BHRT Hormone Replacement Therapy Compounding

Hormone Replacement Compounding

  • Natural vs. Synthetic
  • Who Needs Hormone Replacement
  • Compounding HRT
  • HRT Benefits
  • Understanding Human Hormones
  • HRT and Health Risks
  • How Do You Get HRT
  • Hormone Symptoms Key
  • Medical History Form

Hormone Replacement Therapy

Natural vs. Synthetic

Bio-identical hormones are “plant derived hormones” from precursors found in wild yam or soybean. They are modified in a laboratory to be identical to the hormones produced by the human body. They possess the same exact chemical structure as hormones produced by our body.

Synthetic hormones are “artificial” not found in nature. Chemically altered from human hormone and not identical in structure or activity to natural human hormones.

Establish your natural hormone levels by getting a baseline test in your late thirties or early perimenopause.

The manner of replacing the lost hormones varies according to the choices made by the patient and their physician. One choice is using the various synthetic hormones available. The alternate choice is using “” hormones. Should a person take a hormone that is identical to the one that the body produced throughout younger life; thereby being natural to the body, or take one that the body does not recognize as natural, but instead a foreign substance. Because it is foreign, it may possess many side effects or even unknown side effects.

Why Hormone Replacement?

With natural aging comes the natural diminishment of our own body’s production of hormones. As the result, all of the general health we took for granted starts to diminish as well. Causing symptoms such as hot flashes, forgetfulness, anxiety, sleep disruption, low libido, and on and on. Here falls the need for “replacement” hormones. Maintaining this balance is the goal of any type of hormone replacement therapy (HRT). The hormones a woman produces until she reaches menopause protect her heart and bones. Once she is no longer producing these hormones, she is at risk of developing heart disease and osteoporosis. The risks continue to worsen the longer she is without these essential hormones.

Why is HRT Compounded?

HRT is available only from a compounding pharmacy, and only with a valid prescription from a doctor. Pharmacy compounding is the art and science of preparing customized medications for patients.  Its practice dates back to the origins of pharmacy. The goal of a compounding pharmacy is the Triad, formed by doctor, pharmacist, and patient.  By working amongst all three, the compounding pharmacy can tailor-make the prescription to fit each individual patient.  The dosage strength and dosage form can be customized to a patients specific needs.  HRT can be compounded in capsules, topical and vaginal creams, gels, oral liquids, lozenges, vaginal and rectal suppositories, solutions, tablet triturates, rapid dissolve tablet, troches, mini troches, and other dosage forms.  Testosterone can be added if deemed necessary by the doctor and patient for libido problems. Conventional HRT has few standard dosage forms. hormone replacement is not available commercially.

What Are the Benefits with Natural HRT?

  • Identical in structure to hormones the human body produces
  • Provide protective benefits that were originally provided by the body’s naturally occurring hormones
  • Far fewer unwanted effects than synthetic hormones
  • Improved libido
  • Helps in the prevention of osteoporosis and restoration of bone strength
  • Protection against hear disease and stroke
  • Reduced hot flashes and reduced vaginal dryness
  • Muscle mass and strength are better maintained
  • Improvement in cholesterol levels
  • Risk of depression is reduced
  • Reduced risk of breast and endometrial cancer
  • Prevention of senility and Alzheimer’s Disease
  • Improved sleep
  • Mood, concentration, and memory become better
  • Over all quality of life is restored/improved
  • Side effects are usually dose related and correct when the proper dose is dispensed
  • Dosage is adjustable and individualized for the patient’s needs and goals
  • Multiple hormones can be combined in one dosage form
  • Several dosage forms available; capsules. topical and vaginal creams, gels, oral liquids, lozenges, troches, and more
  • Can bypass the digestive tract and liver with non-oral dosage forms

How Do You Get HRT?

