G Derm Summit NYC 2011G Derm Summit NYC 2011

How Hormones Affect Skin Health How Hormones Affect Skin Health

in Aging Men and Womenin Aging Men and Women

Rick K. Wilson MDRick K. Wilson MD

The Cooper Clinic – DallasThe Cooper Clinic – Dallas

Board Certified – Dermatology & PhlebologyBoard Certified – Dermatology & Phlebology

Secondary Certification – Age Management Secondary Certification – Age Management HRTHRT

Aging gracefully Aging gracefully whether regarding our whether regarding our appearance or general somatic health is about appearance or general somatic health is about Squaring off the CurveSquaring off the Curve,,

holding back the degenerative decline brought on holding back the degenerative decline brought on byby

intrinsic and extrinsic modulating factors.intrinsic and extrinsic modulating factors.

Keys to Optimal Health

Whole FoodNutrition

Dietary Habits

Exercise aerobicresistive

Sleepquality &quantity

Hormone Therapy

StressReduction

WaterHydration

Aging gracefully Aging gracefully whether regarding our whether regarding our appearance or general somatic health is about appearance or general somatic health is about Squaring off the CurveSquaring off the Curve,,

holding back the degenerative decline brought on holding back the degenerative decline brought on byby

intrinsic and extrinsic modulating factors.intrinsic and extrinsic modulating factors.

FOCUS: FOCUS: hormonal influences on the cosmetic hormonal influences on the cosmetic consequencesconsequences

and morbidity problems associated with skin and morbidity problems associated with skin agingaging

…… …… our hormones keep us healthy, and when our hormones keep us healthy, and when restoredrestored

to optimal ranges, they keep us energetic and to optimal ranges, they keep us energetic and youthful….youthful….

____ Neal Rouzier MD____ Neal Rouzier MD

…… …… our hormones keep us healthy, and when our hormones keep us healthy, and when restoredrestored

to optimal ranges, they keep us energetic and to optimal ranges, they keep us energetic and youthful….youthful….

…… …… When I prescribe HRT … they will begin to When I prescribe HRT … they will begin to feelfeel

good with increased energy, libido, skin texture,good with increased energy, libido, skin texture,

muscle-to-fat distribution and improved mental muscle-to-fat distribution and improved mental clarityclarity

____ Neal Rouzier MD____ Neal Rouzier MD

Receptors for Te, E, other hormones Receptors for Te, E, other hormones are everywhereare everywhere

… … our Endocrine Systemour Endocrine System

Regulates all essential functions of our Regulates all essential functions of our bodiesbodies

Begins an inexorable decline in function Begins an inexorable decline in function betweenbetween

25-30 years of age25-30 years of age

Significant neuroendocrine decline impact Significant neuroendocrine decline impact notednoted

by most of us by 50 +/- 5 years by most of us by 50 +/- 5 years

Neuroendocrine DeclineNeuroendocrine Decline

Eventually, loss of hormonal effects on these tissuesEventually, loss of hormonal effects on these tissues

leads to degenerative disease – cognitive decline,leads to degenerative disease – cognitive decline,

vascular decline, muscle loss, lagging mental acuity, vascular decline, muscle loss, lagging mental acuity, etc..etc..

When Medicare was activated in 1965, the average When Medicare was activated in 1965, the average ageage

of death was 58-60. Now, we are living so much of death was 58-60. Now, we are living so much longerlonger

that we are that we are outliving our hormonal sufficiencyoutliving our hormonal sufficiency..

Effects of the Neuroendocrine Effects of the Neuroendocrine Axis DeclineAxis Decline

Most ANABOLIC Hormones decreaseMost ANABOLIC Hormones decrease Hormone Receptor Sensitivity decreasesHormone Receptor Sensitivity decreases Increase in CATABOLIC HormonesIncrease in CATABOLIC Hormones Decline in Repair Capacity Decline in Repair Capacity Decline in Organ ReserveDecline in Organ Reserve

Age-Related Disease & DebilityAge-Related Disease & Debility

. . Do we have to be resigned to . . Do we have to be resigned to thisthis

physical and mental physical and mental deterioration ?deterioration ?

