Salmon Sperm, Facial Estrogen, and What Really Matters for Perimenopausal Skin

In medicine and in life, I’ve never been a trend setter or a trend follower. For the most part, I’ve played by the rules.

And many trends in skincare conflict with rules I’ve lived by and never questioned until now. For example, I generally aim to keep any form of ejaculate off of my face, and yet recently I had PDRN, aka Salmon Sperm DNA, injected into my face in South Korea.

The animal kingdoms are colliding in ways I never anticipated in dermatology, let alone in my skin.

While social media and influencers fuel this Zootopian age of skincare, I find myself wondering why we are venturing into these wilds to begin with, and what is it that we are seeking in these relatively unstudied and uncharted areas?

I know what motivated me. After 45 years of inhabiting my body and navigating challenges like Type 1 Diabetes, I found myself in perimenopause with night sweats, insomnia, bladder spasms, and hormonal acne.

My skincare survival pack that served me well through my 20s and 30s was filled with irrelevant tools: prescription retin-a I no longer tolerated, vials of potent L-Ascorbic acid that broke me out, and gritty exfoliants.

I set out on a quest to understand my body’s new terrain, learning about hormone health and its impact on the skin. My commitment to answering a patient’s question, “Should I put my vaginal estrogen on my face?” led me to a new path in my career to help women revive their skin and hair health in perimenopause with a strategy that made sense.

What I found is that perimenopausal skin isn’t a mystery. It’s a pattern. And once you see the pattern, you can build a strategy around it.

I call this strategy The Core Four, and it’s based on the simple premise of protecting what you have and replacing what you’ve lost. I’ll break it down into what’s changing in your skin in perimenopause, and then give you tools to put your skin back together.

The Core Four revolves around non-hormonal treatments, because it is important to me that a skin care strategy is safe for and accessible to as many women as possible, and incorporating hormones into that narrative currently leaves out many women with breast cancer. Also, facial estrogen is not validated enough yet to earn a place amongst the real heroes like retinoids, antioxidants, hydrators, and sun protection that comprise The Core Four framework.

Understanding the Terrain: Perimenopausal Skin Shifts

This is not the uplifting part, that comes later, but you need to understand the biology to make sense of the mayhem and why you aren’t looking like yourself anymore.

Skin Shift 1: Collagen and Elastin Collapse

In perimenopause, collagen decline is kicking up, and since collagen supports skin structure, wrinkles are one of the results. You’ve been losing 1% per year since age 18-20, and you’ll lose 30% of your collagen within 5 years of hitting menopause and another 2% per year thereafter.

Elasticity goes with it. That magical protein that gives skin its spring and recoil. Without it, your skin hangs limp like the stretchy hand your 9-year-old stuck on her ceiling last year, gradually reaching for the carpet below.

The hormone-mediated loss of skin structure and stretch is now colliding with the more gradual damage from UV exposure, and browns, reds, and deeper lines surface. You’ve been aging your entire life, but perimenopause is now pressing on the accelerator.

Gut leakage, urinary leakage, and now skin leakage. Shifts in lipid composition, skin pH, and increased trans-epidermal water loss accompany estrogen’s erratic perimenopausal decline. Hence, the new burning, redness, and even peeling from products that used to work well for you.

This is also why you’re suddenly oily and dry at the same time. These biologic paradoxes define perimenopausal skin. Whether you were dry or oily your entire life leading up to this point, yesterday’s skin type no longer matters. You are now the owner of combination skin.

Skin Shift 3: The Sins of Your Youth

Tanning beds in high school or college? Blistering sunburns every spring break? Years of letting wine convince you not to wash your face before bed? Skipping sunscreen because of ANY REASON AT ALL? Those choices show up more so now as pigmentation and redness because your skin cell turnover rate is slowing down significantly.

Perimenopausal skin also doesn’t recover as quickly from injury. That could be accidental, like cutting your face while trying to shave your new chin hairs, or intentional, like the laser treatment you tried to get your glow back. You just can’t get away with the things you used to: the third glass of wine, 4 hours of sleep, and not taking care of your skin regularly.

If our 20s and 30s were the decades when we got away with a use-and-abuse approach, midlife is the time to heal and repair. And unlike the inflammation and injuries that showed up overnight, this restoration period takes time.

The Core Four Framework for Perimenopausal Skin

You don’t need a complicated routine. You need the right four targets.

I think about perimenopausal skin care through a simple frame: protect what you have, replace what you’ve lost. Within that, four goals, the Core Four, cover almost everything that matters.

The best thing about the Core Four approach is that you don’t need a prescription or a 14-hour flight to Seoul to start immediately. Products in these categories are inexpensive and readily available over the counter. I bet you even own a few of them and just need a refresher on how to use them.

1. Hydrate

Estrogen decline reduces hyaluronic acid production and weakens the skin’s ability to hold water. The fix is layering: humectants under occlusives. Look for hyaluronic acid and glycerin in a serum applied to damp skin, then seal with a moisturizer containing ceramides, squalane, or shea butter. Apply within 60 seconds of cleansing. The damp-skin step is the single most underrated move in perimenopause skincare, and it costs nothing to add.