  • Get HRT information and fill out medical history form
  • Discuss HRT prescription to B & B Pharmacy (call for a pharmacist consult 800.231.8905) or fax prescription and medical history form to B & B Pharmacy at 800.705.8964
  • Get recommendation from compounding pharmacist and coordinate with prescribing physician

One the patient and the physician have determined that the patient is a candidate for HRT our compounding pharmacists’ work directly with the patient and the physician to tailor a hormone regimen to “fit” the patient with the appropriate dosage strengths and dosage form. (Generally the physician is a general practitioner, gynecologist, or endocrinologist. If you do not have a physician, or yours is not familiar with HRT, you can contact a compounding pharmacist for further information) Our compounding pharmacist will have a consultation with the patient using the baseline hormone levels (if available), in some cases a saliva test, along with patient medical history, and patient goals. With that, they will derive the compound that seems appropriate for the patient and send a consultation report to the doctor with recommendations. After the doctor approves or makes changes to the recommendation, the patient starts a three week course and is reviewed by the pharmacist again before continuing therapy. Any adjustments in therapy or consultations are reported to the doctor for review/approval. It usually doesn’t take more than 2-3 months to find the appropriate hormone regimen. The doctor continues to follow the patient at their discretion. The pharmacist follows the hormone regimen regularly, with refills, and communicates any modifications with the physician.

The Human Hormones

There are four groups of hormones that are of major concern:

  1. Estrogens
  2. Progesterone
  3. Testosterone
  4. Dihydroepiandrosterone (DHEA)

The Estrogens include estrone (E1), estradiol (E2), and estriol (E3). Together they are referred to as Tri-Est. In some cases E2 and E3 are combined and referred to as Bi-Est. The plant source of these chemicals is the soybean.  These estrogens are prescribed for replacement therapy due to menopause, ovarian failure or for women who have had a hysterectomy with removal of their ovaries. There are benefits to prescribing the bio-identical hormone replacement of estrogen. When prescribed for menopause, estrogen can alleviate, in most cases hot flashes, vaginal and urinary tract dryness, sleeplessness and mood swings. There are also cardiovascular benefits to replacement therapy. Lastly, hormone replacement therapy can help osteoporosis if treatment is begun early enough.

(Dosing guidelines: Triest 0.3mg-3mg QD-BID)

Progesterone is derived from the mexican yam or the soybean. Progesterone can be prescribed for infertility, luteal phase defect, PMS or in combination with estrogens for menopause. Progesterone comes primarily from the ovaries both before and after menopause, but it is also produced in both the brain and peripheral nerves. It prepares and maintains the uterus for pregnancy, by stimulating the uterine lining to thicken with rich, well vascularized tissue to support an embryo. Progesterone also affects the brain by producing a sense of calmness, and its sedating, anti-anxiety effect helps promote rejuvenating sleep.

(Dosing guidelines: Progesterone 25mg-800mg QD in divided doses QD-QID)

Testosterone is a hormone produced by both men and women. It promotes muscle growth, increases energies, elevates mood, strengths bones, helps relieve menopausal symptoms, increases sensitivity to sexual pleasure in nipples and genitals, and enhances sex drive. In women, testosterone is produced in the ovaries, adrenal glands, and to a lesser extent in the skin, brain, and liver. Adequate levels of testosterone can help to prevent heart disease, stroke, vascular disorders such as diabetic blindness, and Osteoporosis.

(Dosing guidelines: Testosterone 0.25mg-5mg for women daily, divided doses. Testosterone 2mg-100mg for men daily, divided doses)

DHEA (dehydroepiandrosterone) is produced in greater abundance by the adrenal glands than any other hormone. It is also produced to a lesser extent by the ovaries, testes, and brain. The body uses DHEA as a buffer hormone or as a storehouse from which the body can produce other hormones such as estrogens or testosterone when needed (DHEA is often referred to as the “mother hormone”). DHEA research has indicated that this hormone may have important therapeutic benefits is such areas as cardiovascular disease, autoimmune diseases, cancer, chronic fatigues, fibromyalgia, and may have anti-aging properties.

(Dosing guidelines: DHEA 2mg-100mg QD)

HRT and Health Risks

Cancer

There is a good reason to believe that the long term use of bio-identical low dose estrogen, balanced with bio-identical progesterone, would result in a very limited increase risk of breast cancer. Preliminary studies have shown that women who excrete the highest levels of estriol in their urine appear to have a lower risk of breast cancer. Progesterone plays many important roles in prevention of breast cancer. Bio-identical progesterone has been shown to reduce estrogen-receptor production on breast cells to decrease the production of estrogen within the first week or so of bio-identical progesterone use, since it initially increases estrogen receptors in the breasts. However, this effect is short-lived and goes away after several days. Dr. John lee, a pioneer in bio-identical hormone research believes that bio-identical progesterone can benefit many women, especially if used during perimenopause, and will likely be found to decrease the risk for breast and other estrogen-responsive cancers that may well get their start during this time of life.

