Testosterone and Skin Health: What Men and Women Need to Know

Testosterone is an active player in skin biology for both sexes. It influences collagen production, dermal thickness, oil regulation, wound healing, and how quickly visible ageing progresses. When levels are appropriate and in balance, these effects are largely beneficial. When they decline, which they do in both men and women from the late 30s onward, the skin reflects that decline in ways that are almost always attributed to ageing alone rather than to the hormonal shift driving it.

At Juvenology, hormone optimisation is a central part of how we approach skin health and biological ageing. Understanding what testosterone actually does and what happens when it drops is part of the clinical picture that separates a longevity medicine approach from a surface-level aesthetic one. So let me go through it properly.

First, some biology worth knowing

Testosterone belongs to a class of hormones called androgens. It is produced primarily in the testes in men and in the ovaries and adrenal glands in women. Both sexes produce it throughout their lives, though in very different quantities. A healthy testosterone level in men sits roughly in the range of 10 to 35 nmol/L. In women the range is far lower, around 0.3 to 2.5 nmol/L, but those smaller amounts are biologically significant.

Testosterone does not act in isolation. In the skin, it binds to androgen receptors found throughout the dermis and epidermis, in fibroblasts, the cells that produce collagen, in sebaceous glands, the cells that produce oil, and in hair follicles. It is also converted within skin tissue into a more potent derivative called dihydrotestosterone, or DHT, via an enzyme called 5-alpha reductase. DHT amplifies some of testosterone's effects, including its stimulation of sebaceous gland activity, which is why it features prominently in discussions of acne and hair loss.

Understanding that distinction, testosterone versus DHT, and where each acts, matters when thinking about skin outcomes. Not everything attributed to testosterone is testosterone. And not all of testosterone's effects on skin point in the same direction.

What testosterone does for skin

Collagen and dermal thickness

The most structurally significant thing testosterone does for skin is support collagen production. Male skin is approximately 20% thicker than female skin at comparable ages, and research attributes this directly to testosterone's influence on fibroblasts, the cells responsible for synthesising and maintaining the collagen matrix that gives skin its firmness and resilience.

This is clinically meaningful. Thicker skin retains its structure longer, resists the mechanical forces of gravity more effectively, and is less vulnerable to the fine-line formation that accelerates in thinner, collagen-depleted dermis. It is one of the reasons men typically develop wrinkles later than women of the same chronological age and experience them differently when they do, often as deeper, later-arriving lines rather than the earlier, more diffuse surface changes that characterise oestrogen-driven ageing in women.

Sebum production and natural moisture

Testosterone stimulates the sebaceous glands to produce sebum, the skin's natural oil. While excess sebum drives acne, which I will come to, physiologically appropriate sebum production is genuinely protective. It forms part of the skin's acid mantle, contributes to barrier function, provides natural lubrication, and helps maintain a degree of hydration from within that is distinct from the hyaluronic acid-driven moisture associated with oestrogen.

One clinical consequence of this is that sebum production in men remains relatively stable across decades, whereas women's sebum production declines more markedly after menopause. This contributes to the pronounced skin dryness, increased sensitivity, and compromised barrier function that many perimenopausal and menopausal women experience, a shift that involves both falling oestrogen and, critically, falling testosterone. The two are not always distinguished in clinical conversations about HRT and skin but the distinction matters for treatment.

Cellular turnover

Testosterone supports a higher rate of cellular turnover in the skin, the process by which old skin cells are shed and replaced with new ones. Faster turnover generally correlates with skin that appears more vital, recovers more readily from environmental stressors, and maintains a smoother texture. This is one of the mechanisms through which testosterone contributes to the overall resilience of skin in both sexes.

Where testosterone complicates things

Testosterone's relationship with skin is not straightforwardly positive. Several of its effects are genuinely double-edged and it is worth being clinically honest about this.

Sebum, DHT, and acne

When testosterone converts to DHT, the sebaceous glands are stimulated more powerfully. Excess sebum provides the ideal environment for Cutibacterium acnes to proliferate within hair follicles. This, combined with DHT-triggered follicular hyperkeratosis, where dead skin cells block the follicle opening, creates the conditions for acne lesion formation. Research confirms that androgens, particularly DHT, are central to acne pathophysiology through their binding to receptors in sebaceous gland cells.

For men, this manifests most obviously in adolescence when testosterone surges, but hormonal acne can persist or re-emerge in adult men when testosterone fluctuates. For women, even small changes in androgen levels, including the relative increase in androgens that occurs as oestrogen falls during perimenopause, can trigger acne that feels confusingly out of place at midlife. I see this regularly in clinic and it is one of the presentations that most clearly signals the hormonal picture needs proper assessment rather than a topical prescription.

