Compounded Biest

Biest is a two-estrogen compounded preparation containing estradiol (E2) and estriol (E3) — the most active and the weakest of the three human estrogens, respectively. The name comes from "bi-" (two) + "estrogen." The 80:20 estriol-to-estradiol ratio is by far the most common, though prescribers sometimes specify 70:30, 50:50, or other custom ratios based on the patient's estradiol targets.

Biest is prescribed by menopause-focused gynecologists, functional medicine physicians, and BHRT clinics for perimenopausal and postmenopausal women seeking bioidentical hormone protocols. It's typically used alongside compounded progesterone, and sometimes alongside a separate DHEA or testosterone preparation, as part of a full BHRT regimen.

Commercial FDA-approved estradiol products (Estrace, Climara, Vivelle-Dot, Divigel, Evamist, Imvexxy, and generics) deliver bioidentical estradiol alone — not the E2+E3 combination. If a prescriber wants a patient on combined estradiol and estriol, compounding is the only legal route in the U.S., because estriol has no FDA-approved product in this country.

Clinicians who favor Biest generally argue that adding estriol to estradiol preserves symptom control while moderating endometrial and breast-tissue stimulation compared to estradiol alone. Clinical evidence directly comparing Biest to FDA-approved estradiol is limited — the framework is based on physiologic reasoning and small studies, not large randomized trials. Claims that Biest is safer than FDA-approved estradiol are not well-supported by the clinical literature, and the North American Menopause Society and ACOG have not endorsed BHRT over FDA-approved HRT. The right comparison for an individual patient is the one their prescriber makes in context.

Transdermal cream is the most common Biest formulation, typically dosed 0.5–2.5 mg/mL total estrogen (E2 + E3 combined) and applied daily or twice daily to the inner forearms or thighs using a metered applicator (Topi-Click or calibrated syringe) for consistent dosing.

Sublingual troches and oral capsules are prescribed less often but are options for patients who don't tolerate or don't absorb transdermal delivery well. Vaginal creams and suppositories at much lower strengths (typically 0.5–1 mg/g total) are prescribed specifically for genitourinary syndrome of menopause when localized therapy is preferred.

Strength and ratio are always prescriber-specified. Your script should name both the total estrogen strength and the E2:E3 ratio (e.g., "Biest 2.5 mg/mL, 20:80 ratio, transdermal cream").

Transdermal Biest creams typically run $50–$110 for a 30-day supply, with the higher end reflecting higher total-estrogen strengths, lower-ratio estradiol components (estradiol API is more expensive per gram than estriol), and premium bases. Sublingual troches are $40–$90 per 30-day supply. Vaginal creams are $45–$85 per 30-day supply.

Because Biest is a custom two-ingredient compound, pricing varies more between pharmacies than single-ingredient estradiol. Getting quotes from multiple licensed compounding pharmacies before filling typically saves 20–40% over the long-term course of HRT, which matters when the medication is filled monthly for years.

Prices vary by dosage, formulation, quantity, and pharmacy. The range above reflects listings currently tracked by Compounding Finder and is not a guaranteed quote. Submit a request below to get a personalized quote for your specific needs.

Compounded medication prices vary significantly between pharmacies — sometimes by 300% or more for the exact same drug, strength, and formulation. Factors that affect pricing include the pharmacy’s location, their ingredient sourcing, and compounding volume.

By comparing quotes from multiple licensed pharmacies, you can find the best combination of price, quality, and convenience without spending hours making phone calls.

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