Hormone Prescriptions and
The Compounding Pharmacy
Q: Where do I get my hormone prescriptions?
A: Dr. Norton does NOT carry hormones in her office. You must obtain your medications from a pharmacy that can prepare them, called a compounding pharmacy. These are custom made for your needs, not the standard pills or creams most pharmacies dispense.
Q: What is a compounding pharmacy?
A: A compounding pharmacy is specially licensed and regulated by the state to meet the qualifications of training and expertise needed to accurately mix your doctor’s prescription. (Did you know that “Rx” means recipe?) Not all pharmacies have the license or ability to mix these prescriptions.
Q: Are these medications pills like I’m used to?
A: No way. With the exception of thyroid medication (where the actual hormone is small enough to be absorbed from the GI tract), bioidentical hormones would be digested and degraded in the GI tract. (This also explains why the pills wrongly called “estrogen replacement” cannot really be estrogen, but drugs with some estrogen effects and their own side effects unrelated to any estrogen like action.) Other routes of administration are required, usually transdermal (apply the cream to the skin) or sublingual (dissolve under your tongue like a nitroglycerin tablet for a patient with angina). The amount of cream to apply must be precisely measured (this is not cold cream!), and therefore is dispensed from the pharmacy in a syringe. The syringe is nothing more than a fancy measuring cup – no needles just a plunger.
Q: What about the cost of compounded medications?
A: Because Mother Nature’s molecular formulas cannot be patented, these are far cheaper than you would imagine. For example, the full retail cost of a month’s supply of Mother Nature’s estradiol (estrogen) is in the range of $15.00 (sometimes cheaper than an insurance copay).
Q: What if adjustments of the dose of a cream are required?
A: The advantage of dispensing hormones in cream form is the ease of changing the amount of medication by varying the amount of cream applied. For example, if a woman who has had no estrogens for a while begins on hormone replacement, sometimes she may notice breast tenderness (similar to tenderness a patient may experience before her periods). If this should occur, instead of using 0.5 cc (5 lines on the syringe), she can cut back to only 0.3 cc (3 lines on the syringe) until her body gets used to having estrogen on board. Such precise adjustments depending on your body’s needs are not possible with standard dose pills.
Q: I still don’t get it, you mean there is no “standard dose” of a hormone?
A: Right! There is NO standard doses of a hormone. As an example, think about a diabetic who requires insulin (a hormone) to regulate their blood sugars. The more precisely they regulate their blood sugars, the healthier they will be, suffering far fewer consequences of their diabetes. Regrettably this requires adjusting their insulin doses to their daily needs in consideration of their physical exercise and daily dietary intake. Obviously, there is no standard dose of insulin. Thankfully other hormones do not need daily monitoring or daily change. However, each individual has individual requirements. This explains why laboratory testing is required (just like a diabetic checking their blood sugars and Hemoglobin A1c levels). Another example is a person requiring thyroid replacement. With thyroid replacement, your hormone levels must be checked at regular intervals and adjustments made accordingly. There is no such thing as a standard thyroid replacement dose.
With regard to estrogen replacement (estradiol and estriol), although a woman may be menopausal and her ovaries are no longer making estrogens, her body has the capacity in the fat tissue to convert hormones made in her adrenal gland to estrogens (this fat tissue conversion is how men make estrogens). If a woman is a bit on the heavy side with her weight, she may not be estrogen deficient at all. This explains why sometimes heavier women have fewer menopausal symptoms – they still have a steady supply of estrogen to combat the hot flashes and night sweats. Clearly, there is no standard dose for estrogen replacement. Compounding allows your doctor and your pharmacist to precisely adjust your medications for you.
