In women a cream preparation is used most commonly. It contains estradiol, the most active form of estrogen, and often estriol, a weaker estrogen considered to be protective against breast cancer. This combination is called Biest, usually in a ratio of four parts estriol to one part estradiol. Initially the cream is applied both in the morning and at night. Later, and in older women, it can be used just once a day. It may be combined with progesterone in the same preparation for convenience and cost-saving. It may also be combined with testosterone. Transdermal testosterone, however, may cause hair growth where it is applied, so we usually recommend it to be applied to the thighs where it is less evident and more easily handled.
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