Barrier function

This is one of testosterone's least discussed effects and in some ways one of the more counterintuitive ones. Despite producing more sebum and having thicker skin, male skin has been shown to have a comparatively more vulnerable barrier function than female skin at equivalent ages. Research suggests testosterone actively perturbs epidermal barrier homeostasis, making male skin more susceptible to transepidermal water loss, irritation, and eczema than its thickness might suggest. Thicker doesn't always mean more protected.

Wound healing

There is a well-established paradox in the wound healing literature worth knowing about, and it has direct implications for aesthetic medicine. Male skin turns over cells more quickly, which might suggest faster wound healing. The evidence shows the opposite. Older men heal cutaneous wounds more slowly than older women of comparable age, and serum testosterone levels are negatively correlated with healing rate. DHT appears to suppress wound healing by modulating the inflammatory response, slowing the resolution phase that allows tissue repair to complete.

In cardiac nursing I learned to think carefully about the conditions in which healing occurs. In aesthetic medicine, that thinking translates directly. How well a patient responds to microneedling, polynucleotides, or PRP depends partly on the hormonal environment those treatments are working in. Optimising the full hormonal picture before pursuing regenerative procedures is not a peripheral consideration. It is foundational.

How testosterone declines and what that looks like on skin

In men, testosterone begins to decline gradually after 30, falling by approximately 1 to 2% per year in total testosterone and slightly faster in free testosterone, the fraction not bound to proteins in the bloodstream. By 50, many men have levels significantly below their peak even if those levels fall within what standard blood testing would call normal. That word normal covers an enormous range and doesn't tell you where a given individual's optimal sits.

In women, testosterone decline begins even earlier, often in the late 20s and early 30s, and continues through perimenopause. At menopause, the ovaries reduce both oestrogen and testosterone production substantially. Women who have had both ovaries surgically removed experience an immediate, steep drop.

In men, declining testosterone contributes to decreased dermal thickness and collagen content, increased skin laxity and loss of structural firmness, reduction in sebum leading to greater dryness than expected, increased wrinkling particularly around the lower face and neck, and reduced capacity for skin repair and recovery from aesthetic treatments.

In women, the picture is often more complex and more frequently missed. Skin thinning extends beyond the oestrogen-related collagen loss and affects texture and resilience in a different way.

Dryness and sensitivity persist despite oestrogen-only HRT because the testosterone component hasn't been addressed. Hair thins at the temples and crown. Skin tone and firmness reduce. And persistent fatigue and low mood affect the systemic inflammatory picture, which shows up in the skin in ways that no topical treatment fully resolves.

There is a clinical nuance here I want to flag specifically for women. Testosterone levels fluctuate throughout the day and are influenced by stress, sleep, exercise, and a protein called sex hormone binding globulin, or SHBG, which binds testosterone and reduces the amount that is biologically available to tissues. A standard blood test showing a technically normal testosterone level in a woman experiencing clear symptoms, fatigue, skin changes, low libido, hair thinning, may not tell the full story. Clinical signs matter. Skin, hair, and energy often reflect what is happening at the tissue level before blood work shows obvious abnormalities.

This is exactly why our Advanced Blood Panel at Juvenology includes a comprehensive hormonal assessment, not just a single testosterone number, but free testosterone, SHBG, DHEA-S, and related markers, interpreted in the context of symptoms and stage of life rather than applied against a generic reference range.

The DHT and hair loss connection

DHT's relationship with hair operates in a genuinely paradoxical way that is worth understanding clearly. In body and facial hair follicles, DHT promotes growth. In scalp hair follicles with a genetic sensitivity to androgens, DHT causes progressive miniaturisation, where each hair grows in thinner and shorter than its predecessor, eventually producing the pattern baldness familiar in men.

In women, androgenetic alopecia presents differently, typically as diffuse thinning at the crown and temples rather than a receding hairline, and is driven by the same mechanism. As oestrogen declines in perimenopause and menopause, the relative effect of testosterone and DHT on hair follicles is no longer counterbalanced and hair loss that may have been subclinical for years can become suddenly and distressingly visible.

Understanding this mechanism matters because it means treating hair thinning in women with oestrogen-based HRT alone may not fully address the androgenic component. In some cases, testosterone optimisation at appropriately low physiologically relevant doses, combined with targeted treatments including PRP injections, can address the problem more comprehensively than either approach alone.

