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

Is estrogen face cream, the new holy grail of anti-aging? Well, here's the truth. It's not new, but we're gonna talk about it today. We're gonna 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 start 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? Does 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 gonna 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. [00:01:00] 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. So it's not just about baby making.

So we see these estrogen receptors. They're in the carat. In the carat actually. Does anyone, um. 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 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 2% per year. Super lame. I hate to be the one to break it to you. And what I'm gonna say next is kind of even worse [00:02:00] in that like skin thickness decreases by about 30%. That is that we lose about 30% 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 what we see. Wrinkled 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. And I think in the future we're gonna see research showing that using topical estrogen on the skin [00:03:00] may also help with skin inflammation or the inflammation that can happen with aging skin.

Now if you are a nerd, like I'm a nerd, let's talk about the research says about topical estrogen. So let's start with what we know from an actual c. So let's start with what we know from actual clinical trials. So firstly, collagen and elasticity improvements can happen with estrogen therapy. So a randomized control trial using 0.01% of estradiol and 0.3% of Estriol found significant improvements.

And what they found was that skin and LA. S what they found was skin elasticity, firmness, wrinkled, depth, and hydration all improved after six months of use.

Then they looked at systemic absorption and they concluded that Estriol, that's E three, that's our [00:04:00] 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.

And 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. [00:05:00] Which is why it's not the estrogen of choice.

If you have hot flashes, cognitive changes, uh, you know, the, the run of the mill kind of symptoms that we think of with perimenopause. No estradiol, that's E two That does absorb more readily, but when used in a low dose topical facial formulations, systemic levels generally remain within the postmenopausal ranges.

However, this is why Estradiol definitely requires more clinical oversight, and I would say. And I will share with you that in my practice, estriol is the one that I prefer to use in the skin until a woman has entered into menopause or she's in the late phase perimenopause. Then we start looking at estradiol 'cause she needs her estrogen levels up anyways.

And we can use this [00:06:00] low dose, which isn't gonna have like a huge systemic effect, but those changes are gonna 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.

Yeah.

Now 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 a 200% increase in hyaluronic acid content when using topical estrogen treatment.

This is why women will often say that their skin feels plumper or bouncier within weeks of using, 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 [00:07:00] 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. Estradiol, E two can, in some cases slightly elevate serum levels, usually not enough to be clinically meaningful to help manage your, uh, menopausal symptoms because we're using such a small, uh, 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 realize let's, 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 E three is estriol. That's our weaker estrogen. That's our weaker [00:08:00] estrogen. It activates er, beta if you care about that nerdy stuff.

It's, uh, minimally systemically absorbed, and it is excellent. We use it most commonly for vaginal dryness, pain with sex, vaginal atrophy, repeat UTIs, pelvic floor, um, 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, and this is why many menopause dermatologists prefer estriol. Now I wanna talk about estradiol. But before I do, can you leave me a review? Can you jump over into wherever you're listening to this right now, leave me a quick review. You [00:09:00] 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, E two. 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'm, 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.

And most prescribers are gonna start with Estriol, unless there is a compelling reason to switch to estradiol. Like, Hey, your estrogen levels are tanking as it is because your ovaries are in retirement. You're now postmenopausal. Now, we should consider getting those levels up. And again, you know, with [00:10:00] estradiol, it's not gonna be enough to put it on your face and raise your level significantly.

But if we are. Already gonna be using hormone therapy to raise your estradiol levels. We can bring in the topical as well on the face.

Now I wanna move into how to use estrogen face cream safely, however. 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 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, uh, 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 [00:11:00] eyelids.

We also don't put it on our lips. We don't want to be eating it.

And I wanna say that sometimes coupling estrogen therapy with like laser therapy, microneedling, uh, doing LED light therapy, doing your 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 size amount.

It's typically enough for the entire face. So, um, what I tell people to do, put a little piece, side amount a piece. So what I tell people to do, put a piece size amount and dab it on your face where you're gonna distribute it, and then go ahead and rub it in. Typically, we're gonna use this three to five nights per week.

And, you know, 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 like retinols. Then we're gonna alternate the times that you're using it and [00:12:00] your dermatologist should be able to advise you on this. Now, the good news about SDR L Cream is that like if you're using something like vitamin C, hyaluronic acid moisturizers in the morning, not gonna 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. I 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 gonna wanna 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 [00:13:00] changes in firmness three months, sometimes four months.

The full results. That's gonna be more like a year and a half to two years. This 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 real realistic expectations because so many times, and I listen.

I am not, I am 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 Esri L Cream will change everything in two weeks.

And honestly, you're gonna see everything change. Take a photo. I always tell, take a photo before you start. You will notice gradual improvements like I [00:14:00] outlined. You'll 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 wanna 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 wanna look younger or stay younger forever. And I think that's what always people's take is like, oh, you're just trying to like never age.

I'm, I'm gonna age. It's gonna happen. My face is gonna 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. [00:15:00] Um, 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. And so when I look at what I'm doing for my skin, do I wanna feel confident? Do I wanna feel beautiful? Heck yes. I'll check that off.

I want that. And. I wanna 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, eh, it perks up and says, Hey, I, I wanna 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. Firstly, pregnancy, you got enough estrogen going on. You gotta be just fine breastfeeding. I don't recommend it. A lot of experts [00:16:00] don't recommend it.

Anything that can go a little bit systemic can affect the baby. And we don't wanna 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 'cause that is cancer until proven otherwise.

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. That doesn't mean it's unsafe. Okay? It just means they're not trained in hormone responsive [00:17:00] 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, nam, formerly nams, um, which is the North American Menopause Society. I'm one of those clinicians who's certified through them. I, uh, actually was prescribing hormones far before I even knew NAMS existed.

But these providers tend to understand topical and local hormone therapy. Dermatologists 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 [00:18:00] topicals, especially estradiol. 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, uh, your provider, I do wanna say this about compounding pharmacies. Compounding pharmacies use FDA approved hormones. What they do that makes their products not FDA approved, 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 gonna go out to everyone. Those are the medications that the compounding pharmacists use. We look at something like progesterone Prometrium, you are gonna do a hundred milligrams to 200 milligrams and that's all you're gonna get.

You might have progesterone intolerance, you might be [00:19:00] someone who's just super sensitive to progesterone, and we need to do things differently for you. If 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 clinician, 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 from. In order to get the exact type of medication that they need. I find that very [00:20:00] 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're not working with a compound 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. 'cause that's super easy and we love that. But if it doesn't, you may need to see someone else. And 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 advise you to ask is, one, do you prescribe topical estriol or estradiol for facial use? You know the difference now, and if you don't go back and just finish listening to this episode or listen to it [00:21:00] all over again, I would ask, what do you use? I would ask what? I would ask, what dose do you typically start with?

How do you monitor? Why am I having such a hard time?

So here are the questions and 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 it, 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.

What results should I expect? I think, uh, 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 [00:22:00] one's ever had a problem with my pro, like with the prescriptions before, uh, that's not comforting.

And I would say they say no one's ever had a problem. But if we cross, 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 E three Estriol, has legitimate scientific support. It can help improve collagen hydration, elasticity, fine lines. It also appears safe for most non-pregnant women when used under medical supervision.

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's not getting you the results you want anymore, then [00:23:00] 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 gonna notice, like things are a little plumper, a little more hydrated in just a couple of weeks.

As always, thank you so much for being here. If these episodes 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. Okay. How long was that one?