CYP19A1 and Lipedema: Given the heightened intracrine estradiol production within the affected adipose tissue—sustained by increased expression of aromatase and 17β-HSD1 and diminished activity of 17β-HSD2—the preferred approach is the use of transdermal formulations (patches or gel) applied to areas not affected by lipedema, such as the back, scapular region, or inner arms (if disease-free).