Dr Louise Newson: [01:00:00] On the podcast today, I'm with Dr Saj Rajpar, a consultant dermatologist. We talk about hormones and the skin, how important they are and why they've been neglected for so long. We do also touch on whether using estrogen on our faces is a good idea or not. So Saj, you are a frequent visitor for my podcast, but not in real life actually. This is the first time that we've done it in this studio, which is great.

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Dr Sajjad Rajpar: [01:00:26] It's really great to be here and to be on your podcast again. Thanks for having me.  [01:00:29][3.7]
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Dr Louise Newson: [01:00:29] Oh thank you. Well you are, I was saying to Jack who runs the studio, you are my go-to dermatologist not just for me but for patients, my children come to you, my husband comes to you because you're a general dermatologist and there's very few people that are really general dermatologists because the skin is a window into our bodies. We've talked about this many times before and so often, and I think it's getting worse actually, that people think if their face looks all right then their body's going to be okay. And so many people have work and tweakments and all sorts of things to their face, but they're not thinking about the rest of their organs and how their skin is a window into everything else, do they?  [01:01:10][41.1]
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Dr Sajjad Rajpar: [01:01:10] Oh yeah, I think it's so important to appreciate that the skin is an organ, and it's one of the biggest organs in the body. And yes, we can actually tell when somebody's got systemic illnesses or issues with their health. You know, there are findings on the skin that could suggest somebody's go a low thyroid hormone level or a high thyroid hormone level. Diabetes presents on the skin. Even a low iron level can present on the skin and of course, hormone deficiencies present on skin as well. So yeah, the skin really is a window into somebody's health status and wellbeing. And you can only go so far in covering up deficiencies, you know, with aesthetic treatments, unless you get the underlying problem, your whole skin will not improve. So it's really important to address the systemic issues as well.  [01:01:58][48.0]
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Dr Louise Newson: [01:01:58] About 10 years ago, when I started the clinic on my own, this lady came to see me as a review. So I'd seen her once, she came back three months later, and she said, I'd just like to thank you, Dr. Newson. You have saved me about £10,000. And I said, what? Sorry? [01:02:11][12.1]
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Dr Sajjad Rajpar: [01:02:11] That's great, isn't it? That's great.  [01:02:12][0.7]
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Dr Louise Newson: [01:02:11] And she said I was going to have a facelift. She said I'd booked in, she said, I'd saved the money. I was gonna tell my husband that I was going on holiday with my sister because I couldn't tell him what was happening. I booked time off work and she said partly it was because I'd felt so withdrawn and so negative in myself that I just felt that if I had a facelift it would give me like a new lease of life. But also my skin was so dull, I looked so tired, I felt that I had more lines, my collagen had gone. Just everything. And she said, even within three months, firstly, I've got that oomph back. I don't care what I look like because I feel so much happier. She said, but my skin is already starting to glow. I can see that, you know, I have got less lines and I've got more moisture in my skin, it's less dry. And I thought, wow, isn't that amazing. But it's true. You get this response with hormones, don't you?  [01:03:02][50.7]
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Dr Sajjad Rajpar: [01:03:02] Yeah, it's fantastic to hear and isn't it the case that as doctors, you can tell from a mile away if a woman's, a post-menopausal woman's on hormones or they're not, you know, and it's that inkling that the skin is healthier and as a consequence it looks better. So I always talk about the function of skin as being more important than the structure, but if the function improves the appearance is very likely also to improve. We're actually improving the function, and consequently the appearance improves. And collagen is so, so important. It's one of the building blocks in the skin. It's the building block in the bones. And we know from a lot of data that women who are on hormone replacement therapy, in the first five years of being on hormone-replacement therapy preserve 30% more collagen than women who were not. So, in other words, if you take HRT, then published studies show that you will save 30% of your collagen in the first five years from being on HRT. And I think that is a massive amount of collagen banking, if you like. And I am not aware, Louise, of any aesthetic or dermatologic treatment that can do that. And when we talk about collagen, and you know, yeah, your skin will look better, there'll be fewer fine lines and wrinkles, there'll be less sagging. But the skin integrity will be better. You're going to heal better after an operation. And we can see that when we're doing skin procedures, the skin quality in somebody who's been on HRT is better. It can take sutures better, it heals better. And we've got data that potentially women who are on HRT have a third less risk of venous ulcers. So even wound healing is better. [01:04:50][107.6]