Medical Standard of CareMedical Standard of Care

When we have ….When we have ….

Vit A deficiency --- give Vit AVit A deficiency --- give Vit A

Thyroid deficiency --- give thyroidThyroid deficiency --- give thyroid

Diabetes mellitus --- give recomb. human insulinDiabetes mellitus --- give recomb. human insulin

Vit D deficiency --- give Vit D ; Vit D deficiency --- give Vit D ;

same for Omega-3’s and vital trace elements ( Se, Zn, same for Omega-3’s and vital trace elements ( Se, Zn, Cu…)Cu…)

Medical Standard of CareMedical Standard of Care

When we have ….When we have ….

Vit A deficiency --- give Vit AVit A deficiency --- give Vit A

Thyroid deficiency --- give thyroidThyroid deficiency --- give thyroid

Diabetes mellitus --- give recomb. human insulinDiabetes mellitus --- give recomb. human insulin

Vit D deficiency --- give Vit D ; Vit D deficiency --- give Vit D ;

same for Omega-3’s and vital trace elements ( Se, Zn, Cu…)same for Omega-3’s and vital trace elements ( Se, Zn, Cu…)

So why are we confused about hormone replacement ? So why are we confused about hormone replacement ? Any change in Any change in hormoneshormones

can cause the ideal function of the body to falter. Sleep, diet and can cause the ideal function of the body to falter. Sleep, diet and exercise doexercise do

influence our essential levels; however, they do not delay the decline by influence our essential levels; however, they do not delay the decline by themselves.themselves.

Mental, emotional , and physical deterioration directly reflect our Mental, emotional , and physical deterioration directly reflect our hormone status.hormone status.

What we are learning about What we are learning about HRTHRT

… … used more than 60 years in Europeused more than 60 years in Europe

As peer-reviewed research continues, evidence is quickly As peer-reviewed research continues, evidence is quickly mounting mounting

that that Bioidentical Hormone Therapy Bioidentical Hormone Therapy is safe and effective with is safe and effective with fewer risksfewer risks

than with synthetic therapy as in WHI reports of 2002.than with synthetic therapy as in WHI reports of 2002.

Bioidentical = bioequivalent=human equivalentBioidentical = bioequivalent=human equivalent. The concept is . The concept is thatthat

of of mimicking naturemimicking nature using hormones with identical molecular using hormones with identical molecular structurestructure

to those naturally occurring in the human body & in to those naturally occurring in the human body & in physiologic physiologic doses doses ,,

Bioidentical – “hand & glove” like fit at human cellularBioidentical – “hand & glove” like fit at human cellular receptor sitesreceptor sites

What we are learning about What we are learning about HRTHRT

*** The hormones ( Premarin and Provera ) used in the WHI study*** The hormones ( Premarin and Provera ) used in the WHI study

are synthetic with different molecular structures, metabolites, andare synthetic with different molecular structures, metabolites, and

biological effects by comparison with bioidenticals.biological effects by comparison with bioidenticals.

““Premarin is a natural hormone if your native food is hay.”Premarin is a natural hormone if your native food is hay.”

Joel Hargrove MD, Medical DirectorJoel Hargrove MD, Medical Director

Menopause Center at Vanderbilt Univ. Med Ctr.Menopause Center at Vanderbilt Univ. Med Ctr.

Provera, medroxyprogesterone (MPA), is a Provera, medroxyprogesterone (MPA), is a progestinprogestin, not progesterone,, not progesterone,

and is a documented carcinogen totally unnatural to the human body. and is a documented carcinogen totally unnatural to the human body.

What we are learning about What we are learning about HRTHRT

The justification is present in our peer-reviewed, evidence-The justification is present in our peer-reviewed, evidence-basedbased

medical literature against these synthetic hormones and in medical literature against these synthetic hormones and in favorfavor

of bioidentical hormone usage.of bioidentical hormone usage.

