Hormonal & Metabolic

Why hormones are read before the skin is treated

Name: Why hormones are read before the skin is treated
Creator: Dr Martin Galy

Dr Martin Galy

Co-Founder & Director of Wellness & Longevity

17 May 2026·5 min·Vol. VII · 01

An editorial page discussing hormones and skin illustrating the subject of clinical care at 23MD

A visible concern is rarely only a surface concern. Pigmentation, laxity, dullness and a face that has lost firmness over the past year can each be a sign that something has shifted underneath, and the most common thing to shift in adults over thirty-five is the hormonal environment. That is why, at 23MD, hormones are read before the skin is treated.

The position, stated plainly

A face that has lost firmness over twelve months does not need more filler. It needs its hormonal state examined. The skin is an endocrine organ: it carries receptors for oestrogen, androgens, thyroid hormone, insulin and cortisol, and it responds to the levels of each. When those levels change, the skin changes with them, often before anything else does. A filler placed into that environment can restore a contour for a season, but it cannot restore the biology that was holding the contour in the first place. So the hormonal environment is assessed first, and treatment follows the reading.

Why hormones show in the skin

Oestrogen is the clearest example. It supports dermal collagen, hyaluronic acid and the skin's water-holding capacity, and it influences sebum, barrier function and wound healing. When oestrogen falls at the menopause, the skin thins and dries, and dermal collagen declines at a rate often quoted as around 30 per cent in the first five years, then roughly 2 per cent a year thereafter (British Skin Foundation). The commonly cited figures come from older clinical studies and should be read as an order of magnitude rather than a prediction for any individual, but the direction is not in doubt.

Thyroid hormone governs the skin's metabolic rate, so an underactive thyroid tends towards dry, coarse, pale skin and hair thinning. Insulin resistance is associated with changes in pigmentation, skin tags and a tendency to inflammation. Androgens drive sebum and, in some women, adult acne and hair changes. Chronic low-grade inflammation, which a raised hsCRP can indicate, is linked to accelerated tissue ageing more generally. None of these is a diagnosis on its own; together they are the context in which any skin treatment will either last or fail.

What we measure, and why

The 23MD hormone panel for a patient presenting with a skin concern reviews eight markers: oestradiol, progesterone, DHEA-S, free testosterone, SHBG, a thyroid panel, fasting insulin and hsCRP.

Each marker answers a different question. Oestradiol and progesterone describe where a woman is in the perimenopausal transition and whether the balance between them has shifted. DHEA-S and free testosterone describe androgen status in both sexes, with SHBG showing how much of that testosterone is actually available to tissue. The thyroid panel rules in or out an underactive or overactive gland. Fasting insulin shows metabolic strain before glucose has moved. hsCRP indicates background inflammation.

The markers are read together, not individually. A single oestradiol level on a single day tells you little, because the hormone fluctuates across the cycle and across the transition. A pattern across eight markers, read against the history and the examination, is what constitutes the clinical picture. The reading is the diagnosis.

What follows the reading

If the hormones are implicated, hormonal optimisation comes first and any aesthetic treatment waits. That may mean body-identical hormone therapy under Dr Galy's care, thyroid treatment, or a metabolic programme addressing insulin resistance, depending on what the panel shows. Only once the base is stable is the skin treated.

If the hormones are not implicated, we proceed directly with the appropriate dermal or regenerative protocol: polynucleotides, skin boosters, energy-based devices or injectables, chosen for the concern rather than for the fashion.

The sequence matters for a simple reason. Treating the skin on an unstable hormonal base produces results that do not last. The patient returns in six months with the same concern, and the temptation is to treat it again, harder. Reading the hormones first breaks that cycle.

Who this applies to, and who it does not

This is the standard of care at 23MD, not a wellness opinion. It applies to every patient over thirty-five and to any patient, of any age, whose skin concerns appeared or worsened within the past eighteen months. A change over that timescale is the signature of a change in the body, and we would rather find it than paint over it.

It does not mean every patient needs hormone treatment. Some panels come back showing that the hormones look normal. Those patients go to the skin protocol, but will return for clinical reassessment if there is little or no improvement. Nor does it mean a healthy patient under thirty-five with a stable, long-standing concern has to be tested before a routine treatment; clinical judgement applies.

A measured view of the evidence

The link between oestrogen decline and skin ageing is well established. The link between thyroid, insulin and inflammatory status and skin quality is physiologically sound and supported by clinical experience. What is less well studied is whether routinely measuring hormones before aesthetic treatment improves the longevity of that treatment; the evidence there is limited, and the 23MD position rests on clinical reasoning rather than on trial data. We say so because a patient deserves to know which parts of a protocol are proven and which parts are considered judgement.

What to expect from a consultation

A consultation begins with the history: when the concern started, what has changed in the past eighteen months, sleep, cycle, weight, energy and mood. Blood is drawn for the panel, and the results are reviewed with the patient by the doctor, not sent as a report. From there the plan is either hormonal optimisation first, or skin treatment now, and the reasons for the choice are explained. Suitability for any treatment is confirmed in person.

If you have noticed a change in your skin over the past year or so and want it understood rather than simply treated, read about hormonal skin changes and doctor-led hormone therapy at 23MD, or book a consultation with Dr Galy.