3 Hormones compounded hormone cream

Applied transdermally to clean, dry, intact skin (inner forearm, inner thigh, or lower abdomen).

• Rotate sites within the same region to prevent local tissue accumulation.
• Allow ~2 minutes for full absorption before dressing.
• Wash hands thoroughly after application to prevent hormone transfer.
• Apply at the same time each day.

Dosing of all three hormone components is individually prescribed based on clinical symptoms, patient history, and hormonal laboratory results. General principles:

• Begin each component at the lowest effective dose; titrate based on follow-up hormone levels and symptom response.
• For preparations including estrogen in women with an intact uterus, progestogen coverage must be adequate to prevent endometrial stimulation.
• Reassess serum levels of all relevant hormones at 4–6 weeks post-initiation, then every 3–6 months when stable.
• All dosing and therapeutic decisions are prescriber-determined.

• Estradiol: Binds ERα and ERβ; modulates gene networks in bone, vasomotor, cardiovascular, and urogenital tissues.
• Estriol (if included): Weak estrogen with preferential ERβ activity; primary therapeutic role in urogenital and vaginal tissue.
• Progesterone (if included): Binds PR-A and PR-B in endometrium and CNS; opposes estrogenic endometrial proliferation and exhibits neurosteroid (GABA-A modulating) activity via allopregnanolone metabolite.
• Testosterone (if included): Androgen receptor agonist; also aromatizes to estradiol locally; supports libido, muscle, and energy.
• Transdermal route bypasses hepatic first-pass metabolism, reducing hepatic coagulation factor and SHBG effects versus oral administration.

Triple-hormone topical cream formulations are prescribed for complex hormonal deficiency patterns requiring simultaneous replacement of multiple hormones. Common clinical contexts include:

• Surgical or natural menopause with concurrent androgen insufficiency.
• Perimenopause with estrogen, progesterone, and androgen deficiency.
• Complex hormonal optimization strategies under specialist management.

Monitoring recommendations:

• Serum estradiol, progesterone, testosterone (total and free), and DHEA-S as applicable, at 4–6 weeks and then every 3–6 months.
• Endometrial thickness assessment in women on estrogen with an intact uterus.
• Annual review of continued clinical need and risk-benefit assessment per current society guidelines (ACOG, NAMS, Endocrine Society).

Contraindications:

• Estrogen-dependent or androgen-sensitive malignancy.
• Unexplained uterine bleeding.
• Active VTE or thrombophilia (for estrogen-containing preparations).
• Active hepatic disease.
• Hypersensitivity to any component.

Warnings & Precautions:

• Multi-hormone preparations increase complexity of monitoring; each component must be evaluated independently.
• Inadvertent transfer to household members — particularly children — is a meaningful risk with multi-hormone topical preparations.
• Virilization (testosterone) and endometrial hyperplasia (unopposed estrogen) are dose-dependent risks.

Drug Interactions:

• CYP3A4 inducers (rifampin, carbamazepine, phenytoin) reduce hormone levels; CYP3A4 inhibitors increase exposure.
• Testosterone potentiates warfarin; INR monitoring warranted.

Common Side Effects: Application site reactions; breast tenderness (estrogen); acne, hirsutism, clitoral enlargement (testosterone excess); mood variability; bloating.

Store at room temperature (15–25°C), away from direct sunlight, heat, and moisture. Keep tightly sealed. Do not freeze. Keep out of reach of children and unintended household contacts. Use by the beyond-use date labeled by Genesis Compounding per USP <795>.

Why does my cream contain three hormones?

Some patients have simultaneous deficiency of multiple hormonal classes. Combining three hormones into one preparation allows the prescriber to address multiple deficiencies with a single, convenient topical application.

Is this preparation FDA-approved?

No. This is a patient-specific compounded preparation from Genesis Compounding under 503A regulations, and is not FDA-approved. Prescribers should document the clinical rationale for use when FDA-approved alternatives exist.

How do I prevent hormone transfer?

Allow full absorption (approximately 2 minutes), cover the application site with clothing, and wash hands immediately after application. Household members, especially children, should avoid contact with treated skin areas.

What monitoring is required?

Your prescriber will order serum levels for each relevant hormone at 4–6 weeks after initiation or dose change, then at 3–6 month intervals. Endometrial monitoring may also be indicated if the preparation includes estrogen.

Can I adjust any one component on my own?

No. All dose adjustments must be directed by your prescriber based on laboratory results and clinical assessment. Do not alter the prescribed dose without provider guidance.