Bi-Est Cream (50:50)
A compounded bioidentical hormone cream containing two types of estrogen: estradiol and estriol in a 50:50 ratio. Used as hormone replacement therapy (HRT) to manage symptoms of menopause with a more potent estrogenic effect.
3-month program. Upfront payment: $297 ($99/month for 3 months).
Prescription required. Provided by board-certified physicians.
Description
Biest (50:50) is a compounded bioidentical hormone therapy containing equal proportions of two naturally occurring estrogens: 50% estriol (E3) and 50% estradiol (E2). This formulation provides a higher concentration of estradiol compared to the more common 80:20 ratio, offering stronger estrogenic effects for women who may require more robust hormone replacement.
Estradiol is the most potent form of estrogen and plays critical roles throughout the body including bone density maintenance, cardiovascular health, cognitive function, mood regulation, and urogenital tissue health. Estriol, while weaker, contributes additional benefits particularly for vaginal and urinary tract health.
The 50:50 ratio is typically prescribed for women who have not achieved adequate symptom relief with lower estradiol formulations, those with more severe menopausal symptoms, or those transitioning from the 80:20 ratio who require stronger estrogenic support. Transdermal delivery provides steady hormone absorption, bypassing the digestive system and first-pass hepatic metabolism. As with all bioidentical hormones, these are molecularly identical to those naturally produced by the human body.
What To Expect
Biest (50:50) cream is applied topically to thin-skinned areas of the body such as the inner arms, inner thighs, or abdomen. Due to the higher estradiol content, symptom relief may be more pronounced and occur within 2–4 weeks of starting therapy. Full therapeutic benefits often emerge over 2–3 months as hormone levels stabilize and tissues respond to treatment.
Women transitioning from the 80:20 formulation may notice enhanced symptom control with this stronger preparation. The higher estradiol content in the 50:50 formulation requires careful monitoring to ensure optimal therapeutic benefit while minimizing risks.
How To Use
Apply the prescribed amount of Biest (50:50) cream to clean, dry skin on rotation sites such as inner arms, inner thighs, or abdomen. Rub in thoroughly until fully absorbed. Apply at the same time each day, typically in the evening, or as directed by your provider. Wash hands after application and allow cream to dry completely before covering with clothing. Avoid applying to breast tissue or areas where skin-to-skin contact with others may occur immediately after application.
Safety Information
Estrogen therapy carries certain risks and is contraindicated in women with a history of breast cancer, estrogen-dependent tumors, active or history of blood clots, active liver disease, or unexplained vaginal bleeding. Potential side effects may include breast tenderness, bloating, headache, mood changes, or spotting. The higher estradiol content in the 50:50 formulation may increase the intensity of these effects. Women with an intact uterus typically require progesterone therapy in addition to estrogen to protect the uterine lining. Discuss your complete medical history with your provider before beginning hormone therapy.