Andropause and skin
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Andropause and the skin refers to the changes occurring within the skin and its appendages alongside the aging of the male hormonal system. The term "andropause" is colloquial, as men do not experience a sudden and physiologically inevitable cessation of gonadal function analogous to menopause. Testosterone levels most often decline gradually, and the rate of this process depends, among other things, on biological age, body weight, chronic diseases, medications, sleep, and physical activity. Androgen deficiency can affect skin thickness, sebum secretion, hair, healing, and epidermal barrier function, but most visible signs of aging result from the interplay of hormones, ultraviolet radiation, tobacco smoking, facial expressions, bone changes, and soft tissue atrophy.
Andropause and skin - what is it
In medical terminology, instead of "andropause", the term late-onset hypogonadism is used, abbreviated as LOH. It is a syndrome of symptoms occurring in conjunction with laboratory-confirmed testosterone deficiency. Age alone, fatigue, deterioration of skin appearance, or a single low test result are not sufficient to diagnose this disorder.
In healthy men, total testosterone levels decline slowly on average, whereas free testosterone levels may drop more rapidly, partly due to an increase in sex hormone-binding globulin, or SHBG, levels. These changes do not have the same intensity in all men. They can be significantly accelerated by:
- obesity, especially visceral;
- type 2 diabetes and metabolic syndrome;
- chronic liver, kidney, or lung diseases;
- pituitary and testicular diseases;
- chronic stress, sleep deprivation, and low physical activity;
- certain medications, including opioids and glucocorticosteroids;
- alcohol abuse and general deterioration of health.
The skin is an androgen-responsive organ. It contains androgen receptors and enzymes involved in the local metabolism of testosterone and dihydrotestosterone. Androgens regulate, among other things, the development of sebaceous glands, sebum production, terminal hair growth, the functioning of the epidermal barrier, and the wound healing process. However, these relationships are tissue-specific. For example, high androgen activity promotes beard growth, but in genetically predisposed men, it can simultaneously accelerate the miniaturization of scalp hair follicles.
Testosterone treatment should not be initiated solely to improve skin appearance. The diagnosis of LOH requires characteristic clinical symptoms and repeatedly reduced testosterone levels measured in the morning, usually fasting. In appropriate cases, SHBG, free testosterone, LH, FSH, and prolactin are also evaluated. Contemporary guidelines emphasize the necessity of treating coexisting diseases and reducing excess body weight before considering hormone therapy.
Andropause and skin - how a man's skin changes
Male skin aging is a multifactorial process. Decreasing androgen activity may be one of its components, but it is not the only nor usually the dominant cause. Concurrently, cellular aging occurs, along with a reduction in regenerative capacity, changes in the extracellular matrix, and the accumulation of damage caused by UV radiation.
The most frequently observed changes include:
- decreased skin density and elasticity, associated with the fragmentation of collagen fibers, impaired collagen renewal, and abnormal accumulation of elastin in photodamaged skin;
- deterioration of hydration, resulting from changes in the composition of epidermal lipids, slower cell turnover, and weakened barrier function;
- altered sebum secretion; sebum production may gradually decrease, although male skin often remains more seborrheic than female skin;
- slower healing, resulting from an impaired inflammatory response, microcirculation, cell proliferation, and extracellular matrix remodeling;
- wrinkles and furrows, especially on the forehead, between the eyebrows, around the eyes and mouth;
- uneven skin tone, solar lentigines, telangiectasias, and roughness, primarily resulting from chronic sun exposure;
- atrophy or redistribution of adipose tissue, worsening folds, the tear trough, and hollowed cheeks;
- hair changes, such as thinning of hair on the torso and limbs, as well as the progression of androgenetic alopecia in genetically predisposed individuals.
A reduction in body hair may accompany significant androgen deficiency, whereas androgenetic alopecia is not simple evidence of „low testosterone”. Its development is primarily determined by genetically conditioned sensitivity of hair follicles to dihydrotestosterone and local enzymatic activity.
Sudden thinning of hair, generalized pruritus, noticeable thinning of the skin, spontaneous bruising, poorly healing wounds, or a rapid change in skin appearance require diagnostic evaluation. They may indicate not only hormonal disorders, but also diseases of the thyroid, liver, hematopoietic system, nutritional deficiencies, diabetes, or adverse drug effects.
