body and contribute to immune system dysfunction and inflammation. This can lead to slowed wound healing, psoriasis exacerbation, acne flares, and atopic dermatitis (often associated with eczema and itch).
  • Increased cortisol and other adrenal related hormones can also impact skin aging by a variety of different mechanisms, such as DNA damage.


  • Androgens like testosterone affect a number of different functions of the skin. Examples include growth of the sebaceous glands, which are the glands that produce the waxy, oily substance known as sebum, as well as keeping the skin ‘s barrier intact and wound healing.
  • An excess of testosterone or a testosterone imbalance relative to the other sex hormones in the body can increase the production of sebum in the skin, which can lead to acne.


  • Melatonin regulates sleep and wakefulness in the body. Some use melatonin supplements to help them sleep. A study showed poor quality sleepers to have increased signs of skin aging including fine lines, uneven pigmentation and reduced elasticity.
  • A study using topical melatonin combined with vitamins E and C showed protection to the skin from the effects of the sun.

Hormones play a significant role in the health and function of the skin and the skin is greatly affected by hormones in the body. Interestingly, recent studies have shown the skin itself can also produce hormones. Dehydroepiandrosterone (DHEA) and androstenedione are converted in the skin to testosterone and 5 alpha dihydrotestosterone (5 alpha DHT). Scientists hope this will further our understanding of how the skin and its hormones affect the health and wellness of the entire human body.

  • Safer JD. Thyroid hormone action on skin. Dermatoendocrinol. 2011;3(3):211-15. Accessed February 13, 2017.
  • Zouboulis CC, Degitz K. Androgen action on human skin – from basic research to clinical significance. Exp Dermatol. 2004;13(suppl):4:5-10. doi:10.1111/j.1600-0625.2004.00255.x.
  • Zouboulis CC. The skin as an endocrine organ. Dermatoendrocrinol. 2009;1(5):250-52. Accessed February 13, 2017.
  • Chen Y, Lyga J. Brain-Skin Connection: Stress, Inflammation and Skin Aging. Curr Drug Targets Inflamm Allergy. 2014;13(3):177-90.
  • Holzer G, et al. Effects and side-effects of 2% progesterone cream on the skin of peri- and postmenopausal women: results from a double-blind, vehicle-controlled, randomized study. Brit J Dermatol. 2005;153(3):626-34. doi:10.111/j.1365-2133.2005.06685.x.
  • Schmidt JB, et al. Treatment of skin aging with topical estrogens. Int J Dermatol. 1996;35(9):669-74. Accessed February 10, 2017.
  • Shah MG, Maibach HI. Estrogen and skin: An overview. Am J Clin Dermatol. 2001;2(3):143-50. Accessed February 10, 2017.
  • Sator PG, et al. The influence of hormone replacement therapy on skin ageing: a pilot study. Maturitas. 2001;39(1):43-55. Accessed February 10, 2017.
  • Dreher F, et al. Topical melatonin in combination with vitamins E and C protects skin from ultraviolet-induced erythema: a human study in vivo. Brit J Dermatol. 1998;139:332-39.
Skin Deep Look At Hormones2018-04-03T17:41:56-05:00

Reading Your Face: What Can It Tell You About Hormone Balance?

Reading Your Face: What Can It Tell You About Hormone Balance?

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

If you know what to look for, the reflection of your face in a mirror can reveal signs of a hormone imbalance. Let’s start at the top to see what you might find.

If you are losing hair at the crown of your head, you might have a thyroid deficiency. Thyroid hormone affects the thickness of the hair shaft and the abundance of hair. Adequate amounts of the sex hormones, such as the estrogens and testosterone, also contribute to hair luster. Another factor to consider is your diet — your hair might need more minerals and proteins. Insufficient intake of these nutrients in your diet, or the inability to assimilate those nutrients, can also contribute to hair problems. Low stomach acid makes it difficult to absorb minerals and protein. Because digestive enzymes are needed to break down protein so it can be absorbed, supplements may be needed.

If you have thinning eyebrows, or you have lost the outer third of your eyebrows, this is called the “Sign of Hertoghe,” named after the endocrinologist who first made this observation. This is also typically a sign of low thyroid function.

