2 Hormones compounded hormone cream

Applied transdermally to clean, dry, intact skin. Common application sites include the inner forearm, inner thigh, or lower abdomen.

• Rotate application sites within the same general region to minimize local irritation.
• Allow approximately 2 minutes for the cream to be absorbed before covering with clothing.
• Wash hands immediately after application to prevent inadvertent transfer to others.
• Apply at the same time daily to maintain consistent hormone levels.

Dosing of both hormones is entirely individualized and prescriber-determined based on patient-specific symptoms, hormone levels, and therapeutic goals.

• Initiate at the lowest effective combined dose and titrate each component based on follow-up lab values and clinical response.
• Reassess hormone levels (serum estradiol, progesterone, testosterone, as applicable) 4–6 weeks after initiation or dose adjustment.
• For estrogen-containing combinations with intact uterus, concurrent progestogen (including progesterone) is required to protect the endometrium from unopposed estrogenic stimulation.
• The prescriber determines the dose, frequency, and duration of all hormone components.

• Estradiol (if included): Binds ERα and ERβ nuclear receptors, modulating gene transcription in target tissues including bone, cardiovascular, central nervous system, and urogenital tract.
• Progesterone (if included): Binds progesterone receptors (PR-A and PR-B) in the endometrium and other tissues, opposing the proliferative effects of estrogen on the endometrium and exerting neurosteroid activity.
• Testosterone (if included): Binds androgen receptors and — via CYP19 aromatization — contributes to local estradiol; supports libido, body composition, and energy.
• Transdermal delivery of all components bypasses hepatic first-pass metabolism, potentially reducing effects on hepatic coagulation factors and sex hormone-binding globulin (SHBG) production compared with oral routes.

A two-hormone topical cream is commonly prescribed for:

• Menopausal hormone therapy (MHT): Combined estrogen + progestogen for symptomatic peri- or postmenopausal women with an intact uterus.
• Female androgen insufficiency: Estrogen + testosterone for postmenopausal women with hypoactive sexual desire disorder or androgen deficiency symptoms.
• Male hormonal support: Combinations such as testosterone + DHEA or other hormonal precursors under prescriber direction.

Monitoring:

• Serum hormone levels for each component at 4–6 weeks, then every 3–6 months once stable.
• Endometrial assessment for women receiving estrogen; uterine protection requires adequate progestogen exposure.
• Per ACOG 2023 guidance, compounded hormone therapy should not be prescribed routinely when FDA-approved options exist; documentation of clinical rationale is recommended.

Contraindications:

• Known or suspected estrogen-dependent or androgen-sensitive malignancy.
• Undiagnosed abnormal uterine bleeding.
• Active or prior venous thromboembolism (for estrogen-containing preparations).
• Active hepatic disease.
• Hypersensitivity to any component.

Warnings & Precautions:

• Skin transfer risk to children and partners; advise proper application and hygiene.
• Monitor for signs of hormone excess (virilization with testosterone, endometrial hyperplasia with unopposed estrogen).
• Compounded preparations lack the standardized pharmacokinetic data of approved products.

Drug Interactions:

• CYP3A4 inducers and inhibitors may alter circulating hormone levels.
• Testosterone may potentiate anticoagulant effects of warfarin.

Common Side Effects: Application site irritation; breast tenderness and bloating (estrogen); acne, oily skin, and hirsutism (testosterone at high levels); mood changes.

Store at room temperature (15–25°C), protected from heat, direct light, and moisture. Keep tightly closed. Do not refrigerate unless directed. Keep out of reach of children and unintended contacts. Use by the beyond-use date labeled per USP <795> standards.

Why are two hormones combined in one cream?

Combining two hormones into a single preparation improves patient convenience and allows both components to be applied simultaneously, supporting consistent adherence to therapy. The prescriber selects the combination based on the patient's specific hormonal needs.

Is this preparation FDA-approved?

No. This is a patient-specific, prescriber-directed compounded preparation from Genesis Compounding, regulated under 503A compounding pharmacy standards, and is not FDA-approved.

How do I prevent transferring the hormone to others?

Allow the cream to absorb for at least 2 minutes, cover the site with clothing, and wash hands thoroughly. Avoid skin contact with partners or children at the application site, especially while the cream is still visible.

How often are labs checked?

Your prescriber will typically check relevant hormone levels 4–6 weeks after starting or changing the dose, then every 3–6 months once your levels are stable.

What happens if I miss a dose?

Apply the missed dose as soon as possible, unless it is nearly time for your next scheduled dose. Do not double-apply. Maintain a consistent daily schedule for optimal hormone levels.