Bi-Est Cream (80:20)
A compounded bioidentical hormone cream containing estradiol and estriol in an 80:20 ratio (80% estriol, 20% estradiol). Emphasizes estriol for a gentler estrogenic effect, often used as a starting point for BHRT.
3-month program. Upfront payment: $297 ($99/month for 3 months).
Prescription required. Provided by board-certified physicians.
Description
Biest (80:20) is a compounded bioidentical hormone therapy containing a specific ratio of two naturally occurring estrogens: 80% estriol (E3) and 20% estradiol (E2). This formulation represents the most commonly prescribed Biest ratio and is often considered a balanced approach to estrogen replacement.
The 80:20 ratio is designed to provide therapeutic benefits of estradiol while incorporating a higher proportion of estriol, which some practitioners believe may offer a gentler, potentially safer estrogenic profile. This formulation may be particularly suitable for women who are sensitive to stronger estrogen preparations, those new to hormone therapy, or those seeking symptom relief with a more conservative estrogenic approach. The higher estriol content may also provide specific benefits for genitourinary health.
Transdermal delivery of Biest cream offers steady hormone absorption through the skin, avoiding first-pass hepatic metabolism and allowing for flexible dose adjustments. This 80:20 formulation may help alleviate hot flashes, night sweats, vaginal dryness, mood changes, and sleep disturbances while supporting bone health and overall quality of life.
What To Expect
Biest (80:20) cream is applied topically to thin-skinned areas of the body such as the inner arms, inner thighs, or abdomen, where absorption is optimal. Symptom relief typically begins within 2–4 weeks of starting therapy, though some women notice improvements sooner. Full therapeutic benefits often emerge over 2–3 months as hormone levels stabilize.
The 80:20 ratio may produce a gentler onset of effects compared to higher estradiol formulations. Your provider will likely recommend follow-up laboratory testing and clinical assessments to monitor hormone levels and symptom response, adjusting your prescription as needed.
How To Use
Apply the prescribed amount of Biest (80:20) 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. Long-term estrogen use may increase the risk of blood clots, stroke, and certain cancers. 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.