How Progesterone and DHEA Levels May Drive Psoriasis

• The study revealed a consistent hormonal imbalance — The population included women with psoriasis matched to women without psoriasis, all averaging about 46 years old. The standout finding was that women with psoriasis had lower progesterone and lower DHEA, while estradiol and testosterone were nearly identical between groups.

• Those with psoriasis had significantly lower progesterone — Progesterone averaged 7.59 ng/mL in the psoriasis group compared with 9.4 ng/mL in controls.² Progesterone helps calm your immune system, so when it drops, your inflammatory pathways fire harder and more often.

• DHEA levels also dipped — DHEA — a hormone that supports metabolic flexibility, resilience, and immune balance — measured at 144.9 ug/dL in women with psoriasis, whereas controls averaged 150.7 ug/dL. Even small declines matter because DHEA influences how your body handles stress and inflammation.

• How progesterone and DHEA influence immunity — Progesterone tempers inflammatory immune cells and slows down the overactive pathways that drive plaques. When levels fall, your immune system becomes more reactive, and your skin responds with redness, itching, and rapid cell turnover. DHEA supports stress adaptation, so lower levels leave you more vulnerable to inflammation triggered by stress, lack of sleep, or hormonal shifts.

• The hormonal shifts suggest a predictable biological chain reaction — When progesterone drops relative to estrogen, your ratio changes — meaning your body feels the effects of estrogen more strongly, even if your estrogen level is normal. This shift heightens immune sensitivity, fuels inflammation, and makes psoriasis symptoms break through more easily. Lower DHEA amplifies the effect by weakening your metabolic resilience under stress.

• Symptoms that don’t match your hormone labs finally make sense — Many women with autoimmune symptoms show “normal” estrogen in bloodwork even though their bodies behave as if estrogen is overpowering. This mismatch happens because intracellular estrogen — the estrogen stored inside tissues — isn’t reflected in standard labs. This explains why your symptoms feel out of sync with what your test results show.

• Your progesterone-to-estrogen ratio tells the real story — According to Dinkov, estrogen dominance isn’t about high estrogen. It’s about estrogen being strong relative to progesterone. When progesterone drops, estrogen’s signal intensifies inside your tissues even if blood levels look normal. As he noted, “blood tests for estrogen are notoriously unreliable,” because they fail to measure the estrogen that drives inflammation inside your cells.

Estrogen inside the cell acts as a pro-inflammatory signal, and without enough progesterone to balance it, immune cells react more aggressively. The predictable outcome is stronger immune activation and more intense skin symptoms when progesterone and DHEA both fall.

• Stress, low thyroid function and poor metabolism push your body toward more inflammation — Dinkov outlined how chronic stress, low thyroid output and slowed metabolism lower both progesterone and DHEA, removing the two strongest hormonal brakes on immune overactivation. When these internal buffers fall, flare-ups intensify.

• Low DHEA links psoriasis to a broader autoimmune landscape — Low DHEA is common in autoimmune disorders and DHEA supplementation improves symptoms in people with the chronic autoimmune disease lupus. This shows that hormonal imbalance isn’t a minor background issue — it actively shapes how your immune system behaves and how intensely your symptoms show up.

• Women’s symptom patterns reveal a clear hormonal fingerprint — The population discussed included women living with chronic psoriasis who experience fluctuating symptoms depending on their hormonal status. Estrogen and progesterone shifts influence not only the inflammation in the skin but also the emotional and social challenges these women face.

• Pregnancy often becomes a natural period of remission — During pregnancy, estrogen climbs much higher, and these elevated levels often lead to symptom relief. Some women experience full remission in the second or third trimester. Pregnancy shifts the immune system toward a calmer, less inflammatory pattern, which explains why your skin quiets down.

• The postpartum crash sets the stage for intense flare-ups — After childbirth, estrogen drops rapidly, and this sudden decline is a major trigger for severe postpartum flare-ups. This period also includes sleep disruption, emotional stress, and physical recovery, which amplify inflammation. Postpartum hormone shifts often trigger severe flare-ups, validating why this phase feels overwhelming and difficult to manage for many mothers.

• Hormonal shifts ripple into emotional and social well-being — Beyond the physical symptoms, hormonal fluctuations influence mood, stress tolerance and body image. These emotional shifts interact with skin symptoms to create a cycle where flare-ups increase stress and stress reinforces inflammation.

• The incidence of psoriasis increased steadily as HRT duration increased — The baseline group with no HRT had an incidence rate of 3.36 cases per 1,000 person-years. Women using HRT for under two years reached 3.75 cases per 1,000 person-years, those using HRT for two to five years reached 4.00 cases, and women using HRT for five or more years reached 4.09.

This progressive rise showed a clear dose–response pattern, meaning longer HRT use consistently tracked with higher psoriasis development.

• HRT use — especially long-term use — elevated psoriasis risk — After controlling for age, smoking, alcohol intake, exercise, body mass index, diabetes, high blood pressure, and dyslipidemia, the relationship held firm. Long-term HRT made psoriasis development 22% more likely compared to women who never used it.

