By Erin Flaherty
Photo-Illustration: by The Cut; Photo: Getty Images
“Swellness” is a monthlong series exploring the health and wellness stuffno one talks about.
Like Indiana Jones searching for the Holy Grail, I’ve spent the better part of two decades as a beauty editor slathering creams and potions on my face with reckless abandon, all in the name of journalism. Questionable ingredients with no long-term studies? Bring it on.
But when my former Marie Claire boss Anne Fulenwider, co-founder of telehealth start-up Alloy, asked me to road-test M4, a new prescription-only cream with .03 percent pharmaceutical-grade estriol, an estrogen hormone, I hesitated. Aren’t hormones risky business?
I surveyed fellow beauty experts — they were genuinely fascinated, but no one has ever heard of estrogen in a face cream. So the OCD researcher in me slid down a hormone-fueled rabbit hole, and what I discovered is both compelling and complicated.
First revelation: A ton of the stigma surrounding hormone replacement therapy (HRT) — the practice of supplementing waning hormone levels associated with menopause to alleviate symptoms like hot flashes or dry vaginas — is based on fake news. An in-depth recent New York Times piece details how American women were misled about the risks of HRT. HRT had historically been considered a gold-standard treatment. But in 2002, an estrogen-progestin trial by the research organization Women’s Health Initiative (WHI) that linked HRT to slight breast-cancer and heart-attack risk in women aged 60 and over resulted in “misinformation and hysteria,” causing a ripple effect we’re still feeling today. According to a 2012 study assessing impact from the resulting panic headlines, HRT usage dropped significantly, creating more of a “suck it up” approach to menopause.
More recently, medical experts have called out the faulty research associated with the WHI’s findings, leading the North American Menopause Society to update their guidelines in 2022: “For women aged younger than 60 years or who are within ten years of menopause onset and have no contraindications, the benefit-risk ratio is favorable.”In other words, they recommend that for many, the benefits of hormone therapy outweigh the risks.
So, if the medical community and the general public are now reexamining HRT, why not consider hormones for cosmetic purposes?
I learned that estrogen loss begins in our 40s, and affects the skin by causing thinning, dryness, and decreased collagen and elasticity. But what if the ultimate anti-aging weapon — or at least a key tool in the arsenal — is replacing estrogen with … estrogen? Several studies point to its capabilities. A 1996 University of Austria study published in the International Journal of Dermatology found that after six months, perimenopausal women treated with topical estrogen experienced marked improvement in elasticity and firmness, as well as wrinkle depth and pore size decreased alongside an increase in collagen; and a 2013 University of Bradford study linked topical estrogens to collagen production. Plus, there’s precedence for estrogen when it comes to cosmetic usage.
Going back to the 1940s, hormones in luxury beauty products were totally a thing. According to The Estrogen Elixir: A History of Hormone Replacement Therapy in America by Elizabeth Siegal Watkins, companies like Helena Rubenstein and Elizabeth Arden promised estrogen was the ultimate miracle in a jar. “From the 1940s through the 1970s, cosmetics manufacturers marketed creams, lotions, and oils containing estrogen; these products were advertised directly to the public in the pages of newspapers such as the New York Times and the New York Herald Tribune (as topical cosmetics, they could be sold without a doctor’s prescription). The ads imparted a clear message: Use of estrogen-containing creams would make a woman’s skin look younger,” Watkins writes.
Eventually, the FDA started regulating drugs in OTC beauty products. Today, cosmetic estrogen is slowly creeping back into that very space. Type “estrogen face cream” into Amazon and you’ll find products ranging from vaguely clinical (Bezwecken’s “Transitions” cream) to more mainstream (Paula’s Choice) to biotech beauty (Emepelle with “MEP Technology”). Many contain so-called “bioidentical estrogens” and phytoestrogens (plant-derived, like soy) to work around FDA-guidelines — and since cosmetics that aren’t considered drugs are basically unregulated, anything kind of goes.
I phoned board-certified dermatologist Dr. Kavita Mariwalla, who says she too has noticed all this recent hormonal skin-care action. While she admitted that many women have preconceived notions around prescription estrogen, acknowledging HRT’s PR problem, she recommended avoiding random products on Amazon. “But I don’t think it’s dangerous as long as you’re under the care of a doctor,” she says of prescription estrogen. She was intrigued by M4, which contains a combination of glycerin, vitamin E, and oleic acid alongside the estriol. But again, she’s quick to point out that when using any kind of drug, you need a physician’s direct supervision.
This is the part where I admit that I wouldn’t describe myself as under a physician’s direct supervision per se, but after answering some basic medical questions via Alloy and feeling more confident about my own research, I made the personal choice to fear not and started incorporatingM4 into my daily regimen. I replaced my a.m. moisturizer with M4, adding SPF right on top. The formula is fragrance free, and goes on as seamlessly as any other skin-care cream, with no pilling and leaves a vaguely plumped, hydrated finish. After about a month, I haven’t broken out (always a good sign), and my skin does feel slightly firmer and thicker, or at least a little less sensitive.
During this testing phase, I reached out to Dr. Corinne Menn, a board-certified OBGYN on Alloy’s medical advisory team who was involved in M4’s development. When I tell her that I’ve noticed that people get funny about hormones, she stresses the difference between a compounded cream and systemic hormone therapy (which usually comes in a more concentrated dose delivered in gel, patch, or pill form). Topical creams are not shown to elevate systemic estrogen levels, so if you’re taking hormones orally or via transdermal methods, there shouldn’t be a conflict.
NYC-based cosmetic dermatologist Dr. Ellen C. Gendler concurs with Dr. Menn, explaining that estriol is a relatively weak form of estrogen and a low topical dosage — applied on the face — wouldn’t be absorbed in the bloodstream in any significant way, if at all. “I have no problem using estrogen on the face,” she says.
Dr. Gendler then busts out this gem: She’s personally been using Premarin (a commonly prescribed estrogen-derived vaginal ointment) as an eye cream for 20 years (!), after one of her older celebrity patients claimed it was her secret to gorgeous skin. “It’s my staple!” she confessed. Her patients love it, too.
Dr. Gendler tables this astonishing admission by saying that to her knowledge, we really don’t have a ton of long-term, well-researched studies about efficacy, admitting she’s been her own guinea pig. “The jury is out on whether or not this is going to make a huge difference, but it’s certainly not going to be harmful,” she says, adding that she’s excited to see the next generation of clinical trials. In the interim, she’ll continue to use Premarin on her eye area.
Meanwhile, back at my vanity, the results of this brave experiment are fine so far, but I can’t honestly say I’m noticing any major differences either — I do not look 30 again, which to be fair, is a little unrealistic at age 43. When I mentioned this to the various experts I spoke with, they all explained that while topical estriol is unlikely to produce any mega short-term visible effects, starting to use it as early as perimenopause is probably the best scenario in terms of benefits over time.
In fact, the consensus is that the window of opportunity seems to be in your early 40s, when perimenopausal estrogen loss and skin thinning begins to get really real, so theoretically, I am actually in the target zone. Start too late and “it’s not going to make a considerable impact on deeper wrinkles,” says Dr. Gendler. (And don’t get her started on neglecting sunscreen, which we all know will make the biggest difference over time.) Interestingly, Dr. Gendler tells me that from her perspective, using topical estrogen for all these years has paid off. She claims her eye area looks a lot more youthful than her mother’s did at a similar age.
Ultimately, I decide I may never find the perfect product, but at this point, continuing to use estrogen cream actually makes sense to me, and certainly seems more legit than, say, snail mucin. I’m all in.
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