If your eyelids are drooping over your eyes, many people resort to plastic surgery to snip away at the extra tissue. Growth hormone deficiencies contribute to the loss of elasticity of this tissue. Dark circles under the eyes may be related to cortisol deficiency.

If your eyes are constantly dry or watering unexpectedly, it may be due to an inability to build the fatty layer of your tears. Proper production of tears has been shown to be influenced by testosterone, DHEA, progesterone, and the estrogen hormones. See the article “Dry Eyes” in our e-newsletter archives for a more extensive discussion.

Eyelashes are considered a point of beauty in our society. Both hypo- and hyperthyroid states can lead to loss of eyelashes. Sex hormone deficits associated with aging can also contribute to losing eyelashes, and is second only to allergies as a cause of eyelash loss. Having allergies is also an indicator of low adrenal hormones, such has hydrocortisone.

Although you may not readily see it in your face, nasal stuffiness is associated with the ebb and flow of hormones. When estrogens peak mid-cycle, you might find that nasal stuffiness also peaks. If you are also plagued with an itching nose and develop a habit of rubbing your nose in an upward fashion, you may develop a horizontal crease across your nose.

Moving down to the upper lip, let’s look for signs of a problem called melasma. Melasma is hyperpigmentation of the skin associated with hormone disturbances, especially with pregnancy and birth control pill use. Sun exposure may trigger melasma, or make it worse. However, the underlying hormone responsible is melanocyte stimulating hormone (MSH). This hormone increases the production of melanin, which is responsible for darkening the skin.

The upper lip is a frequent location, but you may find dark spots in other areas as well. These are sometimes called liver spots, age spots, or sun spots. An increase in areas of darkened skin can actually be related to adrenal fatigue. As you become stressed, your body produces more and more cortisol to help cope with the stress. As more cortisol is produced, the precursor hormones like progesterone and pregnenolone are depleted, which leaves the estrogens in an unbalanced situation. This extra estrogen stimulation actually increases MSH, which in turn increases the amount of melanin deposited. Re-establishing hormone balance and relieving stress can help prevent this, and may even help reverse it. See the article “The Hormones of Relationship” in our e-newsletter archives for a discussion of how the hormone oxytocin can also help tone down high levels of cortisol.

While you are looking at the lips, do you notice wrinkles vertical to the lips? These wrinkles may indicate an estrogen deficiency, as well as a testosterone deficiency, both of which accompany menopause. Dry or cracked lips are also frequently associated with menopause. It is certainly true that older women do not have the full luscious lips of their youth, and applying lipstick may just emphasize the cracks in the lip tissue. Some advocate treating menopausal lips with a progesterone cream applied directly to the lips. Just as a side note, vitamin D may enhance the effectiveness of progesterone, and vitamin D deficiency is rampant in North America (See our newsletter on Vitamin D for more information.)

And what about one of the most annoying features of menopause, which is the proliferation of chin hairs? You can tweeze, you can shave, you can wax or use a string, you can use lasers and electrolysis, but what is really going on? In general, as women age, the androgen hormones start to predominate, including testosterone, dihydrotestosterone, and androstenedione. These hormones are believed to become more active as other hormones, such as the estrogens, progesterone, and cortisol are depleted.

Chin hair growth is especially egregious if polycystic ovary syndrome (PCOS) has developed. These chin hairs resemble the hairs on our head rather than the soft downy hairs we associate with femininity. The solution should include a careful evaluation of hormone balance. Progesterone deficit likely plays a role. As estrogen levels decline, less of the carrier protein sex hormone binding globulin (SHBG) is produced, which means that more of the testosterone-like hormones are unbound and therefore more active. Restoring estrogen may help as well. Some synthetic drug options include blocking receptor sites for the testosterone-like hormones, or blocking conversion of testosterone to its more active form, dihydrotestosterone.

Another factor potentially contributing to the problem of unwanted facial hair in women is the dysregulation of insulin and glucose, which also occurs with PCOS. Some women have reported diminished facial hair growth with a gluten free diet.

