Topical Estrogen for the Face: Estriol Cream

I am seeing many ads on social media for topical estrogen and estradiol creams for the face to treat wrinkles and skin aging. The one being advertised the most is Alloy M4 Face Cream a face cream with estriol. Do these work? Are they safe, and which ones are best to use? I will discuss the various types of estrogen skin care, natural options and compare the pros and cons of each.

To shop for skin care using your Bauman Skin Type, take our skin care routine quiz.

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There are really only 3 reasons to use an estrogen face cream: 

1. Estrogen deficiency due to loss of ovarian function 
2. Menopause 
3. Transitioning to female gender.

If you have had your ovaries removed or your estrogen levels are abnormal due to polycystic ovarian disease, or other disorders, discuss treatments with your doctor.

Menopause heralds a new stage in a woman’s life, accompanied by many changes throughout the body, including the skin. My patients often complain of rapid skin aging, hair loss, acne, sun spots, dry skin, and itching during the premenopausal, menopausal, and postmenopausal years. As ovarian function wanes, declining hormonal levels significantly impact skin health and appearance. Understanding the science behind these cutaneous changes can help design the perfect skincare routine for maturing skin during the menopausal transition. The key is to protect the skin from aging with the best menopause skincare, and one promising option is the use of estrogen creams. Note that if you are already taking hormone replacement therapy (HRT) you probably do not need an additional estrogen cream. Please discuss with your doctor before using any of these  topical estrogens.

Topical estrogen gets into the skin really easily and goes into the systemic circulation. So topical estrogen creams with greatly affect your hormone status. Please discuss with your gender affirmation care specialist before using any of these estrogen face creams. Hormone therapy is very complex and needs medical oversight.

There are many good antiaging creams. The only way to know whichis best for you is to shop using your skin type octagon. When you take our skin type quiz, you will be assigned to 1 of 16 skin types. Once you know your skin type color and number, look for the skin type octagon when shopping for skin care to know if that is the best anti-aging product for you.

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Estrogen creams are formulated to address the skin changes that occur with menopause. These creams contain different forms of estrogen, each with unique properties and benefits:

• Estradiol : Known for its potency, estradiol is effective in improving skin elasticity and reducing wrinkles. Available with a doctor's prescription only.
• Estriol : A gentler alternative, estriol is less potent but still beneficial for skin hydration and reducing signs of aging. Available with a doctor's prescription only.
• Methyl Estradiolpropanoate (MEP) : A synthetic derivative that offers stability and effectiveness in skincare formulations. This is found in cosmetic skin creams that do not requre a subscription such as Emepellle.
• Xenoestrogens : Synthetic or natural compounds that mimic estrogen in the body, sometimes included in skincare products for their estrogen-like effects.
• Bioidenticals : Hormones identical in molecular structure to those the body produces, often used in hormone replacement therapies and increasingly in skincare for their natural effectiveness.
• Plant-based Estrogens (Phytoestrogens) : Derived from plants, these estrogens are used in skincare for their gentle, estrogen-like effects, commonly found in ingredients like soy and wild yam.

Below are the estrogen or estrogen analog creams available without a prescription:

Estrogen creams offer several benefits for aging skin:

• Preserves skin elasticity: Maintains elastin levels preventing sagging
• Reduces fine lines and wrinkles: Stimulates fibroblasts to produce more collagen types I and III
• Enhances skin hydration : Estrogen boosts the production of hyaluronic acid (HA), a natural moisturizer, and strengthens the skin barrier to help skin hold on to water.
• Strengthens and thickens skin: With more collagen, HA, and elastin, the skin becomes thicker and more resilient.
• Softens and smooths skin and reduces coarse facial hair

While estrogen creams offer many benefits, they also come with potential side effects such as:

• Hormonal imbalances
• Increased risk of breast and uterine cancer
• Melasma
• Potential impacts on eczema and rosacea

On the other hand, the association between sex hormones and atopic dermatitis (AD) is less clear. Some studies report no consistent link between sex hormones and AD, while others suggest that fluctuating hormone levels during life stages like pregnancy and menopause can influence AD symptoms. The variability in findings suggests a complex relationship that warrants further research.

Estrogen will make your melasma worse.  Do not use it if you have a any forms of hyperpigmentation.

Research shows a significant connection between hormonal factors and the risk of rosacea. Studies indicate that rosacea is often diagnosed during perimenopause and can be influenced by hormonal changes during pregnancy or with the use of oral contraceptives. A study (3) involving 89,062 women found that postmenopausal women had a lower risk of rosacea compared to premenopausal women. However, the use of exogenous hormones, such as postmenopausal hormone therapy and oral contraceptives, was associated with an increased risk of rosacea. This means that estrogens creams used on the face may worsen rosacea. However, if rosacea is caused by hot flashes, the creams may improve rosacea.  

The association between sex hormones and atopic dermatitis (AD) is less clear. Some studies report no consistent link between sex hormones and AD, while others suggest that fluctuating hormone levels during life stages like pregnancy and menopause can influence AD symptoms. The variability in findings suggests a complex relationship that warrants further research.