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Dr Louise Newson: [01:04:51] It's so important, and also collagen isn't just in our skin, we have it throughout our musculoskeletal system as well. And you show a great slide that you showed on a recent educational event of, it was a side on of a woman getting older with more sort of laxicity of the skin. And what was it that you asked people?  [01:05:14][22.7]
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Dr Sajjad Rajpar: [01:05:14] Yeah, so I said, which person do you think has thinner bones? Is it the woman on the left? And I assumed that the woman was the same age.  [01:05:25][10.4]
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Dr Louise Newson: [01:05:25] Mmm.  [01:05:25][0.0]
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Dr Sajjad Rajpar: [01:05:26] I said, is it the woman on the left of the slide who's got minimum lines and wrinkling, or is it that the woman on the right of the side who's very thin skin, and consequently has more lines and wrinkling and a really good study showed that women who had fine lines, wrinkling and skin ageing were much more likely to have a lower bone mineral density on DEXA scanning. So in other words, if your bones are thinning, it's likely your skin is thinning. And then we've got this indicator, we don't need a scan. So if you see somebody in their late 40s and early 50s, and this is really important, that this study was actually in women in their 40s, and 50s. We're not talking about elderly women in their 70s and 80s, we're talking about women who are just, you know, sort of peri- and post-menopausal, that if they've got increased number of facial lines, they're much more likely to have bone thinning, and this a marker of osteoporosis potentially.  [01:06:22][56.6]
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Dr Louise Newson: [01:06:23] Yeah and that's really important because I was showing you some, a consensus statement that was written by one of the menopause societies not so long ago and they were saying that HRT is not an indication for skin concerns and I sort of feel, for two reasons, that's not right. Firstly the skin is an organ so why are we not worried about our skin. But secondly you've already said that the skin as a window into our health. So if we are more worried about our skin, just because it's easier to see than our liver, for example, is that a bad thing? And I don't think it is actually.  [01:06:58][34.9]
Dr Sajjad Rajpar: [01:06:58] No, absolutely not. And we know from published studies again that something like 70% of women have skin concerns around the perimenopause and menopause, and 40% have hair concerns around the permenopause and menopause. And certainly if you can improve skin symptoms and hair symptoms with treatment, I'm not saying every single skin concern and every single hair concern is going improve. But why shouldn't we? Why should we be using expensive, dangerous immunosuppressant drugs for somebody's eczema that might have deteriorated around the perimenopause and menopause, instead of guiding the person and saying, look, potentially your low hormones could be causing this. Why don't you see if that's the case and try HRT seeing as, you know, you're perimenapausal.  [01:07:43][44.2]
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Dr Louise Newson: [01:07:42] Absolutely. Yeah, and it has other benefits. So, you know, the listeners already know the many benefits of taking hormones, but we shouldn't dismiss skin. And it was almost quite a sort of disparaging comment for dermatologists as well. And we're saying the skin isn't important, but it really is. And It's very interesting when you talk about pre-existing conditions like eczema, like psoriasis, even acne, people who have had skin conditions, pityriasis sometimes can flare up with the immune system not working so well. Rosacea, all of these conditions that people think, oh, I've grown out of that, for example, they can often come back when hormones change, can't they? [01:08:19][37.1]
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Dr Sajjad Rajpar: [01:08:19] Yeah, absolutely. And in a questionnaire study, 46% of women said that their pre-existing skin diagnoses flared around the perimenopause and menopause. The skin clearly is important, and estrogen is clearly important to the skin. And when we look at skin cells, we actually know that virtually every cell in the skin has estrogen receptors and is stimulated in one or another by estrogen and also travelling cells such as the immune system and white blood cells that go into the skin also have estrogen receptors. So there is this, you know, inflammatory balance. Is estrogen reducing inflammation in the skin? And is that the reason why inflammatory conditions like  eczema and psoriasis might flare?  [01:09:03][44.2]
