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In this episode of Skinside Out, Dr. Zain Husain, Heather, and Courtney continue their Dermatology Through the Decades series by exploring how perimenopause, menopause, hormonal changes, and aging affect the skin—and what you can do to keep your skin healthy and vibrant.
The team discusses collagen loss, thinning skin, rosacea, hormonal acne, hair thinning, dryness, pigmentation, enlarged pores, neck aging, and how declining estrogen impacts skin health. They also explain evidence-based skincare routines, hormone replacement therapy, topical estradiol, retinoids, chemical peels, microneedling, lasers, facials, growth factors, and lifestyle changes that can help you age confidently.
Whether you're entering perimenopause, already in menopause, or simply noticing your skin changing after 40, this episode offers dermatologist-backed guidance to help you understand—and proactively care for—your skin.
Timestamps
00:00 – Welcome back to Dermatology Through the Decades: Your 40s & 50s
00:55 – Why skin changes accelerate during midlife
01:15 – Collagen loss, elastin decline, and slower skin repair
02:00 – Photoaging, brown spots, wrinkles, and skin cancer risk
02:35 – Perimenopause, menopause, and hormonal skin changes
03:00 – Dry skin, sensitivity, adult acne, and rosacea
03:45 – Facial volume loss, temples, and changes in facial structure
04:30 – Midlife skin changes in men
05:00 – Hair thinning, testosterone, and aging skin
05:30 – The most common concerns patients bring to dermatologists
06:45 – Hormonal acne, facial hair, and androgen changes
07:20 – Building an evidence-based skincare routine
08:15 – Retinoids, vitamin C, moisturizers, and sunscreen
09:00 – Chemical peels, peptides, exosomes, and growth factors
09:45 – Estradiol creams and restoring skin hydration
10:45 – ReJuve, collagen stimulation, and newer therapies
11:30 – Why sunscreen becomes even more important after 40
12:00 – Hydration facials and restoring the skin barrier
12:40 – Microneedling, RF microneedling, CO₂ lasers, and resurfacing
13:30 – Hormone replacement therapy: benefits and risks
15:00 – Testosterone therapy and steroid-induced acne
16:00 – Lifestyle habits that improve skin health
17:00 – Why your 40s can be the most stressful decade
18:00 – Annual skin cancer screenings and self-exams
20:00 – Final takeaways: prevention is easier than correction
Creators and Guests
Host
Host
What is Skinside Out?
Welcome to Skinside Out, where science meets beauty, the ultimate dermatology podcast! Dive deep into the fascinating world of skin health with expert insights, evidence-based discussions, and myth-busting truths. Each episode explores the medical, cosmetic, and surgical aspects of dermatology, while keeping you informed about trending skincare topics. Whether you’re a skincare enthusiast, medical professional, or just curious about how to achieve your best skin, Skinside Out is your go-to resource for staying informed and inspired.
62 - Skinside Out
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Dr. Zain : [00:00:00] Welcome to Skin Side Out. I'm your host, Dr. Zain, with Heather and Courtney. So today we're continuing our journey of dermatology through the decades. Now we're in the midlife area, so the 40s and 50s. So Heather, what are we gonna talk about today?
Heather: we'll talk a lot about a lot of different things, but I think we're gonna focus on, like, perimenopause, um, menopause in general, especially for, um, females going through that.
But, um, men have a lot of changes, too, so we'll touch on that as well.
Courtney: Yeah. Dr. Hussein, you're in your 40s now. What changes have you noticed?
Dr. Zain : Um, less tolerant of annoying- Annoying.
Heather: Annoying.
Courtney: Yeah. Go
Dr. Zain : on. What was that last word gonna be? People. Yeah. I'll just leave it at people. I'm becoming more crotchety.
Mm-hmm. Okay. All right. So, um, let's talk about skin aging and what are the [00:01:00] drivers of this process. So Courtney, what are some of these drivers that we know are causing these changes?
