Journal / Anti-Aging

HRT as an Anti-Aging Treatment for Your Skin

Nancy L. Belcher

Medically reviewed by Nancy L. Belcher Ph.D, MPA

Written by Winona Editorial Team

Last updated November 25, 2021

HRT as an Anti-Aging Treatment for Your Skin

The evidence surrounding how hormone replacement therapy (HRT) plays a role in anti-aging, or we like to call it “pro-aging,” treatments is a hot topic. For decades there have been anti-aging creams including eye cream for wrinkles and crow’s feet that claim to be the ‘answer.’  While anti-aging face cream can help reduce fine lines, there are more effective anti-wrinkle treatments available. This article will review how HRT and our pro-aging body lotion can prevent future wrinkles. There are pro-aging products that reduce the development of wrinkles and slow the signs of aging.

Menopause &  Aging

Menopause is a part of a woman’s natural aging process and begins after you’ve gone 12 months without a period. On average menopause occurs at 51 years of age, but the variations are wide. Most women start perimenopause – the years leading up to menopause – at about 40. There are many symptoms of peri- and menopause including hot flashes and night sweats that affect around 75% of women.1

Hormone replacement therapy (HRT) can be used to provide relief from menopausal symptoms, preserve bone density (preventing osteoporosis), and may offer benefits for preventing colorectal, uterine, and breast cancers, as well as depression and cognitive decline.1 

Anti-Aging vs. Pro-Aging

There are lots of products that promise the benefits of their anti-aging properties. If you are like me, you are dubious about these treatments, especially after trying some of the over-the-counter treatments that provided disappointing results. Women know they are aging, and they’d like to do it well. So, pro-aging is the option that is the focus of Winona.

Have you ever wondered what makes a person recognize someone their own age vs. someone older or younger? Even very small children know if someone is a grandma, a mom, or a sister. It’s not just gray hair, it’s the subtle things. Did you know that your ears and nose continue to grow as you age? Longer ear lobes are one very subtle indicator of a person’s age. I have a neighbor that used to say someone was ‘very long in the tooth.’ I knew it meant “old” but didn’t know why until a dentist explained that as we age our gums recede and our teeth appear longer than in our 20’s. 

Those subtle indicators of age aren’t things we can do much about, but fine lines and wrinkles are some of the other contributing factors to making a person look older and we CAN do something about them. There are safe and effective ways to remove fine lines and wrinkles and minimize their appearance. The pro-aging treatments that Winona offers can be employed to give you not only the skin that you once enjoyed, but even better (not trying to return you to the acne days).

What is most surprising to most women is the role that HRT can play in pro-aging. As you age and move into perimenopause, at about 35 years of age, your levels of estrogen, progesterone, testosterone, and human growth hormone drop. This drop begins long before you are thinking about menopause, but it can lead to accelerated aging-related changes in the skin.1 

What Does Skin Actually DO?

When we look in the mirror, we see one layer of skin. Skin is an actual organ, like your heart or brain except that it is far bigger than the other organs in our body. Much of what happens in your skin, like acne, dryness, and even sweat, is impacted by reactions and activities deep within the skin. 

Skin has three primary layers, and each layer has a specific job 1) The Epidermis 2) The Dermis  3) The Subcutaneous Layer. 

  • The Epidermis is the outer layer of skin, and the body’s first line of defense against the outside world including bacteria, viruses, and even the weather. But the epidermis has four 4 of its own thin layers.

    1. The topmost layer is the stratum corneum, varies in thickness depending on where it is on the body, for example, your feet have thicker skin than your eyelid.  

    2. The stratum granulosum. The layer is waxy and makes skin waterproof. 

    3. The stratum spinosum, binds cells and adds strength and flexibility to your skin cells.

    4. The bottom layer of the epidermis is the stratum basale where the stem cells produce new skin cells that are pushed up to the skin’s surface constantly replacing old skin cells.

  • The Dermis is where much of the activity of how your skin looks happens. Collagen and elastin make up most of the dermis.  The dermis layer is responsible for:

    1. Delivering nutrients to your skin and removing by-products or toxins.

    2. Sweat glands push sweat through your pores to cool and clear your body of toxins.

    3. Your hair follicles are in the dermis as well as oil glands, which produce the oil that softens and smoothes skin or can cause breakouts and greasiness.

  • The Subcutaneous Layer This is the deepest layer of skin, and it attaches to your bones and muscles. It is such a deep layer that the active ingredients in skincare products will never reach it. So what does it do?

    1. It insulates the body and works like a thermostat. 

    2. Acts to pad and protect your muscles, bones, and organs from injury.

    3. Contains blood vessels, nerves, the hair follicles roots and glands which create oil.

What Happens to The Skin as We Age?

