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Where to Apply: A Guide to Effective Hormone Cream and Gel Placement

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For many of our patients on Hormone replacement therapies (HRT), including testosterone treatments, of estrogen therapy, many of them will opt to try a cream or gel based medication as opposed to injections when starting hormone therapy. Hormone creams or gels are often prescribed to treat several different medical conditions.  For example, things like hypogonadism or andropause for men or perhaps women who’ve undergone a hysterectomy or have menopause symptoms may all qualify for those prescribed hormones from their physician. Topical applications, like creams and gels, have become a preferred method for many patients because it offers a non-invasive, steady delivery and absorption of hormones into the bloodstream without the fear of having to give themselves an injection. Even women are discovering the benefits of testosterone therapy. They are normally conveniently packaged in a pump with an applicator that delivers a precise dose of medication based on your specific protocol.  However, the effectiveness of these treatments heavily depends on the correct application — specifically where on the body the hormones are applied. It’s one of the most commonly asked questions we get from our patients when they first start treatment.

The Importance of Picking the Proper Application Sites When Starting Gel/Cream Based HRT Therapy

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The skin is the body’s largest organ and acts as a protective barrier. Its responsible for preventing germs and bacteria from entering our bloodstream. However, it does allow for certain substances, including medications like hormones, to be absorbed and enter into the bloodstream when applied correctly. The rate that it gets absorbed and the efficiency of absorption will depend on a few different factors like skin thickness, blood flow in the area, and the presence of hair follicles. Choosing the right application site ensures the hormone is delivered consistently and predictably, leading to better clinical outcomes and maximizes the efficacy of the medication.

Putting the cream/gel in the wrong spot can lead to inconsistent or lower hormone levels, which will reduce its effectiveness, and can even accidentally expose others to these hormones through direct skin contact. Understanding the best locations for putting on hormone cream and gels is critical for both safety and efficacy for patients.

The Most Commonly Recommended Application Sites

When it comes to where the best place to apply hormone creams and gels are, medical guidelines and clinical experience suggest a few areas that are preferred for better absorption and superior clinical outcomes:

Inner Thighs. The skin on the inner thighs is relatively thin and highly vascularized and often has less hair follicles for most people, allowing for more efficient absorption. Additionally, this area tends to be covered by clothing, which can minimize the risk of accidental transference to others. To apply, the patient should apply the cream evenly over a large surface area to maximize absorption and avoid occlusion. We tell our patients that it is important to allow the product to dry thoroughly before putting on clothing. Having a routine is important so if you get ready for work at the same time every morning, you can easily apply the cream/gel after showering and drying off, which can help it absorb properly and also keeps you on a schedule.

Inner Upper Arms.  Like the inner thighs, the inner upper arms (inner bicep area) have relatively thin skin and smooth skin as well as a good blood supply which helps the medication travel through the body after absorption. This area is also generally free from dense hair, unlike the forearms for example, which can impede absorption.  Apply the 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 which could absorb the medication instead of the skin.

Abdomen. The abdomen offers some advantages such as being a large surface area for application, and patients can easily apply the cream themselves. It has plenty of blood flow and usually the skin is soft and thin, however some patients (especially men) that may have hairy stomachs that can negatively impact absorption. It’s best to apply around the lower abdominal area, 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 the hormone cream absorb more evenly into the body.

Shoulders The shoulders, particularly the deltoid area, have been popular for gels because they are easy to reach and have consistent absorption rates. Theres good blow flow, normally not very hairy and the skin is generally soft and allows for good absorption. Apply the hormone cream/gel evenly over the upper outer shoulder area, ensuring that it’s well rubbed in to prevent transfer to others via contact and make sure that the medication is dry before putting a shirt on and covering it.

Chest. Like the shoulders, the upper chest area is another easily accessible and effective site for hormone absorption, especially for estrogen or testosterone creams. Apply the medication to the upper chest, ensuring that the cream is massaged into the skin thoroughly and left to dry before covering.

