Top Questions Women Ask About Aging

As women age, their hormones take off on a roller coaster, often exacerbating any signs of aging. Most aging women have one major complaint: thinning hair and skin problems such as sagging, wrinkling, and even breakouts. Why? The short answer is that hormones are often the culprit; bringing them back into balance will remedy these common worries and reduce the symptoms of aging.

I’ll take you through the typical hormonal changes by decade and answer your most pressing questions, while addressing solutions to rebalance your hormones.

Perimenopause: Women in their 40s

First, progesterone declines in the beginning of perimenopause, as women run out of ripe eggs. Second, women become more resistant to estrogen, meaning that estrogen levels climb higher, starting around age forty-three. Taken together, women experience irregular periods, faltering memory, irritability and moodiness, declining sex drive, and weight loss resistance.

Testosterone drops as well, leading to less muscle mass (a drop of 5 pounds of muscles per decade) and rising fat mass, a combination that accelerates the aging process. Once these hormones are out of whack, they drag down the thyroid too. The thyroid governs metabolism and when it’s off kilter, you gain weight too easily.

These changes explain why so many women begin to experience slow metabolism and fat-loss resistance after age forty. The bottom line: These hormonal imbalances create a vicious cycle that impacts your biology in many ways.

How Do These Hormonal Changes Affect Women’s Hair and Skin?

Estrogen protects the hair follicles and skin so lower estrogen-to-testosterone ratios may trigger hair loss, as well as weaken your bones and contribute to heart disease. Meanwhile, a slow thyroid can cause dry skin and hair, more tangles, and hair loss. Your cells also become increasingly insensitive to the hormone insulin, which leads to rising blood sugar in the morning. Higher blood sugar means you may feel foggier, experience stronger cravings for carbs, and notice more skin wrinkling and sagging.

Dermatologists have called the physics of aging the “triangle of youth.” If you draw a line across the cheeks from ear to ear and then close the triangle by drawing a line from each ear to the chin, the widest part of the face is at the cheeks. But as you age, thanks to gravity, cheeks deflate, and fat moves south. Your body makes less collagen, and the collagen that it does make is less elastic, so your skin is not as thick and firm as before. Your bones thin, so the cheekbones shrink. Excess skin moves to the jaw, and now the widest part of your face is at the jawline, and the triangle of youth is upside down.

What Can Women Do When They Start to See Thinner Hair?

Sometimes hair loss is associated with high androgens (other sex hormones), but more commonly, the root cause is low iron, thyroid hormone imbalance, or insulin resistance. Rapid hair loss can be an early sign of a thyroid problem, often first diagnosed in the beauty salon. In addition to thinning and shedding, your hair can become coarse, dry, and easily tangled. In one study, 90 percent of women with thinning hair were deficient in iron and the amino acid lysine. Lysine helps transport iron, which is essential for many metabolic processes.[1]

Insulin, the helper hormone in charge of regulating blood sugar levels, also affects hair growth. Think of it this way: when glucose builds up in the blood instead of entering the body’s cells, you may experience hair loss. Half of female patients with hair loss have a constellation of signs and symptoms related to insulin resistance, blood sugar abnormalities, high blood pressure, and abnormal cholesterol.[2] Most of the time, there are hormonal imbalances with thyroid, insulin, or testosterone. Occasionally, hair loss is linked to physical and emotional trauma, and probably dysregulation of cortisol—aka your stress hormone. Even more rare, I find underlying health conditions such as autoimmunity as the root cause.

What About Oily Skin and Breakouts?

Acne and breakouts are often linked to overactive androgens, like testosterone or DHEA. Findings indicate that the sebaceous glands (part of the endocrine system) are sensitive to the functions of androgens.[3] In fact, these glands grow in size as we age. Addressing and managing androgens, particularly testosterone levels, can curb breakouts.[4]

Why Do Women See More Hyperpigmentation or Aging Spots in Their Forties?

In short, because of cumulative sun damage and inflammation. Sun damage can impact the production of melanocytes that influence skin color, spotting, and hair follicles.[5]

Hyperpigmentation may also be caused by inflammation, possibly from topical sources, chemical peels, UV light exposure, and other environmental causes. This study also looked into the impact of postinflammatory depigmentation on different skin types. Even vitamin D deficiency could be the cause. Practicing safe exposure to the sun could curb aging spots[6].

Skin, Hair, and Body Changes in Your Fifties  

In menopause, the loss of estrogen makes skin look saggy, increases wrinkles, and depletes testosterone. With low testosterone, fat glues to your body so you don’t see any difference from workouts and it’s hard to build muscle. Skin starts to dry out as an effect of low estrogen and thyroid, same as described above but more severe after menopause (average age fifty-one).

What About Hollowing Eyes?

I think of four factors:

  1. Allergies/intolerances, particularly allergic rhinitis or eczema and sometimes called “allergic shiners” from rubbing or scratching eyes, lead to irritation in the eye and below, where it drains.
  2. Fluid accumulation, due to dysfunction of the thyroid, adrenals (cortisol), and/or liver. Lowering salt intake, warm compresses, liver function testing and detoxification may help, as well as appropriate diagnosis and treatment for thyroid and adrenal function (see my first book, The Hormone Cure.)
  3. Fat loss on the upper and lower eyelids, and the sagging of midcheek fat pad can cause contour irregularity and shadowing.
  4. Genetic predisposition related to bone or soft tissue or both. 

