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 and dyes 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
A. No. bio-identical estradiol and progesterone are also available in name-brand, FDA-approved formulated tablets, patches, gels, lotions, nasal 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
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, thanks to the efforts of Suzanne Somers, 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 and illegal! 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, and it is unfortunate that money seems to motivate more than ethics on the part of these entities. 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.