Topical Estrogen Therapy for Aging Skin: Current Evidence and Clinical Considerations

Jaden Troxel; Laura Correa Ferrer; Aya Iwamoto; Bradley J. Van Voorhis; Jennifer G. Powers

doi:10.1016/j.jdrv.2025.12.003

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Topical Estrogen Therapy for Aging Skin: Current Evidence and Clinical Considerations

Journal article

Open access

Peer reviewed

Topical Estrogen Therapy for Aging Skin: Current Evidence and Clinical Considerations

Jaden Troxel, Laura Correa Ferrer, Aya Iwamoto, Bradley J. Van Voorhis and Jennifer G. Powers

JAAD Reviews, Vol.7, pp.73-80

03/2026

DOI: 10.1016/j.jdrv.2025.12.003

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https://doi.org/10.1016/j.jdrv.2025.12.003View

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Abstract

Estrogen exerts well-documented effects on skin structure and repair, making it an appealing candidate for anti-aging therapy. The use of prescription cosmetic and off-label topical estrogen creams (0.3% estriol, 0.01% estradiol) has grown rapidly in recent years despite limited clinical evidence, though broader adoption remains constrained by safety concerns. Unlike prior reviews that extrapolate from systemic (HRT) data, this focused review critically examines clinical, histological, and mechanistic studies of natural topical estrogens to directly assess their therapeutic potential. Evidence from small clinical trials demonstrates collagen stimulation, epidermal thickening, and fibroblast activation, supported by findings of increased procollagen and TGF-β1 signaling with suppression of collagen-degrading enzymes. Increases in elastin density and dermal vascularity have also been reported, though results are inconsistent. Importantly, studies suggest that these regenerative effects may be attenuated in photoaged skin, likely due to UV-induced fibroblast dysfunction. Despite encouraging histological changes, clinical endpoints remain inconclusive. Few controlled trials report visible or patient-perceived improvements, and results vary by site and methodology. Safety data indicate minimal adverse effects, yet systemic absorption and hormonal activity have been observed. With the rising use of topical estrogens, cautious interpretation of their benefits is warranted until larger, independent trials establish efficacy and long-term safety.

anti-aging

cosmetic dermatology

estrogen

topical estrogen

Details

Title: Subtitle: Topical Estrogen Therapy for Aging Skin: Current Evidence and Clinical Considerations
Creators: Jaden Troxel - University of Iowa, Orthopedics and Rehabilitation
Laura Correa Ferrer - University of Iowa
Aya Iwamoto - Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Iowa Health Care, 200 Hawkins Dr, Iowa City, IA 52242
Bradley J. Van Voorhis - University of Iowa
Jennifer G. Powers - University of Iowa
Resource Type: Journal article
Publication Details: JAAD Reviews, Vol.7, pp.73-80
DOI: 10.1016/j.jdrv.2025.12.003
ISSN: 2950-1989
eISSN: 2950-1989
Publisher: Elsevier Inc
Language: English
Electronic publication date: 2025
Date published: 03/2026
Academic Unit: Dermatology; Orthopedics and Rehabilitation; Obstetrics and Gynecology
Record Identifier: 9985112982202771

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