Courtney: Um, I think definitely obviously losing more collagen and more elastin, um, over time, especially in this decade. I would say we definitely notice, um, slower cellular turnover, so things might take longer to heal.
Your skin doesn't really bounce back the way it does when you were younger. Um, thinner skin, maybe more, more bruising. You know, just overall I think a, a slower response to things.
Dr. Zain : Yeah. And, you know, as we are living, you know, longer, right, we are exposed to more light and getting photoaging. So what type of changes are we seeing with that?
Heather: Noticing more, like, fine lines and wrinkles, brown spots what we consider, like, photoaging, um, any sort of pigmentation. But you can also get, like, um, broken blood vessels, texture. We can start to notice more pre-cancerous lesions and increased skin cancer risk because of [00:02:00] those decades behind you that are accruing- Mm-hmm
and popping up.
Dr. Zain : So those are kind of similar to what we have discussed in previous episodes, right? So it's kind of that theme of, you know, cumulative damage and decreased cell turnover, collagen production, et cetera. But now we're introducing a new, um, change in this decade, especially for women with hormones.
So what changes are we seeing in regards to hormones, and how is that manifesting in our skin's changes?
Courtney: Um, definitely that perimenopausal area for a lot of women, I think women tend to go through dryness when they're experiencing that. Some women might have acne. I think we get that a lot in the office, where they've never really had acne before, but they do have that adult acne.
Um, sensitivity to different products, I feel like we hear a lot, "Well, I've been using this product for years"- Mm-hmm ... but, you know, maybe it's just that you've become more sensitive to it. So those hormones I think just really disrupt a lot of things, um, especially in the skin.
Dr. Zain : And also, let's not forget the classic, um, signs.
Obviously there's hot flashes. Mm-hmm. We can start experiencing that, that [00:03:00] vasomotor instability or dysfunction, and a lot of those patients also have rosacea. Mm-hmm. So that's- usually when we start seeing those patients, those female patients, "Hey, I'm just getting this excessive redness. I feel flushed."
Mm-hmm. "I get hot, um, really quickly." So, you know, we're co-managing, like, the rosacea, but also, like, the very distressing, um, you know, flushing that we see.
Heather: Mm-hmm. Yeah, definitely. I think we kinda touched on, like, collagen, um, production is really slowing down in general, but we're losing collagen too, and so that can start to show in, like, areas that you may not have noticed.
So, like, your temples might look a little bit, um, like concave or, um, you can notice that your fat support and your bone support in your skin is a little bit less-
Dr. Zain : Yeah ...
Heather: over time.
Dr. Zain : And just a reminder, I mean, hormones are these chemicals that our body produces, and they have profound changes [00:04:00] on body functions, and there's a whole host of different changes that these hormones are initiating, and it's not just skin.
I mean, there's metabolic changes happening as well. Um, so we talked about women. What about men? So do men experience similar changes to women during this time of life?
Heather: Yeah. I mean, they're having decline in testosterone- Mm-hmm ... and other hormonal changes, so the dryness is a big factor. Um, wounds heal a lot slower.
Um, y- you may notice that you may not have as much bounce or elasticity to your skin as you used to. And, and you might be noticing some of those, um, sun exposure changes that are accruing with time.
Dr. Zain : Yeah. And I especially get patients who are really concerned about hair loss. Mm-hmm. Um, we start really seeing an uptick in men who are concerned about, um, their receding hairlines or their vertex scalp showing more.
And, you know, now they're [00:05:00] seeking help because they're actually noticing in the mirror.
Heather: Mm-hmm.
Dr. Zain : And, you know, it's something that is very distressing for men, but also distressing for women, too.
Heather: Mm-hmm.
Dr. Zain : Um, but I feel like this is really becomes visible for men in this decade. All right. So the most common midlife skin concerns.
