Each month, we filter the noise in women's health and longevity. First up: collagen, menopausal skin, hair loss, and which treatments actually hold up.

As we celebrate our clinic’s first anniversary, women’s health, especially in midlife, is finally getting more of the attention, research, and investment it deserves. The upside is more information and more solutions. The downside? A lot more noise. Between a growing chorus of experts and influencers, an endless stream of new products, and AI making health content easier than ever to create and distribute, the volume keeps rising. Every day brings another supplement to take, device to buy, food to avoid, or wellness practice to add to your list. 

We see our role as making that list shorter. Each month, we’ll edit down what’s happening across women’s health and longevity and share our evidence-based perspective on what’s worth your attention and what’s probably not. Think of it as one less thing for you to figure out. 

We bring this same rigor to the care of our members, and now we’re excited to share that perspective with our broader community.  That mission is personal to me: I founded FLI MD to help women step into their power and intuition to balance the world with their wisdom.

Have a question or something you want us to investigate? Send it our way. And if you’re nearby, come by the clinic and say hello.

UNDER THE MICROSCOPE

The women’s longevity topic we’re diving into this month

Few areas in women’s wellness are as oversold as aesthetics. From procedures and products to powders and supplements, there is no shortage of things promising better skin and thicker hair. What makes this category particularly confusing is that the claims often begin with real biology, then extend well beyond what has actually been demonstrated in people.

Collagen is a perfect case study: compelling biology, enormous consumer interest, and far less conclusive clinical evidence. 

Why collagen?

Collagen is a structural protein that gives skin strength and support. We naturally lose collagen as we age, so the idea that by consuming collagen we might “replace” what we lose feels intuitive.

Menopause adds another important layer. Declining estrogen affects collagen production as well as skin thickness, elasticity, hydration, sebum production, and barrier function. These changes help explain why dryness, sensitivity, wrinkling, and loss of firmness can become more noticeable during perimenopause and after menopause.

The magnitude may be meaningful. Observational and histologic studies summarized in a recent review found that skin collagen declined with menopausal age rather than simply chronological age, averaging approximately 2.1% per postmenopausal year over a 15-year period.

Cue the collagen powders, drinks, and gummies. 

The problem? Biological plausibility does not equal demonstrated clinical benefit.

What does the evidence actually say about collagen supplements?

If you look at all the studies together, collagen supplementation can look promising. Some pooled analyses report modest improvements in skin hydration, elasticity, and wrinkles.

But study quality matters.

A 2025 meta-analysis evaluated 23 randomized trials involving 1,474 participants. When all of the studies were pooled, collagen appeared beneficial. But when researchers looked specifically at higher-quality studies or studies without pharmaceutical-industry funding, the apparent benefits disappeared. The authors concluded that there is not currently sufficient clinical evidence to support collagen supplementation for preventing or treating skin aging.

Harvard Health reached a similarly cautious conclusion, noting that many studies are small, test supplements containing multiple ingredients, or lack the quality needed to determine whether collagen itself is responsible for the result. Evidence that oral collagen improves hair growth is even weaker.

That doesn’t mean collagen supplements do nothing. It means “some studies show…” is very different from “this has been proven to work.”

So what does work at home?

Rather than focusing primarily on replacing collagen, we prefer to protect the collagen you have and stimulate the skin’s own remodeling processes.

Start with sunscreen. There is a reason you’ve heard this advice forever: it works. Next, consider a topical retinoid if your skin tolerates one. Prescription tretinoin remains among the best-studied topical treatments for photoaging and can improve fine wrinkles and other signs of sun damage over time. 

But I don’t tolerate retinoids well, so I went on a search to find the most credible evidence-based substitute. 

That search led me to DefenAge, which may appeal to women looking for a gentler approach. The strongest published study was a multicenter, double-blind, vehicle-controlled trial of 44 women ages 41–71 using the regimen for 12 weeks. Researchers reported statistically significant improvements in several measures of skin appearance, including superficial wrinkles, visible pores, pigmentation, and overall evenness. Biopsies also demonstrated increased epidermal thickness without evidence of increased inflammation or excessive proliferation.

What works in the clinic?

For women looking for more noticeable changes in texture, pigmentation, or fine lines, procedures can stimulate a much stronger remodeling response than skincare alone.

Laser resurfacing creates controlled microscopic injury that triggers wound healing and new collagen formation. Both ablative and nonablative approaches can improve photoaged skin. More aggressive treatments generally produce a larger response with greater downtime, while lighter treatments can be repeated over time for cumulative improvement.

We increasingly think of this as ongoing skin maintenance rather than a one-time aesthetic intervention: protect the skin every day, then periodically stimulate repair and remodeling. 

There is also growing interest in pairing fractional procedures with regenerative products such as exosomes. Early clinical studies—including randomized and split-face trials—have reported possible improvements in recovery, texture, pigmentation, and scar outcomes when exosome preparations were added after laser and microneedling treatments. But this remains an emerging area: products are not standardized, studies are generally small, and the evidence is nowhere near as mature as it is for laser resurfacing itself. Product quality and delivery methods also matter. We source ours from RESILIÉLLE, whose intact exosomes have been validated at Harvard laboratories.

And what about HRT?

This is where women’s skin biology gets particularly interesting.

Skin is highly responsive to hormones, including estrogen. Estrogen receptors are present throughout the skin, and estrogen influences collagen production, hydration, vascularity, elasticity, wound healing, and barrier function.

