Can a patient apply a combination of biestrogen (estrogen), progesterone, and testosterone to the face?

Facial Application of Compounded Hormone Creams

No, patients should not apply compounded biestrogen/progesterone/testosterone creams to the face. There is no evidence supporting facial application of these hormone combinations, and this practice carries significant risks including acne exacerbation, skin irritation, and unintended systemic absorption with potential adverse effects.

Why Facial Application Is Not Recommended

Lack of Evidence and Approval

• No guidelines or FDA-approved formulations exist for applying compounded hormone combinations (biestrogen/progesterone/testosterone) to facial skin 1
• Hormone replacement therapy formulations are designed for application to specific body sites (lower abdomen, upper buttocks, back, or upper arms) where absorption is predictable and controlled 2

Risk of Acne Development

• Testosterone application to the face would likely worsen or trigger acne, as androgens are a primary driver of acne pathogenesis through increased sebum production and follicular hyperkeratinization 1
• Hormonal acne treatment guidelines specifically recommend anti-androgenic therapies (like spironolactone or combined oral contraceptives), not topical androgens 1
• The American Academy of Dermatology guidelines emphasize that hormonal agents for acne work by reducing androgen effects, not increasing them 1

Unpredictable Absorption and Safety Concerns

• Facial skin has different absorption characteristics than approved application sites, leading to unpredictable systemic hormone levels 2, 3
• Combined estrogen/progesterone therapy carries cardiovascular and thrombotic risks that increase with uncontrolled dosing 1, 2, 4
• The face's rich vascular supply could lead to excessive systemic absorption compared to recommended application sites 2

Approved Application Sites for Transdermal Hormones

Correct Body Sites

• Transdermal estradiol patches should be applied to clean, dry, intact skin on the lower abdomen, upper buttocks, back, or upper arms 2
• These sites provide predictable absorption while avoiding areas with high sebaceous gland density (like the face) 2, 3

Why These Sites Are Chosen

• Lower risk of skin irritation and acne development 2
• More stable and predictable hormone absorption patterns 2
• Avoidance of first-pass hepatic metabolism while maintaining controlled systemic delivery 2

Addressing Potential Motivations for Facial Application

If Goal Is Facial Rejuvenation

• Facial hormone application is not an evidence-based anti-aging strategy 5
• Comprehensive facial assessment should guide appropriate cosmetic interventions (topical retinoids, chemical peels, or procedural options), not hormone creams 5

If Goal Is Hormone Replacement

• Use FDA-approved transdermal estradiol patches (50-100 μg daily) applied to approved body sites 2, 4
• Combine with appropriate progesterone dosing (micronized progesterone 200 mg daily for 12-14 days per month for sequential regimens, or 100 mg daily for continuous regimens) 2, 4
• Testosterone supplementation in women, when indicated, should be prescribed and monitored by specialists, not applied to facial skin 6, 7

Critical Safety Warnings

Contraindications to Consider

• History of breast cancer or hormone-sensitive malignancies makes any hormone therapy inappropriate 1, 4
• History of venous thromboembolism, stroke, or cardiovascular disease significantly increases risks with estrogen/progesterone therapy 1, 2
• Active liver disease contraindicates hormone therapy 4

Monitoring Requirements

• If hormone replacement is medically indicated, annual clinical review is required to assess compliance, side effects, and ongoing risk-benefit balance 2, 4
• No routine laboratory monitoring is needed unless specific symptoms arise, but cardiovascular risk factors should be screened 2, 3

The Bottom Line

Compounded hormone creams should never be applied to the face. If the patient requires hormone replacement therapy, prescribe FDA-approved transdermal estradiol patches applied to the lower abdomen, buttocks, back, or upper arms, combined with appropriate oral progesterone dosing 2, 4. If facial skin concerns exist, address them with evidence-based dermatologic treatments, not hormone creams 1.