Cardiovascular Disease

There is a good reason to believe that the long term use of bio-identical low dose estrogen, balanced with bio-identical progesterone, would result in a very limited increase risk of breast cancer. Preliminary studies have shown that women who excrete the highest levels of estriol in their urine appear to have a lower risk of breast cancer. Progesterone plays many important roles in prevention of breast cancer. Bio-identical progesterone has been shown to reduce estrogen-receptor production on breast cells to decrease the production of estrogen within the first week or so of bio-identical progesterone use, since it initially increases estrogen receptors in the breasts. However, this effect is short-lived and goes away after several days. Dr. John lee, a pioneer in bio-identical hormone research believes that bio-identical progesterone can benefit many women, especially if used during perimenopause, and will likely be found to decrease the risk for breast and other estrogen-responsive cancers that may well get their start during this time of life.

Osteoporosis

The gradual loss of bone slightly increases during menopause, and then reverts back a year or so thereafter. A woman who enters menopause prematurely, for any reason, is at increased risk for osteoporosis unless she gets adequate hormone replacement during the years when her body would normally have been producing higher levels of hormones. HRT with estriol is effective against degenerative osteoporosis. Epidemiological and clinical data indicate that progesterone is active in bone metabolism. Progesterone appears to act directly on bone by engaging an osteoblast receptor or indirectly through competition for a glucocorticoid osteoblast receptor. Progesterone seems to promote bone formation and/or increase bone turnover. It is possible through estrogen stimulated increased progesterone binding to the osteoblast receptor, that progesterone plays a role in the coupling of bone resorption with bone formation.

Saliva Testing for Hormones

Why test saliva? In the past 20-30 years a number of research studies have validated saliva as a diagnostic medium to measure the unbound, biologically-active fraction of steroid hormones in the bloodstream. Saliva is a natural ultra-filtrate of blood, and steroids not bound by carrier proteins in the blood freely diffuse into saliva. The majority (90-99%) of steroid hormones in the blood are bound tightly to carrier proteins (cortisol-binding globulin, sex-hormone binding globulin, albumin) rendering them unavailable to target tissues. Steroids are very small lipophillic (fat-loving) molecules that, when released from the binding proteins and red blood cells in the blood, freely diffuse into tissues, which include the salivary gland and saliva. The steroid hormones most extensively studied in saliva are: Estrogens (Estradiol, Estrone, and Estriol), Progesterone, androgens (DHEA-s, Testosterone) and Cortisol for assessment of adrenal function. Saliva testing is used to guide the compounding of the patients initial dose of HRT. It identifies the hidden hormonal imbalances (deficiency or excess) associated with patient symptoms of menopause and andropause as well as reproductive disorders, chronic illness and diseases of aging. B & B Pharmacy offers this simple test to patients who want to retake control of their lives with HRT.

Advantages of saliva vs. serum testing:

  • Saliva measures the free, “bioavailable” fraction of steroid hormones that have moved out of the bloodstream (blood and urine measure total levels) and into the tissue
  • Saliva is the most reliable measurement of tissue uptake with topical hormone supplementation
  • Painless, noninvasive and needle-fee (stress of conventional blood draw can alter test results)
  • Private (home collection) convenient for both patient and doctor allows for optimal collection time
  • Hormones are stable in saliva at room temperature for weeks allowing for worldwide shipping
  • Transport of saliva samples to laboratory requires no special handling
  • Less expensive than convention blood testing

Test and fee schedule:

Comprehensive profile: Please contact our pharmacy at 562.866.8363 for detailed information.

