FAQ on compounding pharmacies
Q. What are compounding pharmacies and are they the best
sources for bio-identical hormones?
A. Compounding pharmacies provide a specialized service of
making up formulas (compounding) to the specifications of the
prescribing physician, so as to be customized to the individual
patient's tolerability. This is an extremely important option to
have available to a patient, as not everyone can tolerate the
inactive fillers, dyes, preservatives often present in pre-made
pharmaceuticals, or perhaps the method of delivery of each drug,
which might affect rate of absorption. An example of when the
compounding service is invaluable is when a patient is
gluten-intolerant, since most pre-made pharmaceuticals contain
the gluten protein in the inactive fillers. While compounding
pharmacies are able to accommodate to patients' special needs
through their service of compounding, they are not necessarily
the best source for bio-identical hormones. In fact, the
bio-identical hormone ingredients they use in compounding
medications begin with pharmaceutical grade generic
bio-identical hormones supplied by pharmaceutical companies.
FDA-approved name-brand bio-identical hormones currently exist
in the market in multiple forms (patch, pill, lotion, gel,
vaginal cream). Whether a patient needs to/should go through a
compounding pharmacy very much depends on his/her individual
medical situation.
Q. Are bio-identical hormones only available at compounding
pharmacies?
A. No. bio-identical estradiol and progesterone are also
available in name-brand, FDA-approved formulated tablets,
patches, gels, lotions, sprays, and capsules. In fact, Estrace,
which is name brand estradiol oral tablet, has been FDA-approved
and available since the 1970s.
Q. Based on saliva testing that my compounding pharmacist
ordered, I was placed on bio-identical hormones, or sold certain
supplements to help me make more hormones. Is this appropriate
for my health?
A. No. While many compounding pharmacists truly do possess great
knowledge about bio-identical hormones, they are not physicians,
and are legally NOT allowed to prescribe treatment. Their
training is different from that of a physician's and they should
not be assumed to possess the same level of medical expertise.
They can consult with physicians if the physician has first
signed a collaborative agreement allowing the pharmacist to do
so. The use of bio-identical hormones has propelled to a billion
dollar industry, and unfortunately, Dr. Chen has seen numerous
cases where patients are receiving their prescribed treatments
from either compounding pharmacies or laboratories, which she
felt were inappropriate. In these examples, the patients came to
Dr. Chen because the prescribed treatments they were receiving
from the compounding pharmacies and/or laboratories were causing
side effects and/or not adequately resolving their symptoms.
There are obvious conflicts of interest involved. It is also
inappropriate to make claims that simply taking supplements will
help the body to make more specific hormones, as the body has
multiple steps along the way of hormone synthesis, each
interconnected to multiple other loops, and each individual step
requiring enzymes (proteins), the regulation of which is under
the control of multiple variables that are individual to each
person, such as food, light exposure, sleep, and stress level.