Dr Louise Newson: [01:09:04] Absolutely. I mean, in my book, I've got a whole chapter about inflammation, because I'm very interested in the immune regulating effects of all three hormones, progesterone, estradiol, testosterone. And what's very interesting is that all our immune cells, as you know, have receptors for those hormones on them. So they'll improve our inflammatory response, they'll reduce inflammation. But what's very interesting, I think, also, if you've got low estradiol in the blood, your macrophages, one of your really important immune cells become pro-inflammatory. So they're not just neutral. They actually can turn against us and increase inflammation. And you see this time and time again, because we know the longer a woman is menopausal, the greater the risk of all inflammatory conditions, cardiovascular disease, diabetes, non-alcoholic fatty liver disease, inflammatory bowel disease, cancers, but also skin conditions as well. A lot of it is this inflammation and as you say, quite often in dermatology, it's been giving steroids, topical steroids, systemic steroids. Now people are having more of the biologics. But the biologists are not without risk either. They help some of the immune system, but they suppress some of the immune system and you don't really want your immune system completely suppressed because we need it to fight infections and other illnesses.  [01:10:19][74.9]
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Dr Sajjad Rajpar: [01:10:19] Absolutely, absolutely. If there was a better way to treat skin conditions, we should be doing that. We're doing our patients a disservice by neglecting basic treatment.  [01:10:30][10.9]
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Dr Louise Newson: [01:10:30] Totally. And I'm very simplistic in the way that I think. I'm sure you realise that. But I was in America recently and I was shocked because there's so many adverts for drugs on the television. We can't do that in the UK, obviously. But every other drug was for a biologic, it seemed, just the bit that I was watching on the TV in the hotel. But there were three adverts that I saw for eczema. And one of them was for child with eczema and two were for adults, saying if your excema's out of control consider having a biologic. It's about $400 a month, but you might get it on insurance. And these were all women in the adverts, actually. One was an adolescent girl, and then the other two were women. And I was thinking, oh, gosh, actually, I would prefer to get my hormones balanced, that it's a lot cheaper, but it's treating the underlying cause. Because in adolescence, often people are very low in progesterone, sometimes estradiol as well. And then obviously any age, people can be low of hormones.  [01:11:27][56.3]
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Dr Sajjad Rajpar: [01:11:28] Yeah. Oh, yeah. But Louise, as you said in one of your previous podcasts, if this was a new drug...with new pharma funding and that said, you know, this drug will preserve 30% of your collagen in the first five years. It may improve pre-existing skin conditions that flare, it may improve hair loss and we've certainly seen many individuals with hair loss improve with their hormone replacement therapy. Then, they would be all over the billboards if this was a new drug that was being licensed for those indications. But the problem is, as you've said in previous podcast, it is not a new drug.  [01:12:06][31.8]
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Dr Louise Newson: [01:12:07] It's dirt cheap.  [01:12:07][0.5]
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Dr Sajjad Rajpar: [01:12:07] It's dirt cheap, nobody's going to make anything out of advertising the benefits. And obviously we can't advertise in the UK, but educating even individuals about the benefits and you know, one of the other things I just wanted to mention about hormones in the skin is I think we're just touching the tip of the iceberg in our understanding of it. It's really interesting because the skin itself can make estrogen and progesterone and testosterone. So the skin is actually an organ that can take cholesterol from the blood and make its own hormones in an intracrine fashion. And this is why, when people come to me and say, look, my blood test shows this. I say, look, your blood test is telling us what's circulating in the body at that point in time. It's not actually telling us what's in the tissue, it's not telling us how much your receptors are being stimulated by that and there's so many things we don't understand. So that doesn't necessarily mean hormones are not involved in this particular instance.  [01:13:07][59.5]
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Dr Louise Newson: [01:13:09] My new book The Power of Hormones is officially out now. I wrote it because too many people are still being told things about their hormones that don't match the science. So in this book, I explain how our hormones, estradiol, progesterone and testosterone really work, why there's been so much resistance to this knowledge and how gaps in training and outdated thinking have affected women's health for decades. It also explores the history behind hormone treatments. The myths that continue to circulate, and the reasons why so many women are still struggling to access accurate information. So if you want to understand your hormones and your health in deeper, more honest way, you can buy The Power of Hormones now. I've included a link in the show notes.  [01:13:56][47.3]