So let's discuss, um, you know, some of those specific, um, changes that we're seeing and how, you know, we kind of present in this decade of life.
Courtney: Yeah, I think especially in the 40s, I think, you know, I, I tend to see a lot of patients who wanna kinda start their journey, um, where they're noticing more fine lines, wrinkles- Mm-hmm
and, you know, some of them are maybe not really wanting to do things like tox or fillers. I think we definitely see that subset of patients that is looking to do more of, like, the laser treatments or more natural treatments. Um, but yeah, uneven, you know, texture is a big, big thing we see. Brown spots, again, just that accumulation of sun damage over the years I think catches up.
[00:06:00] Um, enlarged pores, rosacea, redness, um, neck. I think the neck we see a lot of- Mm-hmm ... in this age period, just, um, crepey skin, textural changes, and sometimes even just loose skin in that area. Um, under eyes a, a lot too. So I think, yeah, just kind of, um, a little bit what we talked about in the 30s, but just maybe a little bit more, um- Mm-hmm
noticeable. Announced, yeah. Yeah.
Heather: Yeah.
Dr. Zain : Um, what are the most common changes that patients come to you for during this, you know, decade of life?
Heather: Um, I think a mix of all of that. I do see a lot of, like, not only the dryness- Mm-hmm ... and just, like, brown spots forming in general, but I think probably some of the most common things I see are the hair thinning and the rosacea actually.
Dr. Zain : Yeah.
Heather: Yeah
Dr. Zain : And, you know, like we had talked about, like with tying it with the hormones, so, you know, we're noticing, you know, the hair loss and the acne often happening simultaneously.
Heather: Mm-hmm.
Dr. Zain : Um, and we [00:07:00] know that they're related to those same type of hormones, those androgens, right? So it's not unusual to see women starting to lose hair, um, while also having hormonal acne and also growing hair in, you know, non-traditional places- Mm-hmm
like on the face- Mm-hmm ... like on the chin area. So all this hormonal imbalance can really influence your skin, and we see that with a lot of women.
Heather: Mm-hmm. Yeah.
Dr. Zain : Yeah. And in terms of building an evidence-based skincare routine, I think that that's really important because as we had mentioned in previous episodes, it's so important to set that foundation.
But when we're getting to midlife, if you haven't done anything yet, it's a really, really important thing to really establish good skincare going forward because, you know, you may have had a little bit more damage, um, since you haven't been taking care of your skin compared to others who have. And if you don't set yourself up for success, you know, you will get, um, faster signs of aging.[00:08:00]
You will potentially get more skin cancers. So what are some of the things that we can, you know, counsel our patients in their 40s and 50s for a good skincare routine? I
Courtney: think definitely, you know, retinol, retinoid, um, will increase cellular turnover, build some collagen, help with maybe a little bit of that acne damage or the sun damage that you've accumulated over time.
But I think that's really a solid foundation along obviously with your sunscreen, um, to, to really start that process. Then I always recommend things like vitamin C. Um, I think we notice in our 40s and 50s that you need a little bit heavier duty of a moisturizer. So where I might recommend something more lightweight for some of my younger patients, those patients who are going through that, you know, dry change, I might recommend something more, um, thick, you know, more cholesterol, more fatty acids lipids, things like that to really repair that dry skin.
Dr. Zain : Anything else that you would recommend in this decade of life? I feel like this is kind of when, you know, [00:09:00] our skin cells are starting to turn over slowly. So stimulating them in some way will help them, you know, function at a better capacity. Mm-hmm. So any suggestions for that?
Heather: I mean, in addition to the retinoids- Mm-hmm
I think that's a great option. I think chemical peels are really nice, too. Mm-hmm. Just to mostly help the dead skin cells flake off and induce that kind of turnover to help with, like, lots of different things, texture, pigment, all that stuff.
Dr. Zain : Yeah. And I think topical peptides- Mm-hmm ... um, exosomes, you know, growth factor-based treatments are really, really helpful.