When it comes to moisturizer, thicker is not always better. Sometimes it’s just thicker. Crisco is not good for your biscuits or your skin. Remember that you have oily zones as well as dry zones, and you want to tend to both.

2. Stimulate Collagen

A nightly retinoid is the most evidence-backed tool you have. If you’re new to actives, start with over-the-counter retinol or retinal a few nights a week and build up. If your skin tolerates it, prescription tretinoin (typically 0.025-0.05% to start) becomes an option.

Every morning, your SPF needs a sidekick in the form of a vitamin C serum to enhance protection from UV and environmental pollution. THD (tetrahexyldecylascorbate) products are often gentler than L-ascorbic acid while still delivering antioxidant protection and collagen support.

This is also the section that may lead you to having salmon DNA propelled into your pores. PDRN, peptides, and exosomes are the exotic creatures of the skincare world. They may make your collagen-building efforts more successful, but they’ll definitely make it more fun to talk about at dinner.

This is also where in-office options like microneedling, radiofrequency, lasers, and biostimulators live, but they amplify a good routine. They don’t replace one.

Daily broad-spectrum SPF 30 or higher, every morning, every season. Rain or shine. Inside or outside. Today, tomorrow, and forever.

This is non-negotiable. If you aren’t going to commit to this, you’re better off burning money than spending it on skincare.

SPF helps prevent skin cancer, collagen loss, elastin breakdown, and discoloration. It protects you from the increased sun sensitivity that your very important retinoid introduces. If you do nothing else, wear SPF every day.

4. Support the Barrier

Simplify. Cleanse morning and night with a non-foaming, pH-balanced cleanser. Use your gritty exfoliants on your feet, knees, and elbows, or just throw them away.

Use ceramide-based moisturizers morning and night. Introduce actives slowly and never stack them on irritated skin. When in doubt, skip a night and let the barrier rebuild. Restraint is a treatment in this stage of life.

If you experience a breakout, don’t turn to the pubertal creatures coinhabiting your space for help. Leave their zit creams alone.

Hormonal acne in perimenopause responds to azelaic acid, gentle salicylic acid, and sometimes prescription help. Do not use benzoyl peroxide or medicated pimple patches on inflamed skin.

The Frame

Replace what you’ve lost with hydrators and collagen builders. Protect what you have with sun protection and barrier support. Together, they cover almost everything that matters in perimenopausal skin.

You don’t need ten products. You need four goals, and a routine that serves them.

The Question You Came Here With: But What About Topical Estrogen?

Since estrogen decline contributes to drier skin, loss of collagen, impaired skin barrier, slower healing, and sluggish skin cell turnover, I completely understand the optimism behind fixing all of these problems with a cream that’s already restored your vaginal area to prime time.

The excitement around estrogen has certainly outpaced the clinical data. Women are simply tired of waiting years for data to prove something that feels intuitive. After all, the last billion-dollar randomized clinical trial on women’s hormone health gave the medical profession and a generation of women a very misguided compass that stopped hormone therapy and just told us to sweat through it, try not to break a hip, and enjoy spending 30 years in adult diapers. Trust has been lost.

We do have sufficient safety data on topical estrogen for the vulvovaginal area, where I feel comfortable with the majority of women using “a little” on their face. Studies are needed to better define dosage, systemic absorption thresholds, and to more objectively show if this really helps facial skin as it does the genitourinary tissues.

I do prescribe and recommend facial estrogen for some patients, and I use it myself. But at this point, I see it as an add-on and not a foundational part of perimenopausal skin health. That may change. But as long as you adhere to the Core Four, you aren’t missing out on an opportunity to optimize your skin health.

On safety: I don’t recommend off-label facial estrogen for women with estrogen receptor-positive cancer or melasma. The first case isn’t worth the risk until we have more data, and there are many more studied and effective things to try. You aren’t missing out. As for melasma, that’s a difficult pigmentation issue to treat, and estrogen can serve as fuel to that fire.

We will get there. Until then, the Core Four is doing more for your skin than any cream you can compound or borrow from your vagina.

You’ve Been Training for This

Perimenopause presents a fresh new hell for a lot of women. It’s where middle school and middle age appear together as chest acne and chin hairs. But unlike 7th grade, when you didn’t know what was happening, you enter the hormone chaos of perimenopause with experience and wisdom. Thanks to many women physicians and advocates, you also enter it with guidance.

It’s not the first time your body has changed due to hormones in unfamiliar ways. You survived puberty with a copy of “What’s Happening To Me” and a stash of canoe-sized maxi pads that required larger pants.

You have a muscle memory for this. As a woman, you’ve inhabited paradoxical realities your entire life. Adolescence and adulthood. Daughter and mother. This new dichotomy of combination skin with Sahara cheeks and Belizean rainforest nose is nothing compared to where you’ve already been.

You’ve also learned that change is the one thing we can always count on. Whether we are talking about our retinoids or relationships, we have learned to step back, reflect, repair, and at times, replace.

I wear a bracelet every day with a Rumi quote: Let us rather not be sure of anything. This helps me remember to stay flexible in my mindset and strategy.

Because after all, sometimes when we are in South Korea or other very specific circumstances, some amount of sperm on the face isn’t the worst idea.