5+ Hormones compounded hormone cream

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

• Rotate sites systematically to minimize local accumulation and support consistent absorption.
• Allow full absorption (~2 minutes) before dressing.
• Wash hands thoroughly after every application.
• Apply at the same time daily to minimize hormonal fluctuation.

Given the complexity of five or more hormonal components, dosing is entirely prescriber-determined and requires careful individualization:

• Each component is prescribed at the lowest effective dose and titrated based on serum measurements and clinical response.
• Serum hormone panel (estradiol, progesterone, testosterone [total and free], DHEA-S, pregnenolone, SHBG) should be measured at baseline, 4–6 weeks after initiation, and every 3–6 months when stable.
• For women with intact uteri, progesterone dosing must be sufficient to prevent endometrial stimulation from unopposed estrogen.
• Regular reassessment of the clinical necessity of each component is recommended as hormonal needs may change over time.

• Estradiol: ERα/ERβ nuclear receptor agonist regulating reproductive, cardiovascular, and skeletal gene networks.
• Estriol: Preferential ERβ agonist with primary urogenital effects and weaker systemic stimulation.
• Progesterone: PR-A/PR-B agonist opposing estrogenic endometrial effects; allopregnanolone metabolite positively modulates GABA-A receptors.
• Testosterone: Androgen receptor agonist with direct and aromatized (via CYP19) estrogenic activity; regulates libido, lean mass, and mood.
• DHEA: Adrenal androgen precursor; converted peripherally to testosterone and estrogens by tissue-specific enzymes; may independently activate DHEA receptors on endothelium and immune cells.
• Pregnenolone: The primary substrate in the steroidogenic cascade, converted to progesterone, DHEA, and other steroid hormones; also acts directly as a neurosteroid modulating GABA and NMDA receptor activity.

Formulations with five or more hormones represent the most individualized tier of compounded hormonal therapy and are typically prescribed by specialist practitioners (endocrinologists, gynecologists, integrative medicine physicians) for patients with documented multi-axis hormonal deficiency. Prescribers should:

• Establish clear evidence of deficiency (laboratory documentation) for each hormone component prior to prescribing.
• Document the clinical rationale for use of a compounded preparation when FDA-approved alternatives exist for any individual component.
• Monitor for cumulative interactions among all components (androgenic, estrogenic, progestogenic, and neurosteroid effects).
• Reassess the need for each component at least annually.
• Per ACOG 2023 guidance: compounded hormone therapy should be reserved for cases with clear clinical justification and patient-informed consent regarding uncharacterized risks.

Contraindications:

• Any estrogen-dependent or androgen-sensitive malignancy.
• Unexplained uterine bleeding.
• Active or prior VTE (for estrogen-containing formulations).
• Active liver disease.
• Hypersensitivity to any component.

Warnings & Precautions:

• Inadvertent transfer to household members (especially children and pregnant partners) is a major safety concern with high-component preparations; strict hygiene protocols are mandatory.
• Complexity of multi-hormone regimens increases monitoring burden and the risk of undetected hormone excess in any one component.
• DHEA at supraphysiologic doses has been associated with androgenic adverse effects in women (acne, hirsutism).
• Long-term multi-hormone therapy lacks the long-term safety data available for individual FDA-approved hormone products.

Drug Interactions:

• CYP3A4 inducers/inhibitors affect circulating levels of all steroidal components.
• Testosterone potentiates warfarin; INR monitoring is warranted.
• DHEA may interact with triazolam, carbamazepine, and SSRIs.

Common Side Effects: Application site reactions; breast tenderness (estrogen); acne, hirsutism, voice change, clitoromegaly (androgen excess); insomnia; mood variability; bloating.

Store at room temperature (15–25°C), away from heat, light, and humidity. Keep tightly sealed. Do not freeze. Store out of reach of children and household members who are not the intended patient. Use by the beyond-use date assigned by Genesis Compounding per USP <795>.

Why does my prescription include five or more hormones?

When laboratory testing reveals deficiency across multiple hormonal axes simultaneously, a clinician may prescribe a multi-component preparation to address all deficiencies efficiently. Each hormone in the formulation serves a specific physiological role that has been identified as insufficient for you.

Is this preparation FDA-approved?

No. This is a patient-specific, prescriber-directed compounded preparation from Genesis Compounding under 503A regulations. It is not FDA-approved. Your prescriber has determined that this compounded option is clinically appropriate for your individual needs.

What monitoring is required?

A comprehensive hormonal panel should be checked at baseline and 4–6 weeks after initiation or dose change, then every 3–6 months. Endometrial surveillance and regular clinical review are also recommended.

How do I protect my family from exposure?

Apply the cream to covered body areas, allow full absorption, cover with clothing immediately, and wash hands. Keep treated body surfaces away from children and others, especially in the hours after application.

Can components be removed or reduced over time?

Yes. As hormonal needs evolve, the prescriber may simplify the regimen by reducing or eliminating individual components. Annual reassessment of the necessity of each hormone is recommended best practice.