For many of our patients on Hormone replacement therapies(HRT), including testosterone treatments, of estrogen therapy, many of them willopt to try a cream or gelbased medication as opposed to injections when starting hormone therapy. Hormonecreams or gels are often prescribed to treat several different medicalconditions. For example, things like hypogonadism or andropausefor men or perhaps women who’ve undergone a hysterectomy or have menopausesymptoms may all qualify for those prescribed hormones from their physician.Topical applications, like creams and gels, have become a preferred method for manypatients because it offers a non-invasive, steady delivery and absorption ofhormones into the bloodstream without the fear of having to give themselves aninjection. Even women are discoveringthe benefits of testosterone therapy. They are normally convenientlypackaged in a pump with an applicator that delivers a precise dose ofmedication based on your specific protocol. However, the effectiveness of these treatmentsheavily depends on the correct application — specifically where on the body thehormones are applied. It’s one of the most commonly asked questions we get fromour patients when they first start treatment.
The Importance of Picking the Proper Application SitesWhen Starting Gel/Cream Based HRT Therapy
The skin is the body’s largest organ and acts as aprotective barrier. Its responsible for preventing germs and bacteria fromentering our bloodstream. However, it does allow for certain substances,including medications like hormones, to be absorbed and enter into thebloodstream when applied correctly. The rate that it gets absorbed and the efficiencyof absorption will depend on a few different factors like skin thickness, bloodflow in the area, and the presence of hair follicles. Choosing the rightapplication site ensures the hormone is delivered consistently and predictably,leading to better clinical outcomes and maximizes the efficacy of themedication.
Putting the cream/gel in the wrong spot can lead toinconsistent or lower hormone levels, which will reduce its effectiveness, and caneven accidentally expose others to these hormones through direct skin contact.Understanding the best locations for putting on hormone cream and gels iscritical for both safety and efficacy for patients.
The Most Commonly Recommended Application Sites
When it comes to where the best place to apply hormone creamsand gels are, medical guidelines and clinical experience suggest a few areas thatare preferred for better absorption and superior clinical outcomes:
Inner Thighs. The skin on the inner thighs isrelatively thin and highly vascularized and often has less hair follicles formost people, allowing for more efficient absorption. Additionally, this areatends to be covered by clothing, which can minimize the risk of accidentaltransference to others. To apply, the patient should apply the cream evenlyover a large surface area to maximize absorption and avoid occlusion. We tellour patients that it is important to allow the product to dry thoroughly beforeputting on clothing. Having a routine is important so if you get ready for workat the same time every morning, you can easily apply the cream/gel aftershowering and drying off, which can help it absorb properly and also keeps youon a schedule.
Inner Upper Arms. Like the inner thighs, the inner upper arms (innerbicep area) have relatively thin skin and smooth skin as well as a good bloodsupply which helps the medication travel through the body after absorption.This area is also generally free from dense hair, unlike the forearms forexample, which can impede absorption. Applythe product between the elbow and the armpit on the inner side of the arm.Again, it should be allowed to dry fully before covering with clothing whichcould absorb the medication instead of the skin.
Abdomen. The abdomen offers some advantages such asbeing a large surface area for application, and patients can easily apply thecream themselves. It has plenty of blood flow and usually the skin is soft andthin, however some patients (especially men) that may have hairy stomachs thatcan negatively impact absorption. It’s best to apply around the lower abdominalarea, avoiding any areas that are directly over any scars or dense patches of hair.Gently rubbing the cream into the skin using a circular motion can help thehormone cream absorb more evenly into the body.
Shoulders The shoulders, particularly the deltoid area, havebeen popular for gels because they are easy to reach and have consistentabsorption rates. Theres good blow flow, normally not very hairy and the skinis generally soft and allows for good absorption. Apply the hormone cream/gel evenlyover the upper outer shoulder area, ensuring that it’s well rubbed in toprevent transfer to others via contact and make sure that the medication is drybefore putting a shirt on and covering it.
Chest. Like the shoulders, the upper chest area isanother easily accessible and effective site for hormone absorption, especiallyfor estrogen or testosterone creams. Apply the medication to the upper chest,ensuring that the cream is massaged into the skin thoroughly and left to drybefore covering.
