Psoriasis and Hormones: What to Know

Stress, the weather, cuts on your skin: If you’ve been living with psoriasis for a while, you know that there are many things that can lead to flare-ups. While you can control some, other triggers are unavoidable, including hormonal fluctuations throughout your life.

Biological women have more estrogen, and biological men have more testosterone. These hormone levels go up and down over a lifetime. “In some contexts certain hormonal changes may have a positive impact on psoriasis, and in certain contexts it actually can have a negative impact,” says Marisa Garshick, MD, an assistant clinical professor of dermatology at NewYork-Presbyterian Weill Cornell Medical Center and dermatologist at MDCS Dermatology in New York City.

Generally speaking, when estrogen is higher in women or testosterone is higher in men, they tend to experience fewer psoriasis symptoms; when these levels are lower, they experience more flares and symptoms. But the exact relationship between psoriasis and hormones isn’t well understood. “There’s still a lot of research that needs to be done in this regard,” says Anne Truitt, MD, a dermatologist at Skin Surgery Medical Group in San Diego.

How Hormones and Psoriasis Interact During Different Life Stages

Although psoriasis can develop at any age, most people experience their first flare between ages 15 and 35, according to the National Psoriasis Foundation (NPF). And about one-third of people with psoriasis have symptoms before age 18.

Here’s what doctors do know about hormones and psoriasis as you go through life:

Puberty

As a person’s body changes from a child to an adult — roughly between ages 8 and 14 — their hormones will surge, setting the stage for sexual maturity. For some young women, these changes in estrogen levels can trigger or worsen psoriasis. But it’s more common to first develop psoriasis just after puberty, which is when hormone levels start to decrease. A similar pattern can be seen in young men, says Dr. Garshick.

During adolescence, it’s more common for girls to have psoriasis than boys, although the ratio balances out in adulthood. This suggests psoriasis may start earlier in girls than in boys, according to one study.

Menstruation

For women in their childbearing years, the monthly fluctuation of hormone levels can affect psoriasis. When estrogen levels are high, in the middle of a menstrual cycle, psoriasis tends to be less severe. Estrogen levels are lowest during menstruation, which correlates to more psoriasis symptoms, according to the NPF.

Pregnancy

Outside of puberty, female hormones will surge to their highest levels during pregnancy. As a result, a pregnant person may get a break from psoriasis flares.

“Particularly in the mid-part of the pregnancy, you’re going to have increased levels of estrogen, and your flares actually decrease,” says Dr. Truitt. But this doesn’t last. “After you have your baby, in that period of time when your hormones start to decrease, that’s when the psoriatic flares come back,” she says.

Middle age

Midlife, the ovaries gradually begin to make less estrogen — a time known as perimenopause. It generally starts when a woman is in her mid-forties, although it can begin earlier. This can put women in midlife at an increased risk for psoriasis flares, although how much it contributes is unclear, says Garshick.

Men also experience a decline in testosterone as they get older, although the drop isn’t as drastic as it is for women. Up to 25 percent of older men have testosterone levels considered too low, according to Mayo Clinic. Some research found that in men with psoriasis, 52 percent had low testosterone levels. But more research is needed before doctors can say whether supplemental testosterone would help decrease the severity of psoriasis in men.

Menopause

Twelve months after a woman’s last period is considered menopause. It occurs after years of declining hormones, when a woman’s ovaries no longer release eggs.

The average age of menopause is 51, according to Cleveland Clinic. “When your hormone levels drop during menopause, that puts you at an increased risk of having flares,” says Truitt.

When to Talk to Your Doctor

If hormone fluctuations cause issues for you outside of psoriasis — for example, if you’re a woman experiencing severe hot flashes during menopause or a man experiencing fatigue due to low testosterone — this might be a reason to speak to a doctor about hormone replacement therapy. But psoriasis itself doesn’t require any hormonal treatment, according to Garshick and Truitt.

Don’t worry too much about how aging may affect your psoriasis, either. It’s not likely to change your overall treatment approach. “Certainly, as an individual, you’re noticing changes [due to hormones],” says Garshick. “But it’s less likely to have as much of an impact on psoriasis treatment.”

While hormones aren’t often a big area of focus when it comes to psoriasis, learning more about the possible link can help you understand yet another possible trigger. And that may make flares seem a little less random.