Happy Birthday to Us!

we're in a gift-giving mood. plus, the bottom-line on hormone creams

Welcome readers, old and new! HNTFUYF has just reached its second birthday and my, how we’ve grown—from around 200 subscribers to more than 10,000! As a special thank you, I’m knocking 20% off paid subscriptions to HNTFUYF for the next 30 days. Aren’t birthmonths more fun than birthdays? Your valuable dollars support an ad-free HNTFUYF, so I can deliver you beauty advice decidedly un-influenced by devilish marketing.

A birthday! A 20% discount! And a huge thank you for your loyal readership. xo

Turning two with two of my favorite knuckleheads.

Also, see the ❤ button above? Please tap it to release a balloon bouquet for beautiful knuckleheads everywhere.

This post comes to you from the land of the Jetsons Japan, replete with flying cars and robot deliveries. Which put me in the mood to experiment with ChatGPT to see how it looked dressed up as a beauty editor. Pretty drab actually, as its best advice to a question about enhancing our appearance as we age was bland enough to piss me off: “Remember, the most important thing is to feel good about yourself and to embrace your age with grace and confidence.” To which I responded, “Easy for you to say, you smug stockpile of URLs. You try tramping around for more than seven decades as a meat puppet.”

And now, a reader question.

Q: I just read your post about whether beauty products are killing us. Loved! While I don't believe a product can do miraculous things, I am still considering using a couple of face creams for perimenopausal and menopausal women. They seem to have more solid clinical research behind them. What is your take on Alloy's estriol cream and Emepelle's skincare line with MEP technology? Talk some sense into me!

A: Before I could talk some sense into you, dear reader, I had to make sense of estriol in skincare and MEP technology. For that, I needed a major tutorial, handily offered by HNTFUYF’s treasured DermDiva, Heidi Waldorf. I sent her your question, along with one of my own: Because I’m using the hormone cream estradiol vaginally to treat post-menopausal symptoms, am I potentially getting too much exposure to estrogen if I also use estriol on my face?

“Your question hits the nail on the head,” says Waldorf. “Topical estrogen can be absorbed into the bloodstream and may increase the risk of side effects such as blood clot, stroke, and certain types of cancer if too much is used for extended periods. An excess of absorption can cause the same symptoms as too much systemic estrogen: nausea, vomiting, breast tenderness, fatigue, and withdrawal bleeding.” 

Waldorf continues, “Studies have shown that topical estradiol estrogen in specific dosing is safe to treat vaginal symptoms of menopause even in women with a history of breast cancer. But additional application on other skin surfaces will lead to additional absorption.”

Well, that sounds perturbing.

The complicating factor in this case, says Waldorf, is that the Alloy cream contains estriol, which is a weaker estrogen than estradiol—and we have fewer data on the ingredient’s safety parameters.

Before I get to the next chapter of Waldorf’s response, I want to say that I believe the idea behind Alloy is admirable: The company’s intention is to make it easier for women to address and find solutions to the issues menopause presents. Huzzah! But Waldorf has some concerns with the process that eventually lands a tube of estriol cream in your mailbox.

Here’s Waldorf’s account of her experience:

To test Alloy’s “medical screening” process, I completed their questionnaire two ways. First, I completed only the 10-second questionnaire required to get a prescription for M4 (estriol) skin cream. For each question, I said my skin is perfect, no signs of aging. I answered the questions about medications and allergies—and in the box that asked, “Anything else we should know?” I wrote “history of breast cancer.” After uploading a photo of my ID, the checkout screen with my recommended prescription of their estriol cream popped up along with the $35 “medical evaluation” fee waived.

I returned to the site asking for an evaluation of everything. Just as I answered that I had no skin issues, I also answered that I had no local or systemic menopausal symptoms—no hot flashes, night sweats, fatigue, etc., and no vaginal or sexual symptoms. There were additional medical questions, all of which I answered in minutes. I checked off my history of breast cancer. This time the checkout included a prescription for an SSRI (an anti-depressant), a treatment for the systemic menopause symptoms I said I didn’t have, and the option to add Alloy’s face, vaginal, and orgasm-stimulating products, all meant to treat other symptoms I stated I didn’t have. Again, the $35 “medical evaluation” fee was waived.