Estrogen creams should be used with caution, especially if you have:

• A family history of breast cancer
• BRCA gene mutation
• Melasma or other estrogen-sensitive disorders
• Conditions such as endometriosis or uterine fibroids
• Pregnancy
• Have a history of blood clots

Some tumors, particularly certain types of breast cancer, are known to be estrogen-responsive, meaning that estrogen can promote their growth. Therefore, individuals with a history of such tumors should avoid estrogen creams. Additionally, those with hormone-sensitive conditions should be particularly cautious. The use of estrogen creams can potentially exacerbate these conditions or lead to other health complications. Always consult with a healthcare provider before starting any new skincare regimen that includes estrogen creams, to ensure it is safe and appropriate for your individual health needs.

Estrogen plays a significant role in skin health by:

• Stimulating fibroblasts : This increases the production of collagen and hyaluronic acid, making the skin thicker, stronger, smoother, and less wrinkled.
• Stimulates melanocytes to make pigment
• Increasing moisture content : By boosting hyaluronic acid levels, estrogen helps keep the skin hydrated.
• Protecting from oxidation : Estrogen has antioxidant properties that protect the skin from oxidative stress.

Loss of estrogen during menopause correlates with reduced collagen types I and IV in the dermis and basement membrane, leading to thinning of the skin, wrinkles, and reduced structural integrity.

Estrogen can be delivered in various forms, each with unique benefits:

• Pills : Systemic effects but potential for more side effects.
• Patches : Provides a steady release of estrogen through the skin.
• Serums and Creams : Direct application to the skin allowing increased estrogen levels in skin
• Intravaginal applications : Targeted for vaginal health but can also benefit skin.

Estrogen creams can help with various skin conditions, including:

• Wrinkles
• Dryness
• Skin fragility
• Sagging skin
• Thin skin

For those who prefer natural alternatives, phytoestrogens offer a plant-based option:

• Phytoestrogens : Found in soy, flaxseed, and other plants, these compounds mimic estrogen and can improve skin hydration and elasticity.
• Herbal extracts : Ingredients like saw palmetto and wild yams are commonly used for their estrogenic effects.

• Soy products
• Flaxseeds
• Sesame seeds
• Garlic
• Peaches
• Berries

Estrogen creams can be a valuable addition to skincare routines for women experiencing menopause. By understanding the benefits and potential risks, you can make informed decisions about using estrogen in your skincare regimen. Take our skin care routine quiz to see if these products are right for you. Always consult with a healthcare provider to ensure the best approach for your individual needs.

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1. Baumann L. Antiaging Ingredients in Ch. 37 of Baumann's Cosmetic Dermatology Ed 3. (McGraw Hill 2022)
2. Baumann, L. Ch. Cosmeceuticals and Cosmetic Ingredients (McGraw Hill 2015)
3. Geng H, Cho E, Drucker A, Parulkar I, Qureshi A, Li W. Reproductive and hormonal factors and risk of rosacea in US women. J Invest Dermatol. 2017;137(5):S33. doi:10.1016/j.jid.2017.02.208
4. Prevalence of rosacea in transgender and gender diverse populations: A retrospective cohort study Sanz, J. et al. Journal of Investigative Dermatology, Volume 142, Issue 8, S25
5. Baumann, L. (2005). A dermatologist’s opinion on hormone therapy and skin aging. Fertility and Sterility, 84(2), 289-290.
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7. Schmidt, J. B., Binder, M., Demschik, G., Bieglmayer, C., & Reiner, A. (1996). Treatment of skin aging with topical estrogens. International journal of dermatology, 35(9), 669-674.
8. Shah, M. G., & Maibach, H. I. (2001). Estrogen and skin: an overview. American journal of clinical dermatology, 2, 143-150.
9. Cohen, J., & Downie, J. (2022). An Open-Label Study Evaluating the Periorbital Skin Rejuvenation Efficacy of a Cosmeceutical Containing Methyl Estradiolpropanoate (MEP) in Women With Estrogen Deficient Skin (EDS). Journal of Drugs in Dermatology: JDD, 21(11), 1185-1190.
10. Cohen, J. L. (2019). Evaluation of efficacy of a skin care regimen containing methyl estradiolpropanoate (MEP) for treating estrogen deficient skin. J. Drugs Dermatol, 18, 1226-1230.
11. Abdalla, Z. A. A., Elabbas, S. F., Saeed, L., ME, E. E., & Mohamed, H. E. (2024). The Effect of Topical Estrogen in Skin Aging Process in Estrogen Deficiency Skin. Clinical Research and Clinical Trials, 9(6).
12. Draelos, Z. D. (2018). A double-blind randomized pilot study evaluating the safety and efficacy of topical MEP in the facial appearance improvement of estrogen deficient females. Journal of Drugs in Dermatology: JDD, 17(11), 1186-1189.
13. Lephart, E. D., & Naftolin, F. (2022). Factors influencing skin aging and the important role of estrogens and selective estrogen receptor modulators (SERMs). Clinical, cosmetic and investigational dermatology, 1695-1709.