Do Hormones Contribute to More Rosacea Flare-ups?

It could be connected to low estrogen and even lower progesterone, called estrogen dominance. It could also be linked to changes in the microbiome, or leaky capillaries in the gut could be causing inflammation. This is particularly common with estrogen dominance, which is linked to the estrobolome, the subset of your microbiome that controls your estrogen levels. The way it works is that toxins enter your gut and are sent to the liver. Your liver doesn’t know what to do with them, so they’re sent to the fat stores, accumulating and magnifying in quantity over time. It’s like the dresser in your spare bedroom: you put things in the drawers that you don’t need. Your body does this to protect your organs from toxic overload, but the strategy backfires when you accumulate too much, hence unwanted flare-ups.

Post-Menopause Problems

When women reach their sixties, they face the unpleasant ramifications of low estrogen: dry skin, dried-out vaginas, more fat, memory issues, brain fog, and high stress. After fifty, low testosterone, plus rising blood sugar and insulin levels cause weight gain and sugar cravings. Insulin resistance means your cells can’t absorb the extra blood glucose your body keeps generating from the food you eat, and your liver converts the glucose into fat. On average, blood sugar rises ten points (in mg/dL) by age fifty.

Why the Wrinkling, Sagging Skin?  

Wrinkles look more pronounced because of a continued effect from low estrogen and less collagen. Loss of collagen makes skin look dull and weathered. Even so, I’ve learned that modulating estrogen levels with targeted lifestyle changes can slow down the loss of collagen. For instance, you can drink a collagen latte to boost production of collagen type III.

A slow thyroid can also contribute to excess wrinkles. Several micronutrients, which your body needs in small quantities for optimal physiological function, can alter your thyroid balance. It’s a good idea to check with your doctor or a functional medicine specialist to see if any deficiencies—particularly with copper, zinc, selenium, and iodine—are accelerating your aging or throwing your hormones into overdrive.

What About Rogue Hairs?

Hirsutism, the presence of coarse hairs in females in a male-like pattern, is often considered an endocrine disorder, signaled by imbalances in progesterone, testosterone, other androgens, and insulin. It’s common in young women with polycystic ovary syndrome (PCOS) and aging women.[7] Unopposed testosterone and other malfunctioning androgens cause these rogue facial and body hairs because these hormones rule the hair follicles, regulating how, where, and what type of hairs grow around the body.[8] 

For more on aging and hormones, check out my latest book, Younger, now available in paperback.

[1] Rushton, D. et al. “Iron deficiency is neglected in women’s health.” BMJ. 2002 Nov 16; 325(7373): 1176.

2 Arias-Santiago S. et al. “Androgenetic alopecia and cardiovascular risk factors in men and women: a comparative study.” J Am Acad Dermatol. 2010 Sep;63(3):420-9. doi: 10.1016

3 Ebede, Tobechi. et al. “Hormonal Treatment of Acne in Women.” J Clin Aesthet Dermatol. 2009 Dec; 2(12): 16–22. Clark, SB. et al. “Pharmacologic modulation of sebaceous gland activity: mechanisms and clinical applications.” Dermatol Clin. 2007 Apr;25(2):137-46, v.

4 Ghosh, S. et al. “Profiling and Hormonal Therapy for Acne in Women.” Indian J Dermatol. 2014 Mar-Apr; 59(2): 107–115. Zouboulis CC. “Acne vulgaris. The role of hormones.” Hautarzt. 2010 Feb;61(2):107-8, 110-4. doi: 10.1007

5 Ortonne JP. et al. “Pigmentary changes of the ageing skin.” Br J Dermatol. 1990 Apr;122 Suppl 35:21-8.

6 Davis, E. et al. “Postinflammatory Hyperpigmentation A Review of the Epidemiology, Clinical Features, and Treatment Options in Skin of Color.” J Clin Aesthet Dermatol. 2010 Jul; 3(7): 20–31.

7 Agrawal, NK. “Management of hirsutism.” Indian J Endocrinol Metab. 2013 Oct; 17(Suppl1): S77–S82. Sachdeva, S. “Hirsutism: Evaluation and Treatment.” Indian J Dermatol. 2010 Jan-Mar; 55(1): 3–7. Pepersack, T. et al. “Hormonal status and clinical relevance of hirsutism in elderly women.” Acta Endocrinol (Copenh). 1993 Oct;129(4):307-10.

8 Randall VA. “Androgens and hair growth.” Dermatol Ther. 2008 Sep-Oct;21(5):314-28. doi: 10.1111/j.1529-8019.2008.00214.x. Agrawal, NK. “Management of hirsutism.” Indian J Endocrinol Metab. 2013 Oct; 17(Suppl1): S77–S82.

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Sara Gottfried MD About Sara Gottfried MD

Sara Gottfried, MD is the New York Times bestselling author of the new book, Younger: A Breakthrough Program to Reset Your Genes, Reverse Aging, and Turn Back the Clock 10 Years. Her previous New York Times bestsellers are The Hormone Cure and The Hormone Reset Diet. After graduating from Harvard Medical School and MIT, Dr. Gottfried completed her residency at the University of California at San Francisco. She is a board-certified gynecologist who teaches natural hormone balancing in her novel online programs so that women can lose weight, detoxify, and slow down aging. Dr. Gottfried lives in Berkeley, CA with her husband and two daughters.