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10.1001/jama.2017.18391 JAMA

How can patients manage side effects during escalation

Hormone Replacement Therapy Women can lose up to 30% of skin collagen in the first 5 years of menopause34 and may also experience a 0.55% loss of skin elasticity each year.35 A double-blind RCT evaluating the effects of hormone replacement therapy (HRT) (2mg 17B estradiol/10mg dydrogesterone) on the skin of 40 postmenopausal women found an increase in skin thickness, hydration, and elasticity after 7 months of treatment.36 Another study (n=55) showed that postmenopausal women on HRT with estrogen and testosterone had 48% higher collagen content in the skin.37 A similar study (n=25) reported significantly higher type III collagen content in women treated with estradiol and testosterone implants.38 Likewise, a large prospective study involving 176 women found a 5.2% increase in skin elasticity after 12 months of HRT.35 Other authors have also reported a significant increase in skin viscoelasticity (n=200) in women on HRT.39 Nonetheless, a large RCT (n=485) detected no differences in facial wrinkles or skin laxity between postmenopausal women treated with HRT and those treated with placebo.40 Elderly individuals may show low levels of growth hormones and also experience a dramatic decrease in skin thickness.41 Two studies have reported increased epidermal and dermal thickness in individuals with deficient growth hormone levels treated with growth hormone therapy.41,42 Potential adverse effects include gynecomastia and carpal tunnel syndrome

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