DO YOU NEED A HORMONE M.O.T.?

Are you looking run down? Is your skin drier than usual and your hair a little thinner? If the answer is yes, it could be your hormones – and there are now treatments to help, tailored just for you. Alice Hart-Davis explains

The conversation about hormones, menopause and perimenopause has become very noisy this year – and hurrah for that. The more we all realise how declining hormone levels can bring on hot flushes, brain fog and loss of confidence and what we can do about this, the better – but what is less well known is the way that hormonal balance impacts on the way we look, as well as the way we feel.

As hormone health is increasingly seen as part of a 360° approach to looking and feeling your best, many aesthetic doctors, who are usually busy treating patients with injectable fillers, toxins, lasers and the like, are expanding their training into hormone replacement and are offering bio-identical hormone replacement therapy (BHRT) to patients to help address aesthetic concerns, such as skin issues, weight gain and hair loss.

“What drove me to train in BHRT was that so many of my patients are perimenopausal,” says Dr Sophie Shotter, who runs the Illuminate Skin Clinic in Kent and London’s Harley Street (illuminateskinclinic.co.uk).

“They’re seeking me out for aesthetic treatments because they hope that by looking more like their old selves they will feel more like themselves again. They are often very upset about their appearance and by life in general, but by injecting them I felt I was only treating half the person and half their issues.”

As Sophie points out, weight gain is often hormonally driven and hormone loss has a massive impact on your skin. “During menopause, oestrogen production – which declines steadily from your 30s – basically falls off a cliff,” she says. “There’s a ceiling to how much skin rejuvenation we can get if someone doesn’t have enough oestrogen in their skin, however much microneedling we do, or how much retinol we throw at it.”

In short, without oestrogen, your skin can’t function anywhere near as well as it used to – and that will show.

“There is a huge link between hormone health and the way we look,” says Dr Martin Kinsella, who runs the Re-enhance Clinic in Hale, Cheshire (re-enhance.com). “And a lot of us aesthetic doctors are interested in a holistic approach to anti-ageing rather than just patching up a wrinkle. There’s no point in having all these cosmetic treatments if you don’t feel good.

“What people need to know is that the whole process of skin ageing is hormone-mediated. Once you lose oestrogen, the dermis [the firm “mattress” part of the skin] becomes thinner. You get more dryness in the skin and more wrinkle formation. The loss of hormones like testosterone and dehydroepiandrosterone (DHEA) leads to more flaccidity in the skin.”

And it’s not only women that are affected. Martin sees a number of men, mostly in their 40s, but some in their 30s. Some have read

about hormone supplements in magazines, others have heard about it from their wives, or have been chatting about it down at the gym. They may feel that they are losing testosterone levels and DHEA (the most abundant hormone in the body and one that can be converted into other hormones) and as a result they can feel that they’re losing their drive and, in the gym, their ability to gain muscle – something that is also closely linked to testosterone levels.

But BHRT isn’t just HRT by another name. It is slightly different to the more common HRT treatments and is only available privately, rather than on the NHS. “BHRT is a customised hormone regime that is tailormade for each patient to optimise overall wellbeing, restore imbalances and improve their quality of life,” says Sophie.

To complicate matters further, doctors working with the NHS and specialising in menopause tend to describe the HRT they offer as “body-identical hormones”. But aren’t the hormones in BHRT also “body-identical”?

“BHRT is a form of HRT that uses structurally identical hormones to your natural hormones,” says Sophie. “Where BHRT is different to body-identical hormones is that it is fully customised – it has been compounded specially for you. I can put three hormones in one special tablet rather than making you take three. And if one hormone is only available as a 100mg body-identical dose, I can prescribe a more precise, appropriate dose.”

Some HRT prescribers have labelled BHRT as “unregulated”, but BHRT practitioners insist this is unfair.

“That’s untrue,” says Martin. “Every bioidentical clinic is regulated by the Care Quality Commission and the pharmacies that make the BHRT are regulated, too. People say that BHRT is ‘off-licence’ [meaning that it is not a licensed use of the product]. The only reason BHRT is not licensed is that you can’t get a licence for a customised medication that changes from person to person.”

So what does a “hormone MOT” entail? It’s much more than just a blood test to check your current hormone profile, says Sophie. She first sits her patients down to ask them what they’re noticing and experiencing.

“We have a thorough chat – and it’s often teary – about everything from brain fog and sleeplessness, via anxiety and weight gain, to an inability to cope. These are high-functioning women who suddenly just can’t manage. Then we do a blood test, have a further consultation and then prescribe appropriately.”

These are particular issues that affect menopausal and perimenopausal women, but Sophie also treats younger women for hormonal issues that affect their looks. “If your hormones are unbalanced and you’re embarking on treatment for hair loss, if you don’t address the hormone problem, your results will be limited,” she says.

A rise or fall in thyroid hormones can also cause you to shed hair, and low levels of vitamin D, which has its own type of hormonal activity in the body, can contribute to hair loss, too. And that is not the only issue. A drop in testosterone makes it harder to hang on to muscle mass. When people say: “I feel like my muscle has turned to fat,” it may be that their testosterone levels have plunged. Also, oestrogen loss changes the pattern of fat distribution – so women who have never gained weight on their stomach before may now find that happening.

Younger women who suffer with polycystic ovary syndrome, where male hormones, or androgens, become dominant, may also find they have receding hairlines, again influenced by those hormones. Supplementing their bodies with hormones to counterbalance those androgens helps nudge the body back towards balance.

“I call it optimisation,” says Sophie. “Is having no oestradiol [the main active oestrogen] normal for a 54-year-old woman? Yes. Is it optimal? No. And, yes, there are certainly aesthetic benefits to taking replacement hormones as well as the well-recognised health benefits for heart health and maintaining bone density.”

Getting hold of BHRT is usually a question of tracking down a practitioner near you who can provide it, but a new nationwide virtual clinic called BioID that Martin is launching this month means this will become much easier wherever you live. With the BioID service, you first request a consultation; then, if you’re a suitable candidate, follow this with a blood test that’s done at home. After that comes a further consultation and a personalised hormone treatment plan, including regular blood tests to monitor your progress.

And there could be more to come in this developing field. Enterprising doctors are increasingly turning their attention towards optimising our health and preventing problems, rather than simply treating us when things go wrong. And the growing awareness around the benefits of hormone supplementation means hormone health could become a key part of this more holistic approach to wellbeing.

“I absolutely think it is,’ says Sophie. “Our thirst for knowledge about ourselves is expanding and the increase in personalisation around health – for example with DNA testing – is developing fast. It’s all about understanding what will work better for us. Hormone health and our understanding of it will only grow.”

A consultation at Dr Kinsella’s virtual clinic costs £50, £350 for blood work and the hormones cost from £199 per month. Visit bioidhealth.com. Alice Hart-Davis is founder of thetweakmentsguide.com.

‘There’s a ceiling to how much skin rejuvenation we can get if someone doesn’t have enough oestrogen in their skin’