Bioidentical estradiol and progesterone demonstrated no Bioidentical estradiol and progesterone demonstrated no increased riskincreased risk

of breast cancer in 10 year study of >100,000 women.of breast cancer in 10 year study of >100,000 women. Breast Cancer Res Treat 2007; 101: Breast Cancer Res Treat 2007; 101:

125-134125-134

Basic BIHT ReplacementBasic BIHT Replacement

Thyroid Thyroid ( compounded, not synthetic T4 )( compounded, not synthetic T4 )

DHEA DHEA ( compound - typically oral )( compound - typically oral )

TestosteroneTestosterone ( gel, cream, injectable, pellets, etc.) ( gel, cream, injectable, pellets, etc.)

EstrogenEstrogen ( compounded, prescription patch, etc. ) ( compounded, prescription patch, etc. )

ProgesteroneProgesterone ( not progestin = medroxyprogesterone ) ( not progestin = medroxyprogesterone )

Other …. melatonin, progesterone, HghOther …. melatonin, progesterone, Hgh

Basic BIHT ReplacementBasic BIHT Replacement

Thyroid Thyroid ( compounded, not synthetic T4 )( compounded, not synthetic T4 )

DHEA DHEA ( compound - typically oral )( compound - typically oral )

TestosteroneTestosterone ( gel, cream, injectable, pellets, etc.) ( gel, cream, injectable, pellets, etc.)

EstrogenEstrogen ( compounded, prescription patch, etc. ) ( compounded, prescription patch, etc. )

ProgesteroneProgesterone ( not progestin = medroxyprogesterone ) ( not progestin = medroxyprogesterone )

Other …. less common such as HghOther …. less common such as Hgh

Why HRT ? Why HRT ? -- because “ NORMAL DOES NOT EQUATE TO OPTIMAL “-- because “ NORMAL DOES NOT EQUATE TO OPTIMAL “

““ ““NORMAL” means you’re just as low as everyone else your age ! “ NORMAL” means you’re just as low as everyone else your age ! “ Rouzier Rouzier

…….. A gathering of plastic .. A gathering of plastic surgeons was asked this surgeons was asked this question:question:

“ “ What cosmetic procedure(s)What cosmetic procedure(s)

would you suggest for thiswould you suggest for this

woman in search for a morewoman in search for a more

youthful appearance ??? “youthful appearance ??? “

Less than one year later…. Less than one year later….

and NO PROCEDURESand NO PROCEDURES

What replacement therapyWhat replacement therapy

molecule made the molecule made the difference ?difference ?

As the largest organ of the body, skin is the organ in As the largest organ of the body, skin is the organ in whichwhich

changes of aging are most visible.changes of aging are most visible.

* target organ: reduced pituitary, adrenal, thyroid, * target organ: reduced pituitary, adrenal, thyroid, andand

gonadal secretionsgonadal secretions

* sex steroids have a profound influence on the skin * sex steroids have a profound influence on the skin aging aging

* reduction of skin functions under hormonal control :* reduction of skin functions under hormonal control :

keratinocytes, melanocytes, Langerhans cells, keratinocytes, melanocytes, Langerhans cells, sebaceoussebaceous

glands, synthesis of collagen and hyaluronic acidglands, synthesis of collagen and hyaluronic acid

Hormonal changes of Aging ….Hormonal changes of Aging …. specific body & skin phenotype specific body & skin phenotype

Philosophical context :Philosophical context :

* * in developed countries women spend up to one third (postin developed countries women spend up to one third (post menopausal) of their lives and men perhaps 20 years withmenopausal) of their lives and men perhaps 20 years with estrogen or androgen deficiencyestrogen or androgen deficiency

* * other hormones also decrease with age: thyroid, melatonin,other hormones also decrease with age: thyroid, melatonin, DHEA, progesterone, GH …DHEA, progesterone, GH …

Hormonal changes of Aging ….Hormonal changes of Aging …. specific body & skin phenotype specific body & skin phenotype

Philosophical context :Philosophical context :