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Dr Louise Newson: [01:13:59] We know that the dosing, the individualisation of hormones is really crucially important and most of us are on some sort of journey where we're fine-tuning our hormones and trying to work out what's right. And increasingly, you know, we give the estradiol, as you know through the skin, usually as a patch or gel, but the absorption can be a real issue for some of us. I've got thicker skin than others, it appears, and it's harder to get it through. Progesterone can be quite different the way it's absorbed and metabolised, whether it's given orally, as a cream or as a pessary, and then testosterone as well, usually the cream or gel, but having the balance, the right dose is really important. And then vaginal hormones, really important, but increasingly, you know, there's a lot of people on social media talking about what about putting it on my face? What do I put on my face? And there's been a bit of a confusion hasn't there? [01:14:50][50.8]
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Dr Sajjad Rajpar: [01:14:50] There has been, there has been. Do you know, using estrogens on the face isn't a new thing. And in the 40s and 50s, creams, beauty creams in the States contained estrogen. So Max Factor had a product called Cup of Youth.  [01:15:02][12.6]
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Dr Louise Newson: [01:15:03] Cup of youth!  [01:15:03][0.5]
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Dr Sajjad Rajpar: [01:15:06] Cup of Youth! Elizabeth Arden had a product called Joie de Vive and these contained estrogen and that was because people realised, people twigged on pretty early on, that you know, this improves skin and you know by improving the function of the skin you're going to improve the appearance of the skin. So this is not new to us, so we know that estrogen stimulation to the skin improves certain parameters, and this is in men and women, by the way, so there are studies that show…  [01:15:35][29.2]
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Dr Louise Newson: [01:15:35] Of course, because men have estrogen as well, don't they?  [01:15:37][1.9]
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Dr Sajjad Rajpar: [01:15:37] Men have estrogen, we forget about that, you know. So one study showed that men who had skin biopsies heal quicker when they've got estrogen applied to it. And another study showed that men who had estrogen put on their skin for two weeks had improved collagen production in that area of skin. So certainly both genders respond to estrogen. And the question about face creams keeps coming up nowadays. It's a big, big topic on social media. And my take on it is yes, if you apply estrogen to the skin, it will respond providing you're absorbing it. But what is your goal here? Is your goal to protect and preserve the 100% of your skin surface area or just 2 or 3% of your skin surface area? You know, what is your goal? Is it a functional improvement in your skin or is it an aesthetic improvement? And really you should be thinking about protecting your whole skin because you don't know where that injury or that leg ulcer, you know, when and where that's going to come in, right? And then you've got all the other benefits of HRT, protecting your bones, your heart, your brain. Now, if you were to put estrogen on a small area of skin like your face, it is possible that that's gonna be absorbed. It's going be part of the surface area that you would absorb your topical estrogen therapy through, so potentially it may contribute to a systemic effect anyway. So if you're going to be having systemic HRT anyway, why don't you just optimise your systemic HRT? And this is what I tell my patients is that that would be your goal. So the studies that show 30% preservation of collagen in the first five years were not on topical HRT on the face. It was systemic. It was a systemic HRT that will improve your skin, that will reach your skin. You don't have to necessarily top it up. And with all receptor interactions, there is this dose response, isn't there? That you can't just keep over-stimulating receptors, you know, so if you double the dose on the skin you're not going to get double the response. So if you've already peaked and plateaued with optimised systemic HRT, you don't really need to go ahead and put, you know, facial estrogen cream.  [01:17:41][124.2]
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Dr Sajjad Rajpar: [01:17:42] Does that make sense? Is that a reasonable justification?  [01:17:43][1.7]
