Compounded or Individualized Hormone Therapy is the Best

In news stories repeatedly echo that compounded hormone therapy is ‘off label’ or ‘experimental’ or that, a physician has gotten reprimanded for biodentical hormone therapy claims that are unsubstantiated. You can read one such news story here. However women in the US have been limited to options that do not contain individualized dosing or dosing with testosterone. There are options in compounded therapy that do not exist in regular prescription therapy, so compounded therapy may be your personal best option.

For good references regarding hormone therapy in general refer to Menopause.org the website of The Menopause Society. Some physicians feel that most of the prescribing of bioidentical hormone therapy is based on faulty research, overstated claims, and the prescription of unsafe medications. However, that too is overstating the risks and there are some women that need unique therapies that cannot be gotten other than by bioidentical therapies. Consultation, re-evaluation as you age, and alternative choices is what is best for each woman.

1. Many menopausal complaints can be treated the most safely and effectively with standard prescribed hormonal therapy. This may be an Estrogen Therapy with estrogen alone, or a combination therapy with Estrogen and Progesterone. Both these types of therapy come in a variety of types of medications and dosages. The combination therapy is usually recommended for those who have not had a hysterectomy.
2. Standard therapies that are not specifically compounded cannot provide natural testosterone.
3. No standard therapies have been shown effective for effects on libido, but treatment of sexual dysfunctions may be possible.
4. For women who have libido or sexuality issues not treated by standard therapies compounded options are available.
5. For women with peanut allergies, they can get compounded progesterone with a canola oil base.
6. The compounds prescribed have to be made individually each time you receive them, thus there are inevitable variances in what you are receiving that have been shown by research to have greater fluctuations than standard pharmaceutical preparations.
7. Not all variations of hormones are available by compounding. Prescription therapy has a wider variety of types of medications, delivery systems, and combinations than are available through compounding. Prescriptions have hormonal medications that aren’t even hormones but act on the hormone receptors.
8. No long term studies on compounding have been done, but some of the data on long term studies like Women’s Health Initiative can give us information that is applicable to compounded therapy.
9. Compounding hormones therapy some times paired with laboratory testing that has not been validated, such as saliva testing. That testing can lead to confusing results. Testing cannot always determine dosing because bio-effectiveness varies based on many factors in your physiology. It is important to remember a lot of hormone testing, whether you are doing blood, saliva, or urinary testing is just a snapshot of your levels, not always the whole picture.
10. The same risks for side effects and complications exist whether hormone therapy is compounded or not. These risks should be reviewed on an ongoing basis.
11. Many women’s health organizations do not endorse compounded therapy. While off label medication is commonly prescribed in medicine, it’s good to understand that if you are taking compounded therapy, it likely is an off label use not specifically FDA approved for the indication you are using medicine.
12. The whole topic is very complicated and should be discussed with providers, hopefully one Certified by NAMS, the Menopause Society, as Dr. Trupin is.