• Hormone therapy revs up your immune system in a way that increases inflammation — The study showed that HRT makes certain immune cells — called T-cells — multiply faster, which turns up your body’s inflammatory response.

It also raises markers like C-reactive protein and boosts one of the main inflammatory chemicals involved in psoriasis. When all of these signals increase at the same time, your immune system becomes more “on edge,” making psoriasis more likely to flare in women whose hormones are already shifting with age.

• Timing and age affect estrogen’s impact on inflammatory diseases — Estrogen has both anti-inflammatory and pro-inflammatory effects depending on the stage of life. In younger women, estrogen typically suppresses inflammation. But in post-menopausal women — especially those older than 58 in this study — estrogen given through HRT interacts with a pre-existing inflammatory environment.

This timing effect mirrors what happens in other diseases such as lupus and atherosclerosis, where estrogen exposure in later life raises inflammation rather than quieting it. The study highlighted previous research connecting HRT to elevated risks of lupus, cardiovascular disease, and vessel-wall inflammation. These conditions share immune pathways with psoriasis, which helps explain why extended HRT use aligns with higher psoriasis incidence.

1. Optimize your progesterone-to-estrogen ratio through targeted lifestyle changes — In the case of female hormones, the progesterone-to-estrogen ratio is a key indicator of endocrine health. For optimal health, this ratio should ideally be quite high, in the range of 200 to 500. A ratio below 100 is typically considered indicative of estrogen dominance, a state associated with various health problems, including increased risk of hormone-sensitive cancers.⁶

Many people believe they’re low in estrogen due to bloodwork, when they actually have high levels in their organs. This is because serum estrogen levels are not representative of estrogen that’s stored in tissues. Estrogen is often low in plasma but high in tissues. Prolactin levels serve as a reliable indicator of estrogen activity, as estrogen directly stimulates your pituitary gland to produce prolactin.

When prolactin levels are elevated, it signals increased estrogen receptor activation, whether from your body’s own estrogen production or environmental exposures to endocrine-disrupting chemicals (EDCs) in microplastics and other pollutants. This relationship is particularly significant when combined with low thyroid function, making prolactin an important marker for identifying hormonal imbalance.

2. Reduce your estrogen load by removing hidden estrogen-mimicking triggers from your daily life — Lowering your overall estrogen burden starts with clearing out the biggest sources that push you toward estrogen dominance — a pattern deeply tied to psoriasis flare intensity. Begin by eliminating seed oils from your diet, since they’re high in linoleic acid (LA) that acts like estrogen inside your body and disrupt hormonal balance.

This step also naturally steers you away from ultraprocessed foods — a major dietary trigger linked to psoriasis. Aim to keep your LA intake under 5 grams per day, ideally under 2 grams. When my Mercola Health Coach app launches, the Seed Oil Sleuth feature will help you track this down to the tenth of a gram.

At the same time, clean up your environment. Xenoestrogens — chemicals that mimic estrogen — hide in personal care products, household cleaners, microplastics and fragrances. Choose natural products, avoid parabens and phthalates, switch to glass or stainless steel, and avoid heating food in plastic. Filter your tap water to reduce microplastic exposure, and choose glass if you buy bottled water.

Finally, take a thoughtful look at estrogen-based therapies or contraceptives you’re using, because external estrogen — even bioidentical forms — adds to your total estrogen load. By removing dietary, environmental and pharmaceutical sources of estrogen pressure, you create a hormonal environment that supports calmer immune activity and more predictable psoriasis patterns.

3. Support your DHEA levels by strengthening your stress resilience — If you live with high stress, your DHEA drops sharply, and your immune system becomes louder. Build simple daily rituals that calm your stress load: slow breathing for two minutes several times a day, regular outdoor walks, and a consistent bedtime routine. These strengthen the metabolic pathways tied to DHEA production, which leads to calmer skin and fewer flare triggers.

4. Optimize your vitamin D levels — People with psoriasis consistently have lower vitamin D levels — averaging 6.26 ng/mL less than healthy individuals — and more severe plaques.⁷ Safe sun exposure helps restore levels, but if you still eat seed oils, be aware that LA oxidizes easily, builds up in your skin and increases your risk of skin damage if you get sun exposure during peak hours (10 a.m. to 4 p.m.).

Cut these oils from your diet for at least six months before getting peak sun exposure. Get your vitamin D levels tested at least twice a year and aim for a level between 60 and 80 ng/mL (150 to 200 nmol/L).

5. Consider natural progesterone — Natural progesterone is one of the most effective ways to increase levels and steady estrogen’s effects, especially when estrogen feels too strong compared to the rest of your hormones — a pattern strongly linked to psoriasis flare-ups.

When progesterone is low, your tissues feel estrogen more intensely, which ramps up inflammation in your skin and makes plaques itchier, redder and harder to control. By restoring progesterone, you balance this internal “see-saw,” reducing the hormonal pressure that keeps your immune system on high alert.