Moving on to the neck area, do you notice any skin tags? These little growths of excess skin are commonly found in the neck area and on the eyelids. Skin tags are also considered to be related to glucose and insulin hormone imbalances. Skin tags are prevalent with metabolic syndrome, pre-diabetes, diabetes, and PCOS. (See our newsletters on Diabetes and PCOS for more information about these conditions.) Although skin tags are painless, and can be easily removed surgically or at home using kits from the pharmacy, skin tags are an indicator of hormone imbalances that can be addressed.

There might also be deposits of fat around the neck, resulting in a double chin or moon face appearance. This appearance has been linked to glucose and cortisol imbalances, and diminished thyroid function. The neck can also be flabby, like waddles on a turkey neck, or have lines of extra skin. Solutions may include neck exercises, yoga, and surgery. However this neck tissue is thin and changes quickly become apparent with losses in hormones, such as progesterone, pregnenolone, and DHEA.

Now let’s look at your face overall. Is your skin pale? Thyroid hormone ensures blood circulation to the skin and, when it is compromised, pallor is evident, rather than a healthy rosiness. Are your cheeks sagging? The androgenic hormones such as DHEA, testosterone, dihydrotestosterone, and growth hormone may be deficient.

Is your skin dehydrated, as in shriveled and shrunken, or plump? If it is dry, an obvious cause may be that you are not drinking enough water. Additionally, according to Dr. David Brownstein, you may not be using enough natural whole salt. The many minerals available in whole salt allow the body to hold on to the water in the cells. And there’s a hormone connection: if you are not getting enough salt and water, the adrenal glands suffer and eventually become exhausted. The hormones affected include DHEA, progesterone, cortisol, aldosterone, the estrogens, pregnenolone, and testosterone. Furthermore, adequate thyroid function is dependent upon the adrenals.

Looking at your face in the mirror can provide clues about your hormone health, especially as you age. Your face is a reflection of potential hormone issues that affect your entire body. (See more about age-related health issues in our Successful Aging newsletter on our website.) Take notice of the changes you might first see in your face, then work with your healthcare practitioner to restore your hormone balance. Your face, as well as the rest of your body, will reflect the results.

Reading Your Face: What Can It Tell You About Hormone Balance?2018-04-09T14:31:59-05:00

Cherry Angiomas

Cherry Angiomas

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy


Do you have bright red, sometimes raised, sometimes flat spots that seem to appear on your skin out of nowhere? Did your doctor tell you they are harmless and people get them as they age?

In his book Dr. Chi’s Fingernail and Tongue Analysis, Dr. Chi says cherry angiomas are created when estrogen attacks peripheral blood vessels, causing an aneurysm. This suggests hormones may be a major factor in cherry angioma formation.

While we don’t know for sure what causes cherry angiomas, they have been associated with excess estrogen and copper, bromide toxicity, and a vitamin C deficiency leading to weakened blood vessel walls. Cherry angiomas have been observed in pregnancy and with immune system suppression including chemotherapy. Also of note, a significant presence of human herpes virus 8 has been detected in cherry angiomas.

The red color is due to broken blood vessels inside the cherry angioma and any trauma to a cherry angioma may cause significant bleeding.

Even though they seem innocuous, cherry angiomas may be an early warning sign that something is amiss. The location of the angioma may be helpful in determining which organs are affected. Cherry angiomas on the abdomen may indicate liver or hormonal problems. Cherry angiomas near the hairline area or on the head may indicate a potential risk of stroke or aneurysm.

It is important to check your skin for these tiny red spots and pay attention to what they are telling us so we can make the appropriate changes to optimize our health!

  • Cohen AD, et al. Cherry angiomas associated with exposure to bromides. Dermatology. 2001;202(1):52-3.
  • Borghi A, et al. Detection of human herpesvirus 8 sequences in cutaneous cherry angiomas. Arch Dermatol Res. 2013 Sep;305(7):659-64. doi: 10.1007/s00403-013-1346-5. Epub 2013 Apr 2.
  • Chi T. Dr. Chi’s Fingernail and Tongue Analysis. Third Edition. Anaheim, CA: Chi’s Enterprise, Inc.; 2010.
  • Delgado A. Cherry Angioma. Healthline. George Krucik, MD, 17 July 2012.
  • Scheinfeld NS. Vascular Nodules and Papules. The Clinical Advisor. 12 July 2011. Web.
Cherry Angiomas2018-04-03T17:34:50-05:00

Treating Cellulite

Treating Cellulite

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

Cellulite is defined as deposits of fat that create a dimpled, orange-peel appearance of the skin. According to Dr. Sharon McQuillan in a webinar prepared for the American Academy of Anti-Aging Medicine, losing weight does not reduce cellulite, but changes in hormone balance, diet, and lifestyle may help to do so.