Courtney: Definitely. Estradiol. I feel like, um, estradiol, um, estradiol we have used topically. It used to be, like, just a cream that women would use for dryness- Mm-hmm ... in other areas. Yeah. But, um, I actually... There's a product called, um, Emepelle that I really like, and it's from BioPeelle. Mm-hmm. And I recommend that for my perimenopausal women who are dealing with dryness, who really need something more than just a [00:10:00] moisturizer to kind of help combat that.
Mm-hmm. And that's a really great product. It's a little pricey- Mm-hmm ... but every woman that's ever bought it has always told me it's well worth it, so
Dr. Zain : Yeah. Yeah. And even topical compounds containing estradiol- Yep ... have been helpful for our patients. I've been prescribing it more for my more mature, um, you know, female patient, and they are just complaining about dullness of skin, lack of hydration.
The bounce and the hydration that they once had is just kind of getting diminished, and they f- look dull, and they feel dull about it. So I think that if we can restore that confidence and get their skin looking really healthy and radiant again, hey, I think it's a great option.
Heather: Go ahead.
Courtney: Yeah, I was just thinking about the, the ReJuve that, um, you know, I know we are beginning to carry in our office.
But, um, that's another great product that basically works by, um, stimulating fibroblast and building collagen in a different kind of way than, you know, your, your growth factors and your [00:11:00] exosomes. Um, so I think anything that's working more at, like, that cellular level, um, you know, your, yeah, your growth factors, your exosomes, um, like Plated- Mm-hmm
and then, you know, things like the ReJuve are really important in this decade.
Heather: Yeah, I think all of these are really nice options, whether it's the estradiol or the growth factors or the ReJuve, um, especially for people who maybe can't tolerate a retinoid. Mm-hmm I think a lot of people are really motivated to start a retinoid at this time if they haven't already.
But a lot of times they're combating that dryness, and so you don't wanna do the retinoid because it can make you more dry and irritated. And so you wanna do something that is not gonna be super irritating, that way you can do it consistently and get the benefit of it.
Dr. Zain : Yeah. And let's not forget our best friend, sunscreen.
Heather: Mm-hmm.
Dr. Zain : So you still gotta protect your skin, and, you know, your skin is becoming thinner, and, you know, it's accumulating damage over time from UV radiation. So it's [00:12:00] really important to protect yourself.
Heather: And especially if you have something like melasma, doing- Mm-hmm ... like a tinted sunscreen is gonna be safer for you.
Dr. Zain : Yeah Um, any other tips from the aesthetician in the house?
Courtney: Um, I think facials are always really good. I, I love facials for adding back hydration, um, in this decade. I think they do really well for just repairing the skin, and I feel like sometimes I get two subsets of patients. I have my young acne patients that I'm like, "Acid, acid, acid" And then I have, like, my older patients who are like, "I'm so dry.
I just need, like, hydration." Yeah. So things like the Bella MD facial or HydraFacial, where you're just getting, um, the serums kind of pushed into the skin, I think can be so helpful for combating that dryness.
Dr. Zain : Yeah. And what procedures would you recommend for patients in these two decades? Um, I personally think that anything that can promote stimulation-
Courtney: Mm-hmm
Dr. Zain : is really helpful. So, you know, we love microneedling. Mm-hmm. Um, whether we're using RF with it or [00:13:00] not. Um, we love using non-ablative fractional lasers. Mm-hmm. Even ablative fractional lasers are fine. Um, whatever we can do to get those skin cells to churn out those proteins and just, you know, function at their best, I think is always helpful.
Courtney: Yeah. I'm planning- Yeah ... my CO2, like, on my 40th birthday. I think- ... go ahead and do a CO2. Yeah. Get ahead of the game. Yeah.
Dr. Zain : So let's switch gears a little bit and talk about hormone replacement therapy. So this is a hot topic in medicine and, you know, there are a lot of opinions about it, and there are right ways and wrong ways about going about it.