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Dr Louise Newson: [01:17:44] It totally makes sense because I think, like we said at the beginning, you know, the skin is not just the face. You know, if you're concerned about the face, why are you concerned? If it's because maybe you've got accelerated ageing, like you said, more lines or whatever, then we should be thinking systemically because does it mean that there's more accelerated ageing in the body, as in more inflammation, loss of collagen elsewhere? So that's really important to take a step back and think systemically in the body. Because as a dermatologist, you're not just focused on the face. It's really important to think about that. Then the other thing is some people do use some of the vaginal hormonal preparations like the low dose estradiol or estriol creams or gels on their face. I mean, there is some data that might have an effect. Of course, it's going to probably have an affect. But I'm more interested, you know, if someone had an area of eczema, for example, and they used one of these low dose vaginal creams, would that help?  [01:18:39][55.1]
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Dr Sajjad Rajpar: [01:18:40] Well, I've had patients certainly come in and tell me that my skin's improved by doing that. So, you know, clearly there is something going on and we don't have enough data on it, but there is some thing going on there, isn't there?  [01:18:52][11.9]
Dr Louise Newson: [01:18:52] And that makes physiological sense. I think in medicine we're constantly adjusting and changing and learning. We're learning from science, we're learning from basic physiology, and we're also learning from our patients. And the risks of using a low dose vaginal hormonal preparation on an area of the skin are incredibly low.  [01:19:12][20.2]
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Dr Sajjad Rajpar: [01:19:12] Especially if it's going to be for a week or two, you know, while the eczema is active or something like that. Yeah.  [01:19:19][6.4]
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Dr Louise Newson: [01:19:19] Somebody sent me a photo, I think I might have showed it to you, she had an awful excema like she couldn't go out of the house, it was absolutely terrible. And her having the right dose of systemic hormones was transformational for her, it really was. And so, so there's no right or wrong with any of this. It's what it, but it's thinking beyond the face I think is what I'm trying to come up with.  [01:19:40][21.4]
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Dr Sajjad Rajpar: [01:19:40] Well, absolutely. And also, what about the bones and, you know, facial ageing, if say that were the goal. You know, the bones are really important on facial ageing and we know in women that the skeleton changes rapidly, the facial skeleton changes rapidly around the perimenopause and menopause, especially on the lower part of the face. So we get a lot of chin and mandibular resorption in women in the first five years of that sort of perimenopause menopause transition. And, you know, you're not going to be able to overcome that if that is related to hormone deficiency, which it's likely to be. You're not gonna overcome that with topical estriol to stimulate very gently the skin cells only. You know, you're going to need systemic HRT. [01:20:27][46.2]
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Dr Louise Newson: [01:20:28] You've also talked before in a previous podcast about our bone structure change, especially the mandible, the jaw line. It's not just the skin and using a topical cream on this or a gel on the face is not going to get into the bones that way. It won't work in the same way. I do think, if anyone's listening, I might try it. I would always say optimise your hormones first, progesterone, estradiol, testosterone.  [01:20:51][23.1]
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Dr Sajjad Rajpar: [01:20:51] And Louise, can I ask you, because I get asked, how do I know I've optimised my hormones?  [01:20:56][4.2]
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Dr Louise Newson: [01:20:55] Yes, a great question. So with estradiol, blood tests can be useful. We do the symptom questionnaire, you know, it's available on Balance. It's been extended, so it's got over 80 questions on it. And that's very useful as well, actually. So thinking, a lot of times it's looking at physical symptoms as well because mental health symptoms are very common. But if someone's also got palpitations, they might have some cystitis, they might have skin changes that's more likely related to hormones. But looking at estradiol levels, looking at testosterone levels are useful as well, because testosterone is very beneficial for the skin. Everyone thinks it's going to give them acne and it's going to make the skin greasy and it often really helps the skin as well.  [01:21:37][41.5]
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Dr Sajjad Rajpar: [01:21:36] Testosterone is a really interesting one, isn't it? If your testosterone is so low, and it's down to your boots, then your hair will drop out and replacing testosterone in women can really help with hair growth. It will actually improve hair growth because it's an anabolic hormone required for several bodily functions. And a lot of women, when they come back having started the testosterone component of their HRT, will say my dry skin is so much better, my dry eyes are so much better, and my blepharitis has virtually cleared. So, and that's because part of your body's moisturising factor includes sebum, which is produced by sebaceous glands, and we all know sebaceus glands as one of the causative issues in acne. But that sebum is really important in hydrating your own skin. And that's where, you know, the testosterone stimulates the sebum and helps hydrate your own skin. So I think there is definitely... [01:22:34][58.1]
