The hormone questions you keep asking me, pulled straight from the comments and answered by a board-certified dermatologist.
If you have ever scrolled through skincare comments late at night, wondering whether your dry skin, low energy, or thinning hair is really a hormone problem, you are in good company. I read every comment on my videos, and the same questions about perimenopause, testosterone, and topical estrogen keep coming up, so I pulled the ones I hear most and answered them here. These are general educational answers, not personal medical advice.
Can any endocrinologist prescribe testosterone?
Any fully licensed physician, including a board-certified endocrinologist, can legally prescribe testosterone, with no special certification needed beyond a medical license. The one caveat is that testosterone is a Schedule III controlled substance, so the prescriber needs an active DEA license, which not every physician keeps. The real question is clinical expertise, because testosterone in women was rarely taught in medical training.
Can I use estradiol and estriol on my face at the same time?
If you already use vaginal estradiol as prescribed, adding a separate estriol cream on your face is fine, and I do it myself, since these low-dose estrogens are minimally absorbed. I would not layer both on your face at once, because we have no research showing the combination helps. Some women simply prefer estriol for the face because it feels lighter.
My eyelids are dry and swollen and flare like eczema. Is it low testosterone?
Dry, swollen, eczema-like eyelids that come and go make me think of a dermatitis or an allergic contact reaction long before low testosterone. Eyelid skin is thin and reactive, and something you touch or apply may be setting it off. See a dermatologist, since treatment usually focuses on calming the inflammation with a gentle steroid or steroid-sparing cream.
What lab work do I need before starting testosterone?
There is no strict number that tells us a woman needs testosterone, so the decision rests mostly on your symptoms, especially low sexual desire. Checking bloodwork first still helps your doctor follow your levels and keep them from drifting too high or too low.
Labs your doctor may order
- Total testosterone
- Free testosterone or sex hormone binding globulin (SHBG)
- Depending on your situation, LH, FSH, prolactin, or hematocrit
Can I use topical estrogen while I am on birth control pills?
This is usually fine, because topical estrogen is absorbed only in small amounts through the skin. Birth control pills do lower testosterone, mostly because the added estrogen raises SHBG and quiets the ovaries’ androgen production, which is why we sometimes prescribe the pill for acne. Whether that dip causes symptoms like low libido in healthy women is still unclear, so talk with your doctor if you feel off.
How do I apply topical estrogen correctly?
It depends on which estrogen you use. Vaginal estradiol is usually about a gram, a fingertip amount, twice a week. For the face, use about half that at night, after your retinoid, in place of a moisturizer. A systemic estradiol gel is different, so follow its label, which sends it to the thigh or abdomen and away from the face and breasts.
Do I need to monitor my estrogen levels with topical estrogen?
For appropriately prescribed topical vaginal estradiol or low-dose estriol cream, the research says you do not need routine estrogen monitoring or progesterone to protect the uterine lining. Absorption is minimal on vulvar skin and even lower on the face, which has a stronger barrier. Vaginal estrogen is also protective, lowering the risk of urinary tract infections and genitourinary syndrome of menopause.
Will facial estradiol help thinning hair and dry skin?
The studies on topical estrogen are small, but they suggest it can build collagen and elastin, thicken the skin, and reduce the water loss that leaves skin dry. The evidence that it stops hair loss is weaker, and the benefits seem greater on sun-protected skin than on skin already damaged by UV. If you are losing hair along with dry skin and eyes, see a dermatologist for a full workup rather than reaching for estrogen alone.
The bottom line
Most of these questions come back to one reassuring idea, that low-dose topical estrogen is minimally absorbed and generally safe for the skin, and that testosterone decisions rest on your symptoms and a thoughtful workup rather than a single lab value. Midlife hormone care carries real nuance, and you deserve a clinician who sees your whole picture.
Want the full conversation?
I walk through each of these questions in more detail in this week’s episode, with the reasoning behind every answer. Watch it, and leave a comment if you want me to answer more in part two.