Approximately 85% of women have some cellulite on their hips, thighs and buttocks. Men do not get cellulite. This gender difference is not simply due to hormones, but also is a result of differences in the structure of the skin and fat cells themselves. Fat cells under the skin are separated by a fibrous tissue called septa. In women, the fat cells and septa are lined up perpendicular to the skin surface. As fat accumulates and the septa become more rigid, the fat bulges around the septa and creates the rippling effect. In men, the septa are in a criss-cross pattern that prevents the bulging effect on the skin surface. Fat cells also tend to be larger in women, further contributing to the bumpy appearance of cellulite.

Women who are insulin-resistant, estrogen-dominant, and eat a high-glycemic diet are prone to cellulite formation. Dr. McQuillan states that hormone balance—especially with regard to insulin, estrogen, and prolactin—may help prevent or treat cellulite. Hormones such as TSH, adrenaline, ACTH, thyroid, glucagon, progesterone, and glucocorticoids help diminish the tendency to form cellulite. In addition to high-glycemic diets, other dietary factors such as protein intake, lack of fiber, and lack of sufficient vitamins and minerals also contribute to the formation of cellulite.

Cellulite is more than a cosmetic issue; it is an inflammatory condition. Because cellulite prevents blood flow to the subcutaneous and deep dermis layer of the skin, areas with cellulite can become sensitive or painful, and even lead to restless leg syndrome.

In The Cellulite Solution, Dr. Howard Murad offers nine strategies for reducing cellulite:

    • Prevent damage to the skin from free radicals. Free radicals can damage the skin and make it more susceptible to cellulite. Raw fruits and vegetables are the best source of antioxidants.
    • Strengthen blood flow. Damage to capillaries is an early component of the development of cellulite. Spider veins are also caused by capillary damage, and often associated with cellulite.
    • Improve the production of connective tissue. Connective tissue includes blood vessels, nerves, tendons, ligaments, and dermis (a layer of the skin). Adequate glucosamine is needed to repair connective tissue.
    • Improve collagen and elastin production. These proteins provide support for the connective tissue. Adequate intake and digestion of protein is needed for the body to make these particular proteins. Supplements of amino acids, which are the building blocks of protein, may help.
    • Attract water to cells. As we age, water that should be inside of cells increasingly tends to seep out and wander between cells and connective tissue. This “wasted water” becomes part of the bloated cellulite fat cells. Essential fatty acids, especially the omega-3 fatty acids found in fish oils, assist in repairing cell walls and help hold water within the cells and connective tissue.
    • Reduce wasted water. As cells and tissues are repaired, there is less water leaving the cells.
    • Repair cell membranes. Supplementing with lecithin or eggs can also help to rebuild cell membranes.
    • Reduce inflammation. The omega-3 fatty acids also reduce inflammation.
    • Promote exfoliation. When old dry skins cells are sloughed off efficiently, new cells now become visible. Washing skin with fruit acids (such as malic acid from apples, glycolic acids from sugarcane, and salicylic acid) helps loosen the old skin cells. Dry skin brushing is another method for removing old cells.

Folk remedies, such as those found at, include recommendations such as applying apple cider vinegar (a fruit acid), moisturizing with coconut oil (to hydrate the skin), and scrubbing the skin with coffee grounds (to exfoliate).

While many people disregard cellulite as an important health issue, it can be considered a sign of more serious underlying health problems. Drs. Murad and McQuillan both concur that addressing issues affecting the skin and fat cells will be a benefit to your total health.

Treating Cellulite2018-04-03T17:48:50-05:00