Areas Generally Not Recommended for Applying HormoneCreams and Gel
Not all skin areas are suitable for hormone creamapplication. Some areas may have poor blood flow, thick skin and a highernumber of hair follicles, making the absorption of the medicine less optimal.Some of these areas include:
Hands and Feet: Skin here is too thick, reducing absorption.
Face and Neck: These areas have more sebaceous (oil)glands, and applying hormones here could lead to irritation or unintendedcosmetic effects (e.g., hair growth).
Genital Area: While absorption is high due to thinskin, this area is highly sensitive and can result in irritation or excessivehormone uptake, which can cause side effects. However, custom-compounded testosteronecreams can be formulated for scrotal application in menon TRT. This can be done because compounding pharmacies can createformulations specifically without alcohol or other irritating ingredients andat lower concentrations designed for the increased absorption in that area, sotalk to your doctor about what method works best for you.
Factors Influencing Absorption of Hormone Creams and Gels
There are several different variables that may influence howwell hormones can be absorbed through the skin. Things like skin Thickness forexample will determine how well medication can enter the blood stream. Thinnerskin allows for better penetration into the blood stream as there are lesslayers for the medication to have to pass through to reach a blood supply. Temperatureis another factor. Warmer skin (from exercise or a hot environment) may enhanceabsorption. Hydration is another example of a factor that can influenceabsorption. Well-moisturized skin tends to absorb creams better than very dryor flaky skin will. The application Area Size is also important as spreadingthe hormone cream over a larger area can improve uptake and speed up howquickly the medicine dries after application.Gently massaging the cream is also important as it helps distribute the hormoneevenly and encourages deeper skin penetration.
Preventing Hormone Transfer to Others
One major concern with topical hormone treatments thatpeople have is the risk of transferring the hormone to another person throughskin-to-skin contact. This is particularly important for individuals who livewith children, partners, or pets. If applied correctly it’s not likely thatthis will be an issue, but it needs to be considered that if you have freshlyapplied medication that hasn’t completely dried, it’s a possibility that needsto be watched out for. To minimize this risk, you should wash hands thoroughlyafter application and allow the treated area to dry completely before dressing.After it dries wear clothing that covers the application site and avoid directskin contact with other people or pets immediately after application. Dependingon your lifestyle, applying the medication at bedtime and then covering thearea afterwards with a shirt or pajama pants may help reduce the risk oftransfer
Rotating Application Sites
Repeatedly putting the hormone cream on the same spot canpossibly irritate the skin or can create inconsistent absorption due to subtle changesin the skin barrier. Most doctors will recommend rotating the application sitesas a best practice for patients undergoing treatment. For example, alternatingbetween the left and right inner thighs may help maintain skin health andpromotes more consistent hormone levels which is the goal of treatment.
Other Considerations When Choosing Where to Apply HormoneCreams and Gels
When choosing where to apply hormone-based creams,individual factors must be considered during your consultation with your physician.As most hormone creams and gels are applied daily, consistent timing ofapplication is important. Usually once daily at the same time either firstthing in the morning or at bedtime ensures stable hormone levels in the body.
A patient’s past medical history may also come into play.For example, patients with certain skin conditions, like eczema or psoriasis,might need to avoid affected areas or if someone has an injury, that siteshould be avoided to prevent side effects, irritation or infection.Interestingly, someone who exercises heavily might prefer inner thighs orabdomen application to avoid excessive sweating at the shoulders or chest.Everyone is a little different so finding the best spot can take a little trialand error. You should listen to your doctor’s advice as it’s essential tofollow healthcare providers and pharmacy instructions, as differentformulations (cream vs. gel) might have slightly different recommendations.
Final Thoughts on Transdermal Hormone Creams and Gels
Topical testosterone and other hormone-based therapies canbe highly effective when used correctly by the patient. For both and Men and Womenon Hormone Therapy, they offer convenience and can be very effective formany patients. Many patients are scared of giving themselves hormoneinjections, Knowing and utilizing the best sites for application, includingthe inner thighs, inner upper arms, abdomen, shoulders, and chest will offerthin skin, good blood flow, and practical convenience and provide the bestresults. Additionally avoiding areas like the hands, feet, face, and genitalsis critical to ensure both patient safety and effective treatment. Patientsshould be thoughtful and diligent about their application techniques practicingthings like rotating sites and preventing the unintentional transfer ofmedicine to others. By carefully following your healthcare providers recommended guidelines, individuals usinghormone creams and gels can achieve optimal therapeutic benefits whileminimizing risks.