Hormone Symptoms Key
Fibrocystic breast + E
– P
Weight gain
+ E – P
Heavy/Irregular cycle + E – P
Hot Flashes – E – P ^ E
Dry skin/hair – E
Anxiety – E – P
Depression – E + P – T + C – TH
Night sweats – E ^ C
Vaginal dryness – E – T
Headaches ^ E ^ P – T
Irritability + E ^ P
Mood swings + E – P
Breast tenderness – P + E
Insomnia/sleep disturbances – P – E + T
Cramps – P
Fluid retention – P + E
Breakthrough bleeding – P
Fatigue – T – TH + P – C
Memory loss – T – E
Bladder symptoms – E – T
Arthritis – T – P
Harder to reach climax – T – E – P
Decreased sex drive – T + E – C – TH
Hair loss + T ^ TH ^ E ^ P
E=Estrogen P=Progesterone T=Testosterone C=Cortisol TH=Thyroid
+=High -=Low ^=Fluctuating Levels
Please feel free to call one of our pharmacists if you have any questions.
Hormone Replacement Consultation with one of our compounding pharmacists that have extensive training and experience.
Information that will be covered during the consultation
  1. Medical history

2. Family history diseases related to natural hormone replacement

a. –Cancer 
b. –Osteoporosis

c. –Heart disease

3. Lifestyle changes related to natural hormone replacement

a. –Tobacco/alcohol
b. –Diet

c. –Exercise

  4. HRT (Bio-identical Hormone Replacement Therapy)

5. Life Stages

a. –Menopause —Pre menopause 
b. –Perimenopause –Andropause

6. Vitamin Supplements
7. Dosages of HRT for different life stages
8. Saliva testing (optional)
9. Final recommendation
10. Follow up—Triad–newsletter—direct mail
Medical History Form
Please bring your form with you when you meet with the pharmacist.

Patient Information:                                                          Today’s date: _______________

Name: _____________________________________      Birthdate: ___________________
Address: ____________________________   City: ___________ State: ____ Zip: _______
Home # ______________ Work # _______________ Email address: _________________
Payment type: ______ Credit card (MC/Visa/Discover) Cash: ______ Other: ____________
Insurance: _________________ ID # _________________ Group # __________________
Referred by____________________________
Doctor information: Are you currently under the care of a physician?  Yes _____ No _____
If yes, please list each doctor from whom you seek care:
Doctors name: ________________________ Phone # _____________________
Doctors name: ________________________ Phone # _____________________
Pharmacy Information: Are you using any other pharmacy? Yes _____ No _____
Pharmacy name _______________________ Phone # _____________________
Pharmacy name _______________________ Phone # _____________________

Lifestyle information:

Do you use?
Yes or No
If yes, how often and how much?
Tobacco (smoke, chew, dip)
Alcohol (beer, wine, hard liquor)
Caffeine (cola drinks, tea, coffee)

Do you exercise regularly? Yes: __________ No: ____________
If yes, describe what you do and how often: ______________________________________
Diet:  Describe your typical daily food intake:
First meal: ________________________________________________________________
Second meal: _____________________________________________________________
Third meal: _______________________________________________________________
Any snacks/others: _________________________________________________________
Medical status:
General Health: Excellent: ___ Good: ___ Fair: ____ Poor: ___ Height: ____ Weight: ____
Medical conditions/Disease: Please check all that apply to you:

__ Heart disease __ Lung condition __ High cholesterol
__ Cancer __ Ulcer __ Thyroid disease
__ Hormone related issues __ Blood clotting problems   __ Diabetes
__ Arthritis/Joint problems  __ Depression    __ Epilepsy
__ Headaches/Migraines __ Eye disease  __ Others: Please list: 

___________________________________________
Current prescription medication ___________________________________________
____________________________________________________________________

OTC Medications:

__ Pain reliever/ Aspirin __ Non steroidal anti-inflammatory __ Decongestants
__ Cough suppressants __ Antihistamines  __ Cough and cold combinations
__ Sleep aids __ Antidiarrheals __ Laxatives/Stool softeners
__ Diet aids __ Antacids   __ Acid blockers