Dr Louise Newson: [01:22:35] And it's funny because you were saying I can recognise people and you can too who are on HRT, but now I can actually recognise people on testosterone as well. It's very sort of subtle, but you can see the skin changes but also hair changes as well with testosterone. But then the other hormone is progesterone. We don't usually routinely do blood tests because like you say, what's in the blood isn't necessarily what's in the tissues, it can be unreliable. But having enough progestorone is really important for hair and skin. A lot of people find their hair growth... it's really beneficial with progesterone like in pregnancy, very high levels of progestorone we have when we're pregnant. But increasingly, we're giving progestrone as a pessary that to, that is the good dose to get absorbed into the body. So a lot of people with PMS, PMDD, and some people who don't tolerate oral progestorrone, the pessary is amazing and they notice skin and hair changes and nail changes in a positive way as well.  [01:23:32][56.8]
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Dr Sajjad Rajpar: [01:23:32] And isn't that interesting? I think progesterone is probably the most misunderstood hormone, isn't it?  [01:23:39][6.6]
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Dr Louise Newson: [01:23:39] It's totally misunderstood.  [01:23:39][0.1]
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Dr Sajjad Rajpar: [01:23:39] And as a dermatologist. I have no significant understanding and I'm really interested to hear that, that you know skin and hair also improve. It doesn't surprise me because how complex the interaction is. [01:23:49][9.2]
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Dr Louise Newson: [01:23:49] No, but you see we've been scared of progesterone for many years because so many women are mistakenly thinking they're taking progestorone but they're using a synthetic progestogen. So something like norethistrone, something like madoxyprogesteron acetate, the Mirena Coil, they all contain a synthetic protestogen. They might have roles but they block the progesterone receptors. Sometimes they increase inflammation. Even the Mirena can get absorbed into the body through the uterine blood supply into the rest of the system. And so a lot of people find that they have really bad acne, they have hair loss. I mean, you've seen it a lot with Mirena coils as well, haven't you?  [01:24:31][42.4]
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Dr Sajjad Rajpar: [01:24:31] Yeah, absolutely. And I think this is this is one of the really most important points that synthetic progesterone is a completely different beast.  [01:24:39][7.9]
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Dr Louise Newson: [01:24:39] It's not a hormone. It is a chemical.  [01:24:41][1.4]
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Dr Sajjad Rajpar: [01:24:42] And it's displacing the hormones that actually want to go into that receptor and properly stimulate that receptor. So it's actually causing a relative deficiency... [01:24:51][9.5]
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Dr Louise Newson: [01:24:52] It's worse than not having anything really and so increasingly when we see people who've had a hysterectomy, have a Mirena coil, even people on hormonal contraceptives, I'll often top them up with progesterone as well and they come back and they say gosh I'm sleeping better, I'm feeling calmer, but also my hair and skin is so much better and that's really interesting isn't it.  [01:25:13][21.0]
Dr Sajjad Rajpar: [01:25:14] And yeah, so absolutely. So really, when we talk about hormone optimisation, we really need to be looking at all three hormones. It's not just about... [01:25:21][7.8]
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Dr Louise Newson: [01:25:22] No, absolutely.  [01:25:22][0.7]
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Dr Sajjad Rajpar: [01:25:23] One. Yeah.  [01:25:23][0.7]
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Dr Louise Newson: [01:25:24] And often people just talk about estrogen because they feel a bit more comfortable with it. But you know, it's interesting because we're talking about the synthetic hormones blocking our natural hormones. But there are drugs that are given to block hormones as well. So we know how common breast cancer is. And a lot of women are prescribed aromatase inhibitors that block the conversion of testosterone to all estrogens, actually. But also the Tamoxifen works as a selective estrogen receptor modulator. So it stops the action of estrogen in various tissues. And there's some interesting data about wound healing, skin, hair changes on those drugs.  [01:26:01][37.5]