* * in developed countries women spend up to one third (postin developed countries women spend up to one third (post menopausal) of their lives and men perhaps 20 years withmenopausal) of their lives and men perhaps 20 years with estrogen or androgen deficiencyestrogen or androgen deficiency

* * other hormones also decrease with age: thyroid, melatonin,other hormones also decrease with age: thyroid, melatonin, DHEA, GH …DHEA, GH …

**Since the skin serves a protective function for our Since the skin serves a protective function for our bodies, even functioning itself as a peripheral intracrine bodies, even functioning itself as a peripheral intracrine organ, shouldn’t we consider supporting and nourishing organ, shouldn’t we consider supporting and nourishing it by hormone replacement ?it by hormone replacement ?

Thyroid- Master of MetabolismThyroid- Master of Metabolism

Overall bodily function Overall bodily function dependentdependent

on this master hormoneon this master hormone

Influences protein synthesis, cellInfluences protein synthesis, cell

proliferation, relative blood flow,proliferation, relative blood flow,

BMR ( temperature )BMR ( temperature )

Other signaling and controlOther signaling and control

functionsfunctions

*** over 200 symptoms and signs*** over 200 symptoms and signs

related to thyroid functionsrelated to thyroid functions

Hypothyroid skinHypothyroid skin sns./ sxs. sns./ sxs.

--cold, dry, coarse skin --cold, dry, coarse skin feauresfeaures

with decreased lustre andwith decreased lustre and

slower healingslower healing

Hyperthyroid skinHyperthyroid skin

-- thinner and more fragile -- thinner and more fragile skinskin

with possible seborrheawith possible seborrhea

DHEA : the Mother HormoneDHEA : the Mother Hormone

Converted to estrogenic and androgenic metabolitesConverted to estrogenic and androgenic metabolites

found only in the skinfound only in the skin

Suppresses destructive TNF effectsSuppresses destructive TNF effects

Powerful antioxidant against peroxyl and superoxidePowerful antioxidant against peroxyl and superoxide

free radicalsfree radicals

Prevents chemical carcinogens from binding to DNAPrevents chemical carcinogens from binding to DNA

Estrogen and Skin AgingEstrogen and Skin Aging

Estrogen in youthEstrogen in youth

* positive influence on collagen* positive influence on collagen and hyaluronate synthesisand hyaluronate synthesis

* increases dermal thickness &* increases dermal thickness & elasticityelasticity

* enhanced wound healing by* enhanced wound healing by suppression of inflammatorysuppression of inflammatory cytokinescytokines

* both topical and systemic HRT* both topical and systemic HRT have been shown to have have been shown to have

positivepositive influences on biophysical influences on biophysical

qualitiesqualities of the skinof the skin

Estrogen deprivationEstrogen deprivation

* loss of collagen and elastic* loss of collagen and elastic tissuestissues

* dryness, atrophy, fine wrinkling,* dryness, atrophy, fine wrinkling, and poor wound healingand poor wound healing

* decreased hydration and turgor* decreased hydration and turgor by decline in by decline in

mucopolysaccharidemucopolysaccharide and hyaluronic acidand hyaluronic acid

* increased sebum production and* increased sebum production and regional pilosityregional pilosity

ConclusionConclusion Our Endocrine System plays a marvelous intimateOur Endocrine System plays a marvelous intimate role in skin youthfulness and function.role in skin youthfulness and function.

Skin has a powerful intacrine system of its own,Skin has a powerful intacrine system of its own, producing key sex steroids which support andproducing key sex steroids which support and protect integumentary integrity.protect integumentary integrity.

Previously age-related decreases (endocrine decline) of Previously age-related decreases (endocrine decline) of various hormone levels have been accepted as “normal”. various hormone levels have been accepted as “normal”. Today this is Today this is

much less the case.much less the case.

The motivational energy derived from the positive effects The motivational energy derived from the positive effects ofof

HRT(BIHT) on our skin and other organ systems regularly HRT(BIHT) on our skin and other organ systems regularly spillsspills

over into generally vibrant living.over into generally vibrant living.

Thank You for your kind Thank You for your kind attention !attention !