A 2025 narrative review found that multiple studies associate menopausal hormone therapy with improvements in collagen content, epidermal and dermal thickness, elasticity, hydration, and sebum production. Some studies have reported large effects, although results across trials have not been consistent.

This is an exciting area, but an important distinction matters: there is not currently enough evidence to recommend menopausal hormone therapy solely as a treatment for aging skin.

For women already considering hormone therapy for established indications such as menopausal symptoms or bone protection, however, improved skin quality may be a meaningful secondary benefit. The lack of definitive guidance here reflects, at least in part, how little rigorous research has historically been devoted to menopause and skin.

Healthy hair aging starts with the scalp

We tend to focus on the hair we can see. But hair health also depends on what is happening underneath it.

With age and hormonal change, susceptible hair follicles can gradually miniaturize, spend less time in their active growth phase, and produce progressively finer, shorter hairs. At the same time, the environment surrounding the follicle may change.

Research increasingly implicates inflammation, oxidative stress, and alterations in the follicular microenvironment in androgenetic or female-pattern hair loss, alongside genetics and androgen signaling.

That makes scalp health more than a cosmetic issue.

Treat dandruff, seborrheic dermatitis, and significant inflammation rather than ignoring them. Keep the scalp clean enough to avoid excessive sebum, scale, and product buildup. I used to think washing my hair less frequently would help with thinning. But one controlled study found that frequent shampooing, including daily washing, did not objectively damage hair in the population studied and produced better scalp measures than very infrequent washing. I’m tapering back my excessive use of dry shampoo as a result!

There is even early randomized evidence that improving scalp barrier function and reducing oxidative stress may reduce shedding.

Most importantly, new or progressive hair loss deserves an actual diagnosis. Hormonal changes, thyroid disease, nutritional deficiencies, medications, telogen effluvium, and inflammatory or scarring scalp disorders can all look like “thinning hair” but require very different approaches.

What actually works for female-pattern hair loss?

For true female-pattern hair loss, topical minoxidil remains one of the best-supported first-line treatments. In a 48-week randomized trial of 381 women, both 2% and 5% topical minoxidil improved objective measures of hair growth compared with placebo, with 5% performing better on several outcomes.

Low-level red light therapy is another legitimate option with clinical evidence behind it—not simply a wellness trend. A 2025 systematic review and meta-analysis covering 38 studies and more than 3,000 participants found significantly greater increases in hair density with low-level laser or LED therapy versus placebo among people with androgenetic alopecia.

PRP also has supportive evidence. A 2024 meta-analysis of randomized trials in women found improvements in hair density and thickness, although protocols vary substantially, and other analyses have rated the overall certainty of evidence as relatively low because of study heterogeneity.

These therapies act through different pathways, which is why an individualized combination can make sense. Minoxidil directly supports follicular activity; photobiomodulation influences cellular signaling within the follicle; and PRP delivers a concentrated mixture of platelet-derived growth factors into the follicular environment.

The goal, just as with skin, is consistent support and early intervention rather than waiting until significant structural change has already occurred.

THE FLI MD TAKE

Aesthetics is an area where the newest or most expensive option is not necessarily the most effective.

For skin: protect it, stimulate it intelligently, and treat the specific changes you are trying to improve.

For hair: diagnose the cause, take the scalp seriously, and intervene before significant follicular miniaturization occurs.

And before adding another powder, gummy, serum, or procedure, ask the question we come back to again and again: is there evidence that this works in people, or just a compelling story about why it should?

In aesthetics, the boring answer is often the useful one: protect, treat specifically, start early, and spend your money where the evidence is strongest.

LYNN’S PICKS

What I'm reading, sharing, and bookmarking

Managing Menopausal Skin Changes
A helpful look at how declining estrogen affects collagen, elasticity, and hydration, plus what the research says about hormone therapy and aesthetic treatments.

The Female Edge by Dr. Sara Szal
Her approach to medicine closely aligns with ours, and we recently had the pleasure of welcoming her to the FLI MD clinic for an UltraClear laser treatment.

WHAT WE’RE BUYING

What we're trying, using, and watching closely

REVIAN red light cap: while researching hair-growth treatments, REVIAN caught my attention. The company markets its red light cap as FDA-cleared and supported by a randomized, double-blind trial in people with pattern hair loss. I’ve now used it for about five months, and my colorist has noticed improvement at my crown. It’s an easy 10-minute morning routine, and I wear it while making the kids’ breakfast. They think it’s making me smarter! We now carry REVIAN in the clinic for patients who want to add red light therapy to their hair-health routine. 

DefenAge is part of my morning routine, and its clinical-strength formulation is only available through medical practices. For evenings, I switched from my estradiol patch to a concentrated cream so I could mix it with a topical peptide trio on my face and neck. I'll continue to share more as the data evolves. The evidence on the particular peptides I use isn’t there yet, but I can tell an immediate difference.

ONE SMALL THING

We end every edit with an easy habit you can start today 

Big 6 Lymphatic Drainage: the “Big 6” is a quick, low-lift way to incorporate gentle movement and massage into your day. It may help temporarily reduce puffiness while getting you moving and helping you tune in to your body. Many people don’t know this but your double chin might simply be fluid stuck there due to a stagnant lymph system and a tight neck. Use this video for a demonstration.