Hormone: Estrogen


Estrogen Therapy




Natural, bio-identical estrogens are available and may be compounded into a variety of dosage forms. There are three main estrogens, estrone (E1), estradiol (E2), and estriol (E3). These are normally present in the body in fairly fixed ratios. However, it is not always necessary to supplement them in any specific ratio. For example, a combination product of E3 and E2 is commonly prepared with amounts ranging from a 50/50 mixture to 80/20 or even 90/10. The important factor is using the correct estrogens for you. Estrogens may be compounded into oral capsules, oral liquids (never taste good), sublingual drops, vaginal suppositories, lozenges or topical creams. In our opinion, the creams offer the best of the many choices. They are easy to use; they're well absorbed; and the doses are easy to adjust.

You may hear the words, TriEst and BiEst. These refer to a triple estrogen and a double estrogen combinations, respectively. The TriEst formulas are not often used these days because of a concern for their estrone (E1) content. The BiEst formulas contain estriol (E3) and estradiol (E2). Women may need estrogen supplementation for a variety of reasons (menopause, hysterectomy, etc.). Regardless of the reason, we believe using natural, bio-identical hormones makes much more sense than any of the synthetic drug products or "natural" products derived from other animals.

Doses vary for each woman - and usually change over time. While it is difficult to recommend a specific dose, we can offer a suggestion for a starting dose. We believe it is important to look at the actual hormone levels indicated in your blood or saliva but more importantly your symptoms related to hormone deficiencies.

Half of the practitioners we know use saliva tests to determine hormone levels and the other half use blood tests. We may choose either depending on the individual. Whatever testing is used, we suggest it be performed periodically to verify that the hormone supplements are being absorbed and balanced. Because we recommend the creams the total amounts can be adjusted when needed. A common starting point is BiEst 1 mg per day, sometimes divided into two doses (.5 mg per dose). The ratio of E3 to E2 can range from 50/50 to 80/20. A BiEst 2mg, 50/50 mixture would provide 1 mg E3 and 1 mg E2 per dose.

We commonly order a transdermal cream that provides 1mg of BiEst in 0.2ml of cream base. This corresponds with one small line on a 10 ml cream syringe. A BiEst 1 mg, 80/20 mixture would provide .8 mg E3 and 0.2mg E2 per dose. 0.2 ml of cream is equal to one small line on a 10 ml applicator. This is a relatively small amount of cream - about the size of a small pea.

While it is possible to combine estrogens with progesterone and testosterone into a single compound, it is no longer recommended - particularly when starting out. There is no way to adjust any particular hormone if they're all mixed into a single cream.

One particular advantage of our protocol is that you can adjust the dose by using a little more or a little less per dose. If your doctor starts with 1 mg per dose and you find it is not relieving you of your symptoms, you can adjust the dose by adding 0.1ml to the original 0.2. The markings on the syringe barrel make this easy.


Estradiol, the principal estrogen found in a woman's body during her reproductive years. It is primarily produced by the ovaries. Estradiol is very effective for the symptomatic relief of hot flashes, night sweats, and facial aging. We look at E2 as the “Pretty” hormone. It makes the hair thick, the skin youthful and the heart healthy. When you see actresses look better in their forties than they did in their twenties, think E2.


E3 works on a woman’s plumbing. It helps with vaginal dryness and increases the thickness of the vaginal wall. A deficiency in E3 causes a thinning of the epithelial lining of women’s vagina and urethra. This will cause painful intercourse, an increase in urinary tract infections and incontinence upon coughing or sneezing. Where E1 and E2 have associations with cancer, E3 has been shown to have anti-cancer effects. It has been shown that women with breast cancer had reduced urinary excretion of estriol. It has also been observed that women without breast cancer have naturally higher estriol levels, compared with estrone and estradiol levels.


Estrone is the estrogen most commonly found in increased amounts in post menopausal women. The body derives it from the hormones that are stored in body fat. Estrone does the same work that estradiol does, but it is considered weaker in its effects. Estrone is very rarely used any longer because of its association with cancer.

How to apply: Estrogen (Bi-Est)

Apply after bathing.

Cream: Areas to apply:

• Inner upper/lower arms

• Inner thighs

• Where the skin is thin and can easily absorb the cream.

Skin should be clean and dry. Spread a thin layer on a large surface to increase absorption. Rub the cream in thoroughly (approx. 10 times back and forth). Rotate the areas for application of the cream so that individual sites don't become saturated. Cream will dry in 5 to 10 minutes and should not be washed off for approximately 2 hours. Therefore activities such as bathing, swimming, exercising (inducing sweat) can wash the medication off your skin and should be avoided for 2 hours following application.



• Women with monthly menstrual cycles should take Estrogen cream on days 1-14 of their cycle unless otherwise directed by our medical staff. (Day 1 is the beginning of your menstrual cycle and may fall on any calendar date).

• There are three protocols for Post menopausal women and to our observance we have not seen much difference between the three, making not one of them better or worse than the other. Protocol 1: utilize the recommended dose for 25 days continuously and discontinue for 3 days. Protocol 2: utilize the recommended dose for 28 days continuously and discontinue for 3 days. Protocol 3: utilize the recommended dose daily.

You choose the protocol that makes more sense to you.



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