Andropause and skin - why aging in men looks different
Men's skin is, on average, thicker, contains more collagen, and exhibits higher sebaceous gland activity than women's skin. These properties are partially dependent on androgens. Men can therefore maintain a relatively high skin density for a longer period, but the wrinkles that appear later are often deeper and more firmly set.
The distinct pattern of aging is also influenced by:
- craniofacial structure: a larger mandible, more prominent brow ridges, and different proportions of the midface determine a different progression of contour changes;
- a smaller amount of adipose tissue in the medial cheek, which means volume loss can reveal bony structures earlier and deepen the infraorbital region;
- stronger facial musculature, promoting the formation of deep dynamic wrinkles;
- facial hair and shaving, which alter the surface properties of the skin and can cause irritation, folliculitis, and ingrown hairs;
- greater sebum secretion, promoting enlarged pores, seborrhea, and the late occurrence of acne lesions;
- occupational exposure and health behaviors, including less frequent use of photoprotection in part of the male population;
- loss of deep tissue volume, leading to flattening of the cheeks, deepening of folds, and a weakening of the jawline.
UVA and UVB radiation remains one of the most important modifiable factors of aging. It induces oxidative stress and matrix metalloproteinases that degrade collagen, as well as causes DNA mutations, pigmentation disorders, and local immunosuppression. Tobacco smoking, air pollution, sleep deficiency, and a nutrient-poor diet further increase oxidative stress.
A decline in testosterone therefore does not solely explain wrinkles, laxity, or discoloration. In dermatological practice, three overlapping phenomena should be separated: chronological aging, photoaging, and potential clinical androgen deficiency. Such a distinction prevents the unjustified attribution of all skin changes to “andropause”.
Andropause and skin - what to pay attention to in skincare
The foundation of mature male skin care is reducing environmental damage and maintaining a healthy epidermal barrier. The routine does not need to be extensive, but it should be consistent.
The most important elements include:
- daily use of a broad-spectrum sunscreen with at least SPF 30, and SPF 50+ during intense sun exposure;
- gentle cleansing without harsh detergents or alcohol;
- regular moisturizing with products containing humectants, ceramides, and barrier lipids;
- gradual introduction of retinoids or retinol, taking skin tolerance into account;
- use of antioxidants, such as vitamin C, as a complement to, rather than a replacement for, photoprotection;
- reducing smoking, excessive alcohol consumption, and chronic sleep deprivation;
- gentle shaving in the direction of hair growth and avoiding irritating aftershave products;
- periodic checks of moles and non-healing lesions, especially on chronically sun-exposed skin.
At Ambasada Urody, procedures are available that can be tailored to the specific aging characteristics of male skin. These include:
- cosmetology and moisturizing treatments, including anti-aging and firming treatments, Intraceuticals Rejuvenate, hydradermabrasion, and ultrasound therapies;
- chemical peels, including DermaQuest Retinol C Infusion Peel, used to improve keratinization, texture, and uneven skin tone;
- mesotherapy and biorevitalization, aimed at improving skin hydration and quality;
- tissue stimulators, including formulations containing polynucleotides, amino acids, or collagen, as well as stimulators based on poly-L-lactic acid;
- classic and fractional radiofrequency, and INDIBA therapy, used for controlled thermal action and stimulation of tissue remodeling;
- laser treatments, laser lifting, and hybrid lifting, tailored to photoaging, wrinkles, enlarged pores, scars, erythema, or hyperpigmentation;
- botulinum toxin and mesobotox, reducing excessive activity of selected facial expression muscles;
- volumetry with hyaluronic acid or poly-L-lactic acid, used for volume loss, weakening of the chin, jawline, or infraorbital area;
- scalp mesotherapy, considered as supportive management for selected hair problems;
- facial massages and manual therapies, which may temporarily improve tissue comfort and reduce swelling, but do not replace skin-remodeling methods.
Aesthetic procedures do not treat hypogonadism and do not replace medical diagnostics. Their selection should be based on the diagnosed issue, skin phototype, condition of the skin barrier, medications taken, and expected results. Special caution is required in the case of active infections, neoplastic diseases, impaired healing, anticoagulant therapy, a fresh tan, and the use of photosensitizing substances.
