4 Hormones compounded hormone cream

Applied transdermally to clean, dry, intact skin on the inner forearm, inner thigh, or lower abdomen.

• Rotate application sites within the designated region.
• Allow ~2 minutes for absorption before covering with clothing.
• Wash hands immediately after application to prevent inadvertent hormone transfer.
• Apply at the same time each day for consistent systemic levels.

All four hormone components are individually dosed and are entirely prescriber-determined based on patient symptoms, clinical history, and hormonal laboratory values.

• Each component is initiated at the lowest effective dose and titrated based on follow-up serum hormone levels and symptom response.
• Serum levels of each hormone (estradiol, estriol, progesterone, testosterone — as applicable) are measured at 4–6 weeks after initiation or dose change, then every 3–6 months when stable.
• In women with intact uteri receiving estrogen, adequate progesterone dosing for endometrial protection must be confirmed.

• Estradiol: Binds ERα and ERβ; drives transcriptional regulation of vasomotor, skeletal, and cardiovascular gene networks.
• Estriol: Preferentially activates ERβ; exerts primary effects on urogenital epithelium with weaker systemic estrogenic stimulation.
• Progesterone: Activates PR-A and PR-B; opposes endometrial proliferation and produces neurosteroid metabolites (allopregnanolone) that modulate GABA-A receptors, influencing mood and sleep.
• Testosterone: Activates androgen receptors directly; aromatizes to estradiol in peripheral tissues; contributes to libido, energy, and lean body mass maintenance.

Four-hormone topical cream formulations address complex, multi-axis hormonal deficiency and are used under specialist management for:

• Surgical menopause with androgen, estrogen, and progestogen deficiency.
• Natural menopause with concurrent sexual function, sleep, and vasomotor symptom burden requiring multi-hormone replacement.
• Individualized hormonal optimization protocols under the guidance of endocrinologists, gynecologists, or experienced practitioners.

Monitoring:

• Serum estradiol, progesterone, testosterone, DHEA-S, and SHBG at 4–6 weeks post-initiation; endometrial surveillance as indicated.
• Annual clinical reassessment of continued need and risk-benefit balance per ACOG and NAMS guidelines.
• Compounded preparations are not required to demonstrate pharmacokinetic consistency equivalent to FDA-approved products; document clinical rationale.

Contraindications:

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

Warnings & Precautions:

• Highest inadvertent transfer risk among multi-hormone preparations — rigorous hygiene protocols are essential.
• Monitor each hormonal component individually for signs of excess or deficiency.
• Long-term use requires ongoing surveillance for hormone-sensitive conditions (breast, endometrial, prostate pathology).

Drug Interactions:

• CYP3A4 inducers/inhibitors alter circulating levels of all steroidal components.
• Testosterone may enhance warfarin anticoagulant effect; monitor INR.

Common Side Effects: Application site irritation; breast tenderness (estrogen); acne, hirsutism, voice change at supratherapeutic testosterone levels; mood changes; bloating.

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

Why does this cream contain four hormones?

Some patients have simultaneous deficiency across multiple hormone axes requiring comprehensive replacement. A single preparation with four components simplifies administration while addressing multiple physiological needs.

Is this preparation FDA-approved?

No. This is a patient-specific, prescriber-directed compounded preparation from Genesis Compounding under 503A regulations. FDA-approved options should be considered first where they exist; compounded preparations are an individualized alternative when clinically justified.

How do I prevent exposure of household members to this cream?

Allow full absorption, cover the site with clothing immediately after application, and wash hands thoroughly. Avoid skin contact between others and treated areas, especially children and pregnant individuals.

What monitoring is needed?

Your prescriber will order serum levels for all four hormonal components at 4–6 weeks after starting or changing doses, then every 3–6 months when stable. Endometrial monitoring may also apply.

Can any component be adjusted independently?

Yes, but only by the prescribing clinician based on laboratory results and clinical assessment. Never adjust or skip any component without prescriber guidance, as hormonal balance depends on the interplay of all four components.