Application Sites for Bioidentical Hormone Cream
Bioidentical hormone cream should be applied to areas with thin skin and good blood supply, primarily the inner arms, inner thighs, lower abdomen, or upper chest, while avoiding areas with lipodystrophy or skin conditions. 1
Recommended Application Sites
Primary Sites (Most Effective)
- Inner arms: Middle third posterior aspect of the upper arm
- Inner thighs: Upper third anterior lateral aspect of both thighs
- Lower abdomen: 2 adult fingerbreadths away from the umbilicus
- Upper chest: Below the clavicle (avoid breast tissue)
Secondary Sites
- Buttocks: Posterior lateral aspect of both upper buttocks and flanks
Application Technique
Skin preparation:
- Ensure the application site is clean and dry
- Allow any alcohol-based cleansers to fully evaporate before application
- Avoid applying to broken, irritated, or infected skin
Application method:
- Apply a thin, even layer using fingertips
- Gently massage until absorbed
- Wash hands thoroughly after application
- Allow cream to dry completely before covering with clothing
Rotation protocol:
- Change application sites regularly to prevent skin irritation
- Rotate between recommended sites systematically
- Avoid using the same site more than once per week
Important Considerations
Safety Concerns
- Avoid transfer to others: After application, ensure the area is completely dry before skin-to-skin contact with others 1
- Avoid breast tissue: Do not apply directly to breast tissue due to potential concentration of hormones in this area
- Avoid lipodystrophy: Do not apply to areas with abnormal fat distribution 1
Efficacy Factors
- Absorption varies by site due to differences in skin thickness and blood supply
- Transdermal formulations may be preferred over oral formulations due to lower rates of venous thromboembolism and stroke 1
- Room temperature application is recommended as cold cream may have reduced absorption
Cautions and Contraindications
- Contraindicated in survivors with history of hormonally mediated cancers 1
- Use with caution in patients with:
- Coronary heart disease
- Hypertension
- Current smokers
- Increased genetic cancer risk 1
Evidence Quality and Limitations
The recommendations for application sites are primarily derived from guidelines for hormone therapy administration. It's important to note that custom compounded bioidentical hormones are not recommended by major medical organizations because data supporting claims that they are safer and more effective than standard hormones are lacking 1. The FDA has not approved any type of bioidentical hormone therapy for the prevention of chronic diseases in postmenopausal women 1.
Studies show that currently used doses of compounded hormones yield lower levels of estrogen compared to standard-dose estradiol patches 2, suggesting inconsistent absorption and bioavailability.