Many of the skin changes you observe with age are due to decreased hormones and environmental factors like smoking, and sun exposure. The hormones that decrease with menopause can be replaced with HRT, but how effective is HRT at reversing these structural changes at improving skin health? Very.  As we age, there are a number of things that happen that make our skin look older and all are related to hormone levels: 

  1. Thickness of the epidermis and dermis is reduced,

  2. Collagen and elastin levels decrease, and 

  3. When you combine #1 and #2 these changes can lead to dryness and itching, wrinkles and fragility, and finally an increased risk of skin trauma. 

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The Discovery of Pro-Aging Treatments

Both the upper epidermis and lower dermis are made up of basically two proteins, elastin, and collagen. Collagen makes up most of your skin and gives it its strength.  There are about 20 different types of collagen. Even though elastin makes up much less of the dermis volume, it is critical to how resilient and supple the skin is.  It is what allows your skin to restore itself after stretch or compression, for example, when you wear your watch too tight. The elastin allows the watch crease to disappear. 

As we age, we likely notice that the elasticity of our skin drops off pretty significantly at about 40. Your skin also has a system of proteins and sugars that bind water to keep it fresh. We call them glycosaminoglycans (GAG), which like hyaluronic acid, holds onto the moisture in your skin, keeping it looking younger and from drying out.2

We see firsthand how estrogen and progesterone can impact the skin when we take birth control pills. Estrogens in a combined oral contraceptive pill can lead to improvements in acne. Or, if you have psoriasis or eczema you often notice an improvement because estrogen levels increase and your skin starts to repair itself.

Since the 1940’s, scientists have recognized the importance of estrogens in the maintenance of healthy skin during menopause. That’s when it was ‘clinically’ observed that elderly women who had experienced a broken bone (osteoporotic fracture) also had thin skin. Then in 1985, researchers revealed that up to 30% of dermal collagen is lost in the first 5 years after menopause starts (when you are in your early 50’s) and that level continues to reduce at a rate of 2% per menopausal year thereafter.3

Although we know that levels of collagen will naturally reduce with age, in women, this decrease is mostly related to the lack of estrogen rather than a woman’s chronological age. Skin elasticity in postmenopausal women decreases at a rate of approximately 0.55% per year.1,3

In the 1990s, scientists were able to identify estrogen receptors on dermal fibroblasts and keratinocytes which produce collagen and are responsible for the thickness of your skin. This was proof that hormones play a critical role in the look of your skin. Estrogen was also shown to stimulate keratinocyte growth, which leads to a thickening of the skin and reduced water loss.

The Influence of HRT on Skin Changes in Postmenopausal Women

With all of this evidence pointing to the importance of estrogen in the maintenance of skin health, it led scientists to believe that HRT could reduce the signs of aging that are associated with menopause: atrophy (thinning), dry skin, and wrinkles. One study of thousands of women found that compared to non-users, HRT use was associated with a significant reduction in dry skin and wrinkling.1

After performing many trials, HRT appears to increase and improve the dermal collagen levels, and improve skin health. The longest study of HRT continued for almost 5 years and used a daily estradiol dose of 1.5mg. The trial observed increases skin thickness of between 7% and 15% in several areas of the body.1 If that isn’t good enough, another study detected a 30% increase in dermal thickness after only 12 months.1

Similar positive results were seen when using estrogen for even short periods of time for improvements in skin hydration after just 6 months.1

Reducing Wrinkles

Collagen is really what holds it all together when it comes to your skin. A reduction in the amount and quality of collagen within the dermis leads to a loss of elasticity or slackness, and wrinkles start to form. This process is made worse with sun exposure especially in areas that get a lot of sun like your face, which is subject to photo-aging.

Sometimes women feel that it’s too late once these wrinkles start appearing, but we know that HRT can improve the appearance of wrinkles on sun-exposed areas of the body. One study found that topical cream HRT and oral HRT were able to reduce skin slackness. Another study using estrogen cream for women between 52 and 70 for 7 months found it significantly helped reduce fine wrinkles. A more recent study had women use HRT for at least 5 years and it also produced improvements in skin elasticity with less pronounced wrinkling.1 In contrast, other trials have not demonstrated the same level of benefits.


There is no doubt that estrogens exert beneficial effects on the skin, and that the reduction in estrogen levels during menopause has a detrimental impact on the skin, which can be corrected through the use of HRT.  The ability of estrogen HRT to decrease the appearance of wrinkles, especially on sun-exposed areas, is still hotly debated.

The evidence around hormone replacement therapy (HRT) and how it plays a role in pro-aging treatments is a hot topic. For decades, there have been pro-aging creams including eye cream for wrinkles and crow’s feet that claim to be the ‘answer.’  HRT pro-aging products work better than anti-wrinkle cream, and anti-aging body lotion.

One of the greatest benefits of taking advantage of pro-aging treatments is improved self-confidence. When a person looks good, they feel good. Maintaining a refreshed, attractive appearance can help a person live life to the fullest. Instead of worrying about facial wrinkles or a double chin, they can spend more time enjoying life and trying new, exciting things.

If you are still in question about the benefits of HRT as an pro-aging treatment, check out Winona today. We can review your medical history and advise you on the best course of action for you.

“This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.”