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Areas Generally Not Recommended for Applying Hormone Creams and Gel

Not all skin areas are suitable for hormone cream application. Some areas may have poor blood flow, thick skin and a higher number 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 unintended cosmetic effects (e.g., hair growth).

Genital Area: While absorption is high due to thin skin, this area is highly sensitive and can result in irritation or excessive hormone uptake, which can cause side effects. However, custom-compounded testosterone creams can be formulated for scrotal application in men on TRT. This can be done because compounding pharmacies can create formulations specifically without alcohol or other irritating ingredients and at lower concentrations designed for the increased absorption in that area, so talk to your doctor about what method works best for you.  

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Factors Influencing Absorption of Hormone Creams and Gels

There are several different variables that may influence how well hormones can be absorbed through the skin. Things like skin Thickness for example will determine how well medication can enter the blood stream. Thinner skin allows for better penetration into the blood stream as there are less layers for the medication to have to pass through to reach a blood supply. Temperature is another factor. Warmer skin (from exercise or a hot environment) may enhance absorption. Hydration is another example of a factor that can influence absorption. Well-moisturized skin tends to absorb creams better than very dry or flaky skin will. The application Area Size is also important as spreading the hormone cream over a larger area can improve uptake and speed up how quickly the medicine dries after application. Gently massaging the cream is also important as it helps distribute the hormone evenly and encourages deeper skin penetration.

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Preventing Hormone Transfer to Others

One major concern with topical hormone treatments that people have is the risk of transferring the hormone to another person through skin-to-skin contact. This is particularly important for individuals who live with children, partners, or pets. If applied correctly it’s not likely that this will be an issue, but it needs to be considered that if you have freshly applied medication that hasn’t completely dried, it’s a possibility that needs to be watched out for. To minimize this risk, you should wash hands thoroughly after application and allow the treated area to dry completely before dressing. After it dries wear clothing that covers the application site and avoid direct skin contact with other people or pets immediately after application. Depending on your lifestyle, applying the medication at bedtime and then covering the area afterwards with a shirt or pajama pants may help reduce the risk of transfer

Rotating Application Sites

Repeatedly putting the hormone cream on the same spot can possibly irritate the skin or can create inconsistent absorption due to subtle changes in the skin barrier. Most doctors will recommend rotating the application sites as a best practice for patients undergoing treatment. For example, alternating between the left and right inner thighs may help maintain skin health and promotes more consistent hormone levels which is the goal of treatment.

Other Considerations When Choosing Where to Apply Hormone Creams 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 of application is important. Usually once daily at the same time either first thing 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 site should be avoided to prevent side effects, irritation or infection. Interestingly, someone who exercises heavily might prefer inner thighs or abdomen application to avoid excessive sweating at the shoulders or chest. Everyone is a little different so finding the best spot can take a little trial and error. You should listen to your doctor’s advice as it’s essential to follow healthcare providers and pharmacy instructions, as different formulations (cream vs. gel) might have slightly different recommendations.

Final Thoughts on Transdermal Hormone Creams and Gels

Topical testosterone and other hormone-based therapies can be highly effective when used correctly by the patient. For both and Men and Women on Hormone Therapy, they offer convenience and can be very effective for many patients. Many patients are scared of giving themselves hormone injections, Knowing and utilizing the best sites for application, including the inner thighs, inner upper arms, abdomen, shoulders, and chest will offer thin skin, good blood flow, and practical convenience and provide the best results. Additionally avoiding areas like the hands, feet, face, and genitals is critical to ensure both patient safety and effective treatment. Patients should be thoughtful and diligent about their application techniques practicing things like rotating sites and preventing the unintentional transfer of medicine to others. By carefully following your healthcare providers  recommended guidelines, individuals using hormone creams and gels can achieve optimal therapeutic benefits while minimizing risks.

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