Her conclusions:

If that was a medical evaluation, I’m a ballerina. The questionnaires clearly went through a program designed to sell products. Even the fastest “provider” couldn’t have interacted with a patient at that speed. The questionnaire format easily allows you to leave out important information because you either forgot it (which happens more than you’d think), or because you never completely understood your own medical history (again, more commonplace than you’d think), or because you just didn’t think it was relevant. Based on the speed, I doubt the box asking for a customer’s current medications is adequately evaluated for potential interactions or contraindications.

To test that theory, Waldorf answered the full questionnaire again, this time excluding her breast cancer history and including Lysteda under her medications. (Lysteda is a pill that promotes clotting to treat uterine bleeding; it’s also used off-label to treat melasma.) This time, Alloy’s recommendation included oral estrogen—which also may promote clotting. “I’d much rather see my doctor who knows my medical history, my medications and their implications on my health, and who can discuss the relative risks and benefits of any treatments and concerning signs or symptoms I need to report,” Waldorf says. “The pills and topicals recommended were all meant to treat symptoms I don’t have—and they aren’t without risk.”

Waldorf went on:

An SSRI must be prescribed carefully. Doses begin low and are gradually increased. The drug I was prescribed, though generally well-tolerated, can cause side effects. And patients should be warned not to discontinue the medication suddenly to avoid serotonin storm (headaches, nausea, etc). The site prescribed topical and vaginal estrogen to me despite my history of breast cancer. While topical estrogen applied vaginally (or gradually released through an inserted ring) has been studied at length and declared safe for patients with a history of estrogen receptor positive breast cancer, the combination with additional topical estrogen has not. And the degree of absorption will depend upon the surface area and amount of product applied.  

Ah! Finally, a bottom-line: It may come as no surprise, but your wisest course of action would be to discuss with your doctor whether any hormone-containing cream is a healthy choice for you and not to assume that an unchecked topical hormone therapy is without risk.

I thought of something else after reading a study Waldorf sent me. Though hormone creams may work to reduce fine lines and wrinkles and improve skin texture, vitamin A derivative retinoids have been proven to do the same. As Waldorf says, sunscreen and retinoids continue to hold their place at the top of the pyramid for treating photoaging and aging skin.

Still with me?

As for Emepelle’s MEP technology: MEP stands for methyl estradiolpropanoate, a non-hormone estrogen receptor stimulator. Waldorf explains that though MEP stimulates estrogen receptors in the skin, it’s deactivated in the bloodstream. Is it worth the $98-$195 price tag? Though the product has a different effect than a simple moisturizer, whether you’ll see anything clinically different on your face depends on your skin condition. Which reminds me of a wise remark dermatologist Estee Williams made once about in-office skincare devices, in general: The less they have to do, the better they work.

For me, that means what continues to make most sense is a drugstore moisturizer, sunscreen, and a prescription-strength retinoid.

A Moment of Personal Horn-Blowing

HNTFUYF was recently included in a roundup of the “23 Best Health and Wellness Newsletters of 2023” by the (what else?) health and wellness website Ness. Thanks, Ness, and thanks to all you HNTFUYF-ers for inspiring me with your thoughtful questions and comments. xo

Serious about selling you kinder self-regard.

HNTFUYF, a Payola-Free Zone

Readers, a few of you have asked if I get a cut from sales when I mention a product. I do not. I only mention products I’d like to buy myself, and therefore think you might like, too. I share this so you know my recommendations are offered without obligation.

Val Asks You

Don’t be shy! What’s your most vexing or intractable appearance issue? Send your beauty-related questions to valeriemonroe@substack.com. If I don’t have a good answer, I’ll find someone who does.