There's no evidence that it doesn't and I think that the best thought is that it does have localized effects even though predominantly it mediates via systemic effects. All's I am saying is that if you are a "journey" sort of person, that is rewarding but the journey to recreate successful protocols might be long and frustrating. I am frankly depressed that others are not seeing better results via HRT which is making me wonder whether oral min or microneedling are key. I have had the botox relaxation so there is very little to nothing which I have not incorporated. Without success, this could get old really fast though.There is no evidence that Estrogel has a local effect. I don't like using something without knowing if it works.