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Dr Sajjad Rajpar: [01:26:02] And I think it's a good model of trying to work out what is estrogen doing on the skin, isn't it? Because people say, does it really do this? And one way of looking at it is to say, well, what happens when I block all estrogen. And what's the consequence of this? And we do see hair loss very commonly in women who are on any form of estrogen blockers and 5% of women can get quite severe hair loss and thinning, significant thinning of the hair shafts and that's called endocrine-induced alopecia. And the other thing the studies show is that women who are on estrogen blockers following breast cancer and have surgical reconstruction have a much more difficult post-operative course. So women on estrogen blockers have something like a four or five times higher risk of infection after surgery. This is breast reconstruction surgery and they have a two or three times greater risk of slow wound healing. So that's telling us that being on estrogen or your tissues having exposure to estrogen must improve wound healing and reduce infection. And, you know, we know that in estrogen brings in inflammatory cells to help clear wounds and also helps bring in new blood vessels, something called angiogenesis. And that's probably why wounds heal a lot quicker when somebody is adequately treated with estrogen than when they're not. So, yeah, I think looking at the instances where estrogen is blocked, helps us understand what estrogen does.  [01:27:37][95.0]
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Dr Louise Newson: [01:27:38] It's really important actually because quite often I see patients who tell me that they've been told to go on an aromatase inhibitor right from the start since diagnosis before their surgery and actually there's no urgency usually for a lot of these women so waiting a few weeks until after surgery then having the discussion might really help with wound treatment especially if they're needing reconstructive surgery as well or if they're on those drugs and they need an operation for another reason, it's worth talking to specialist about, could I just come off the drug for a little bit to try and help with wound healing? But also, not just for women who've had cancer, so many women are incorrectly told they need to stop their body identical hormones before an operation. And I always say, well, there's no clot risk, so you can carry on. But also you are more likely to heal better after your operation, which is what you're saying, isn't it?  [01:28:31][52.3]
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Dr Sajjad Rajpar: [01:28:30] You're saying. Yeah, it's ironic, isn't it? Because a lot of the DVT screening questionnaires before surgery in many of the hospitals still say, you know, is this person on HRT? And if they are, they need to be given extra DVT precautions because they're at higher risk. And, you this just is so, so far behind the truth, isn't it?  [01:28:53][23.2]
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Dr Louise Newson: [01:28:53] Yeah, yeah. So we've got a long way to go, but I just love talking to you about skin. There's so much more that we can talk about, and I'm sure there'll be lots of questions, which is great, and there's lots of information on Balance app. You're our go-to dermatologist on Balance, which great. But before I end, I always ask for three take-home tips. So we've covered a lot of information, but what are the three most important things about hormones and our skin and hair that you would want people to know?  [01:29:22][28.8]
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Dr Sajjad Rajpar: [01:29:23] Okay, well, the first one is think about hormones as a potential cause for certain skin and hair conditions, especially if they're happening around the perimenopause and menopause. Because we now have data to suggest that pre-existing skin conditions can flare and new skin concerns can also develop. The second is not every skin and hair condition around the perimenopause and menopause is going to be from hormones. And you know, get good advice on getting a proper diagnosis. And I know it's really tempting to self diagnose, we haven't got the time to see someone, you don't always see somebody who can help you and it's difficult, I get it. But sometimes just getting that first bit right, you know. This is diagnosis X, you know this is diagosis Y. That will actually change your future trajectory of managing that concern significantly. And number three is referring our listeners back to what you said about optimising your hormones, you know, really think about getting the most out of your hormones by optimising them, because I think that's the way we're going to see the better outcomes.  [01:30:31][67.8]
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Dr Louise Newson: [01:30:31] Absolutely. Thank you so much. It's been great. Thank you.  [01:30:34][3.0]
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Dr Sajjad Rajpar: [01:30:35] Thanks Louise.  [01:30:35][0.0]
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Dr Louise Newson: [01:30:38] Thanks so much for listening. It would be amazing if you could follow me or subscribe because it will really make a difference to grow numbers and enable this to reach even more people. Thanks so much.  [01:30:38][0.0]