What this means in practice

The practical takeaway from all of this is not that testosterone should be aggressively supplemented as an anti-ageing strategy. The evidence does not support that and the risks, including effects on cardiovascular health, prostate health in men, and unwanted virilisation in women at excessive doses, are real.

What the evidence does support is this: testosterone is a clinically relevant variable in skin ageing and in both men and women its decline from the late 30s onward contributes to changes in skin structure, quality, and resilience that are regularly attributed to other causes. Where testosterone is genuinely low and producing symptoms, optimisation at physiological levels as part of a properly assessed and monitored hormonal health protocol is supported by good evidence and can have meaningful effects on how skin ages.

It also supports a more integrated approach to aesthetic treatment. Regenerative treatments like polynucleotides and Profhilo work by stimulating cellular repair and collagen synthesis. If the hormonal environment in which those treatments are working is significantly depleted, if the cells receiving the stimulus don't have the metabolic resources to respond fully, the results will be less than they could be. This is not a theoretical concern. It is something I see reflected in treatment outcomes regularly, and it is one of the most compelling arguments for assessing the hormonal picture before and alongside aesthetic treatment rather than treating them as separate conversations.

The honest summary

Testosterone protects and supports skin in both sexes. It builds collagen, supports dermal thickness, regulates oil production, and contributes to cellular turnover. As it declines, gradually in men over decades, more variably in women from the late 20s onward and sharply around menopause, skin loses some of that structural and regenerative support.

That loss is not inevitable to the degree it is often experienced. It is measurable. And in many cases it is addressable, provided someone is actually measuring it.

What it requires is a practitioner who takes hormonal health seriously as a component of skin health, not as a separate clinical domain. That is the Juvenology approach, and it is the approach that my training in hormonal health at the Marion Gluck Academy, combined with my postgraduate longevity medicine qualifications, has shaped into how I practice every day.

Book your consultation at Juvenology, Maidstone

If you are experiencing skin changes, hair thinning, or persistent fatigue that doesn't fully resolve with conventional approaches, your hormonal picture may be part of the story that hasn't yet been properly told.

Our Advanced Blood Panel includes a full hormonal assessment, testosterone, free testosterone, SHBG, DHEA-S, oestradiol, and more, interpreted in the context of how you feel and how your skin is ageing rather than applied against a generic reference range.

Book a longevity medicine consultation at Juvenology

In cardiac nursing I learned that symptoms rarely have a single cause and that the systems driving them are always interconnected. Testosterone's relationship with skin is a perfect illustration: it affects collagen, oil production, wound healing, hair, and systemic inflammation all at once. When you address it as part of a complete picture, the results reflect that completeness. And when you don't, you treat the surface of a problem that runs considerably deeper.

About the author

Nurse Marina is an aesthetic nurse specialist and longevity medicine practitioner based in Maidstone, Kent, with over 25 years of nursing experience including cardiac care at KIMS Hospital. She holds an EMSc in Longevity from the Geneva College of Longevity Science, a Longevity Medicine Intensive from NUS Yong Loo Lin School of Medicine in Singapore, and a qualification in Hormonal Health and Bioidentical Hormone Therapy from the Marion Gluck Academy. Marina is NMC Registered, JCCP Verified, BACN Member, ACE Group Registered, and a Member of the Royal College of Nursing.

From anti-wrinkle injections and dermal fillers to advanced regenerative treatments and longevity medicine, Marina combines rigorous medical knowledge with a nurturing, patient-centred approach.

Book a Consultation with Nurse Marina

Clinical references

1. Impact of sex hormones on postoperative outcomes and skin healing: https://pmc.ncbi.nlm.nih.gov/articles/PMC12410364

2. The role of androgen and androgen receptor in skin-related disorders: https://pmc.ncbi.nlm.nih.gov/articles/PMC3763909

3. Sexual hormones in human skin: https://pubmed.ncbi.nlm.nih.gov/17326004

4. Cutaneous effects of androgens and sebum production in acne vulgaris: https://tandfonline.com/doi/full/10.1080/09546634.2023.2298878

5. Modulating the testosterone pathway, a strategy for male skin ageing: https://pmc.ncbi.nlm.nih.gov/articles/PMC3459575

6. Menopause and the effects of HRT on skin ageing: https://gremjournal.com/journal/01-2024/menopause-and-the-effects-of-hormone-replacement-therapy-on-skin-aging-a-short-review

7. Male skin characteristics and topical antioxidant efficacy: https://pmc.ncbi.nlm.nih.gov/articles/PMC8457217

8. Low testosterone in women, Cleveland Clinic: https://my.clevelandclinic.org/health/diseases/24897-low-testosterone-in-women