And I wanted to kind of get your take on it, Heather. What are your thoughts?
Heather: I think it's really beneficial, I think, because estrogen has so, um, such a close relationship with the skin changing. It, it can change your skin in a lot of different ways, um, like we talked about. So topical hormonal therapy, I think, is really important because [00:14:00] it can help kind of reintroduce that hydration, um, that firming kind of feeling that people, I think at this time, are noticing.
And but it does require, um, a customized approach. And so there's topicals. There are orals as well. So it really just kind of depends.
Dr. Zain : Yeah. And not only are women doing hormone replacement therapy, but men are also. Mm-hmm. And, you know, we gotta be careful about hormone replacement therapy. I think it's a very, um, gray area because you can get into a lot of issues if done the wrong way.
Yeah. I mean, hormones are very powerful substances, and for women and for men, um, we have to be mindful of that balance, and there can be complications associated with, you know, using the wrong doses or overdoing it. Um, and it has consequences on other parts of the body as well. So for men, yes, I mean, if you have truly low testosterone- [00:15:00] That can help not only with energy, but a lot of other bodily functions.
But, you know, excessive testosterone, um, which a lot of people are doing now- Mm-hmm ... um, and, you know, I don't know how some of them are probably receiving it through illegal methods- Mm-hmm ... but, um, I mean, testosterone's out there. And, you know, men are suffering from, you know, cardiac death- Mm-hmm ... um, you know, other complications because there are other functions that testosterone has on the body, and it's n- meant to be in, like, a therapeutic range.
If you're above that because, hey, you wanna build muscle, um, or, you know, lift heavy weights, but, um, you also don't wanna drop dead.
Heather: Right.
Dr. Zain : So you gotta be careful about that. Yeah. And then also, like acne- Mm-hmm ... hair loss accelerate with
Heather: this. Yeah, steroid-induced acne. Oof. We see it
Dr. Zain : a lot. A lot of- That's
Courtney: so hard to treat- It really is
steroid-induced acne. Yes.
Heather: Yeah. It's very, um, persistent- It is ... and stubborn.
Courtney: Yeah.
Dr. Zain : Yeah. So, um, now we had talked about hormones w- and therapy. We've talked about [00:16:00] procedures. What else do we counsel our patients, um, for the upcoming parts of their lives l- looking forward? Yeah. Lifestyle.
Courtney: Yeah. Mm-hmm.
Dr. Zain : I was cueing you for that.
Heather: Oh, I did not
Dr. Zain : catch that. You're, you're the, you're the lifestyle guru.
Heather: Courtney, take it away. Sleep. Sleep, diet.
Courtney: No, it's funny. Like, I do feel like, you know, the 40s and 50s are a kind of interesting decade, um, two decades, because I think there are a lot of people who they have kids maybe in their late 20s or 30s, and so their kids are a little bit more grown now, so they have a little bit more time to, like, look into things like their skincare and procedures, but other things as well as lifestyle changes.
Um, you know, eating a little bit more healthy going to the gym a little bit more, staying more active. I think they have a little bit more flexibility once the kids are a little bit older. Mm-hmm. So, I do think we see a shift in the 40s of people really coming back especially mothers coming back to take care of themselves and kind of get, um, back on, back on track, I guess.
Heather: Yeah.
Dr. Zain : I mean, [00:17:00] it's a stressful two decades. Um, they say, like, the 40s are the most stressful- ... out of all your decades because, hey, you're sandwiched in between having children typically, who have a lot of demands on- Mm-hmm ... your time, your energy, resources, and then you're also having your parents now. Mm-hmm.
They're getting older- Mm-hmm ... and you're starting to see those changes. Mm-hmm. And they need, you know, potentially more help. Mm-hmm. And so you're kind of balancing these two out- Yeah ... along with professional growth- Yeah ... um, other responsibilities. I mean yeah, it's a, it's a tough decade.