List types (ex: Rolaids): __________________________________________________
Allergies: Please check all that apply
__ Penicillin    __ Morphine    __ Dye    __ Pets    __ Codeine    __ Aspirin    __ Nitrate        __ Sulfa drugs    __ Food allergies    __ Seasonal (pollen)    __ No known allergies            __ Others: Please describe when your reaction occurred and what you experienced: __________________________________________________________________________________________________________________________________________________
Childhood diseases: ________________________________________________________
Family history: Please list family members and relatives that may have important diseases such as high blood pressure, heart disease, cancer, diabetes, osteoporosis, etc. _________________________________________________________________________
Have you ever had your cholesterol level checked: ____ Date: _______ Results:_________
Have you ever had a mammogram: _____ Date: ________ Results: __________________
Have you ever had a bone density scan: _____ Date: _______ Results: _______________
Have you had your thyroid levels taken recently: _____ Date: ________ Results:_________
How did you arrive at the decision to consider prescription natural hormone replacement therapy?
Doctor: __________ Self: ___ Friend/Family member: __________ Other:__________
Have you ever used oral contraceptives: ___No___Yes  If yes, how long ______
Any problems ___Yes___No
How many pregnancies have you had? __________ How many children? ________
Have you had a hysterectomy: ___ Yes  ___No  If yes, date of surgery ___________
____Total ___Uterus only
Have you had a tubal ligation: ___ Yes ___No
Date of last pelvic exam: ____________  and pap smear: ______________
Age at first period: ____________
Since you first began having periods, have you ever had what you would consider to be abnormal cycles?  ___ No  ___Yes  If yes, please explain (age when occurred and symptoms): ________________________________________________________
_________________________________________________________________________

When was your last period: ___________________
How many days did it last? ___________________
Have you ever had Premenstrual Syndrome (PMS): ___ No  ___ Yes
If yes, explain symptoms: ____________________________________________________________
What are your goals for Bio-identical Hormone Replacement Therapy?________________________
_________________________________________________________________________________

What dosage form do you prefer? ___Cream  ___Capsules  ___Lozenges  ___Other
SYMPTOMS                             None               Mild           Moderate         Severe
Hot flashes                               ______          ______          ______          ______
Night sweats                            ______          ______          ______          ______
Vaginal dryness                       ______          ______          ______          ______
Incontinence                            ______          ______          ______          ______
Foggy thinking                        ______          ______          ______          ______
Memory lapse                          ______          ______          ______          ______
Tearful                                     ______          ______          ______          ______
Depressed                                ______          ______          ______          ______
Heart palpitations                    ______          ______          ______          ______
Bone loss                                 ______          ______          ______          ______
Sleeplessness                           ______          ______          ______          ______
Headaches                               ______          ______          ______          ______
Aches and pains                      ______          ______          ______          ______
Fibromyalgia                           ______          ______          ______          ______
Morning fatigue                      ______          ______          ______          ______
Evening fatigue                       ______          ______          ______          ______
Allergies                                  ______          ______          ______          ______
Sensitivity to chemicals          ______          ______          ______          ______
Stress                                       ______          ______          ______          ______
Cold body temperature           ______          ______          ______          ______
Sugar cravings                        ______          ______          ______          ______
Elevated triglycerides             ______          ______          ______          ______
Weight gain–waist                  ______          ______          ______          ______
Decreased libido                     ______          ______          ______          ______
Loss of scalp hair                    ______          ______          ______          ______
Increased facial or body hair  ______          ______          ______          ______
Acne                                       ______          ______          ______          ______
Mood swings                          ______          ______          ______          ______
Tender breasts                         ______          ______          ______          ______
Bleeding changes                    ______          ______          ______          ______
Nervous                                   ______          ______          ______          ______
Irritable                                    ______          ______          ______          ______
Anxious                                   ______          ______          ______          ______
Water retention                        ______          ______          ______          ______
Fibrocystic breasts                   ______          ______          ______          ______
Uterine fibroids                        ______          ______          ______          ______
Weight gain–hips                    ______          ______          ______          ______
Cystic ovaries                          ______          ______          ______          ______
Endometriosis                         ______          ______          ______          ______

**Please bring completed form with you for your consultation with a compounding pharmacist.
All pharmacist consultations include evaluation and interpretation of symptoms, dietary recommendations, lifestyle recommendations and a suggestive initial dosing of HRT with follow up evaluations and recommendations.