September 16, 2015 Bioidentical Hormones and Compounding Pharmacies When I prescribe bioidentical hormones for men and women, I often write a prescription that can only be filled through a compounding pharmacy instead of a pharmacy such as Walgreens or CVS. So what’s the difference between the two kinds of pharmacies? The regular pharmacy of today is more of a distributor/seller of drugs and other medical items that are manufactured somewhere else. They buy the drugs in bulk, and then count out the pills and put them in a labeled container for the patient. They also help guard against dangerous drug interactions, and when needed, they educate the patients about their prescriptions. On the other hand, a compounding pharmacy is in some ways a throwback to the way pharmacies used to be. The pharmacist back then would prepare the medicine or remedy for the patient right there in his store – either his own concoction or something prescribed by a medical doctor. Each prescription could be tailor made for each individual patient. And, today, that is how we often do bioidentical hormone preparations, because the exact formula we want is often not available from a regular drugstore, or it is prohibitively expensive. Now I say “often” because sometimes the patient can get bioidentical hormones in a form that is made by a drug company (even though bioidentical hormones are not drugs per se). Examples are Prometrium (progesterone) capsules, Vivelle-Dot patches (estradiol), or AndroGel (testosterone). But many times, I want to use a form of hormone delivery that is not commercially available, or if it is, may be hugely expensive. So here are two big advantages of compounding pharmacies: They can provide greater access to hormones in the exact right form for each individual patient, and they can make up a prescription that costs a lot less than one from a drug company. Another advantage of compounding pharmacies is that they can prepare medicines in forms that are more easily tolerated by highly sensitive patients, either because of taste, sensitivities, or allergies. For example, a patient might need progesterone pills but Prometrium contains peanut oil. If that patient is allergic to peanuts, a compounding pharmacy can prepare progesterone in a different kind of oil that the patient can tolerate. One extra big way we use compounding pharmacies is in our use of subdermal bioidentical hormone pellet implants. A number of compounding pharmacies produce these, because only one pellet implant is currently available from big pharma, and that’s called Testopel, a 75mg testosterone pellet. Our practice uses pellets of estradiol and testosterone in many different sizes, so we can give patients the just right dose for them. What a world of difference that has made in dozens of lives. Dr. William Epperly, Fellow American Academy of Family Practice Fellow American Academy of Otolaryngic Allergy Member of Christian Medical and Dental Society.