Heather: Yeah.
Courtney: Yeah, I think the stress is definitely a- Yeah
big, um, component. Not sleeping enough- Yeah ... things like that. I mean, it, it's... there's definitely wear and tear on, on you in those age gaps. Yeah.
Heather: Good luck.
Courtney: Yeah, good luck. That's
Heather: what I was thinking
Courtney: too. Well, I
Dr. Zain : am dealing with it all. Yeah. Um, and then- I
Courtney: love the way also he's describing the kids. He's like, "It's a lot on your, on your..."
What did you say? "On your finances, on your personal life." It's a lot of questions. I'm like, "Oh, wait, do I want kids?" [00:18:00]
Heather: Let me rethink that.
Dr. Zain : Yeah. All right. And then let's talk a little bit about skin cancer ch- prevention and screening. Um, I do think that's really important. So, I mean, Heather, do you typically recommend patients get their skin checks?
Oh, yeah.
Heather: Yeah. Yeah. Um, most people should be doing annual full body skin checks. Um, really just to kind of, if you haven't been doing it, to get a baseline of what your moles look like, make sure you don't have any of those pre-cancers popping up or anything that should be biopsied. Um, I think we do see that a lot in these decades.
We definitely see it before and after too. Mm-hmm. But we really start to see an abundance of it, unfortunately, around this time. Um, but of course- Mm-hmm ... also kind of knowing what to be on the lookout for at home, so there are things that you can kind of monitor for, so anything that's asymmetric or has funky borders, different colors, larger than a qu- [00:19:00] Um, the size of a pencil eraser or something that's new or changing can be really important and helpful to know, like, "Hey, should I go get this checked?"
Um, especially if you're not sure.
Dr. Zain : Yeah, absolutely.
Heather: Yeah.
Dr. Zain : Um, anything to add on to that?
Courtney: No, I just... You know, it's always so funny. Sometimes you'll get someone who's, you know, in their 40s or 50s who's like, "Oh, I've never had a skin check before."
Heather: Yeah, like 60s and 70s. Yeah. Oh, yeah. And it's
Courtney: always shocking.
Heather: Yeah, it's very shocking. Like, what took
Courtney: you this long?
Heather: Yeah.
Dr. Zain : Hey, better late than never, right?
Heather: Yeah. True. 100%. Yes. Yeah.
Dr. Zain : All right. I think this wraps up our discussion of our 40s and 50s and how our skin changes. So this is a very dynamic period, a lot of changes in hormones, um, and we see those manifestations in our skin.
So, um, what are some key takeaways that you wanna leave the audience with?
Courtney: Um, you know, I would say if, if you're dealing with something like persistent dryness and your moisturizers are not feeling enough, I think that's totally worth seeing, you know, your [00:20:00] dermatologist or provider, um, about exploring options because there definitely are more options out there than just your, you know, over-the-counter moisturizers.
And then, you know, being open to things, especially like energy-based devices, IPL, microneedling. Um, I think it's never too late to start on those things. I always get patients in sometimes that are like, "Well, I don't ha- I don't have that many wrinkles yet." And I'm like, "Yeah, yet." Mm-hmm. So I think prevention's always better than, than correction, and just, um, staying ahead of things is really important.
Heather: I would say, you know, I think it's scary because your body is changing in so many different ways, and so just be kind to yourself. Mm-hmm. Um, you can't do it all, and that's okay. But if you- if there are areas you wanna focus on, we can definitely help you.
Dr. Zain : Yeah. Great. So as I have officially entered my 40s, um, I will hopefully be implementing a lot of these-
you know, tips that we have and, like, hopefully, um, you know, keep my skin looking really [00:21:00] healthy for the next decades to come. So, um, hopefully you enjoyed this episode. Please follow, like, and subscribe. And until next time, Skin Side
Heather: out.