Recent “Oprah” shows have encouraged women to become informed about “Bio-identical Hormone Replacement Therapy” (BHRT) and to take charge of their health. BHRT uses hormones with a chemical structure that is identical to the hormones that the human body naturally produces - such as specific types of estrogen, progesterone, and testosterone. Christiane Northrup, MD (author of “Women’s Bodies, Women’s Wisdom” and “The Wisdom of Menopause”) and Prudence Hall, MD, discussed the science behind several of the major hormones, drug options and some of the basic differences between bio-identical and non-bio-identical hormones. Visit www.oprah.com for more information.
Unlike BHRT, the major form of commercially available estrogen that is prescribed for hormone replacement is NOT from a natural source such as soy that yields hormones which are identical to the hormones produced by the human body. Rather, the most commonly prescribed form of commercially available estrogen is “conjugated equine estrogens” that are derived from pregnant mare’s urine, and contain numerous estrogens, most of which are not found in humans.
You can be confident about the quality of all preparations compounded at our pharmacy. All pharmacies, whether traditional, combined traditional and compounding, or compounding-only, are inspected, licensed and regulated by their respective State Board of Pharmacy - not the FDA. Compounding pharmacies are also required to adhere to USP <795> and USP <797> guidelines, and submit preparations to independent laboratories for potency, stability, and (in the case of sterile products) sterility testing.
Like Dr. Northrup, we encourage women to find physicians who will partner with them and be open to finding the therapy that is most appropriate for solving their specific problems. Each woman has unique needs, and to paraphrase Suzanne Somers, needs to “feel alive while she is living.” Hormone replacement therapy should be monitored with laboratory testing, so that necessary dosage adjustments can be made. Proper nutrition, exercise and lifestyle are also vital for optimal health.
Our pharmacists welcome your questions about Customized HRT and can assist with the selection of quality nutritional supplements.
Physicians, nurse practitioners, or other health care professionals who would like to attend a seminar, with continuing education credit, on current options for Hormone Replacement Therapy can contact our pharmacist for a schedule of upcoming events.
"There is a silent health crisis in America... on average, American men live sicker and die younger than American women.î according to Dr. David Gremillion of the Men's Health Network. Men die at higher rates than women from the top 10 causes of death.
While the life-expectancy gap between men and women has decreased, it's no secret that men still need to pay more attention to their bodies. Several factors work against men: men tend to smoke and drink more than women; men don't seek medical help as often as women; and some men define themselves by their work, which can add to stress.
Improving men's health starts at home with individuals and families taking steps to live safer and healthier lives. The biggest threats to men's health can often be prevented. The Mayo Clinic compiled a list of the top seven threats to men's health:
#1 Heart disease
#4 Chronic lower respiratory diseases
#6 Type 2 diabetes
Understanding your health risks is one thing; taking action to reduce your risks is another. Make healthy living a part of your daily routine. There are numerous things you can do every day to improve your health and stay healthy, many of which don't take a lot of time and cost very little. We suggest the following healthy lifestyle choices. The impact may be greater than you'll ever know!
• Don't smoke, and avoid exposure to secondhand smoke. Within 20 minutes after smoking that last cigarette, your body begins a series of positive changes that continue for years. Ask us about help for smoking cessation.
• Eat a healthy diet.
• Manage high cholesterol and high blood pressure, and keep your blood sugar under control. Our pharmacist can help.
• Include physical activity in your daily routine.
• Get enough sleep. Insufficient sleep is associated with a number of chronic diseases and conditions, such as diabetes, cardiovascular disease, obesity, and depression.
• Maintain a healthy weight. We can recommend a weight loss program that is most appropriate for your needs.
• Limit alcohol.
• Manage stress. Ask us about adrenal support.
• Steer clear of pollutants. Minimize exposure to chemicals and outdoor air pollution.
• Take early detection seriously, and get regular health screenings. Screening tests can find diseases early, when they are easier to treat.
Testosterone therapy: Key to male vitality?
Testosterone is a hormone that peaks during adolescence and early adulthood. As men age, testosterone levels gradually decline - typically about 1% a year after age 30. Testosterone helps to maintain men's:
• Bone density
• Fat distribution
• Muscle strength and mass
• Cardiovascular protection
• Red blood cell production
• Sleep quality
• Motivation, self-confidence
• Sex drive
• Sperm production
Problems with some of the functions listed above can be a normal part of aging, or can result from low testosterone levels secondary to underlying factors including medication side effects, thyroid problems, depression and excessive alcohol use. Laboratory testing is the only way to diagnose a low testosterone level. Hypogonadism is the condition of having low levels of testosterone. Testosterone replacement therapy can improve the signs and symptoms of hypogonadism.
Our compounding pharmacist will work together with each man and his physician to customize medications in the strength and dosage form that are most appropriate for each individual, to minimize the risks and maximize the benefits of therapy.
Help improve the health of the men in your life!
Ask our pharmacist how we can help.
International Men’s Health Week is June 9-15, 2014. “Recognizing and preventing men’s health problems is not just a man’s issue. Because of its impact on wives, mothers, daughters, and sisters, men’s health is truly a family issue,” said U.S. Congressman Bill Richardson. Knowing that on average, men smoke more, drink more, see doctors less, and die five years sooner than women, we want to encourage men to take care of their health. Many of the major health problems that men face, such as colon cancer and heart disease, have better outcomes with early diagnosis and treatment. We encourage all men (and women!) to schedule regular wellness checkups and know your cholesterol, blood pressure, and glucose levels.
Another important value that is not always measured is testosterone (“free” testosterone indicates the bioactive form). “Low T” or testosterone deficiency is strongly associated with common medical conditions including metabolic syndrome, obesity, diabetes, hypertension and atherosclerosis; as well as elevations in triglycerides (TGs), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C). Other signs and symptoms include:
• Diminished sex drive and sense of vitality
• Erectile dysfunction
• Reduced muscle mass and bone density
• Increased fat mass
Evidence indicates that appropriate therapy can relieve or partially reverse the progression of these problems in testosterone-deficient men. Transdermal therapy facilitates adequate absorption of testosterone to mimic the normal daily production. Testosterone can also be administered as a sublingual drop or a lozenge that dissolves in the mouth. Compounded preparations can be very advantageous because customized therapies increase compliance.
The presence of prostate or breast cancer is an absolute contraindication for testosterone replacement therapy, or use of other hormones in this class, known as androgens. Guidelines recommend that testosterone therapy should not be started in older men with PSA serum levels above the normal range. Testosterone should be used with caution in men with severe heart, kidney or liver disease, increased red blood cell counts, and sleep apnea.
A healthy lifestyle is associated with higher hormone levels, and higher hormone levels seem to induce a more active, healthier lifestyle. For optimal results, it is vital that hormone replacement therapy be combined with adequate exercise, proper nutrition, weight management and treatment of other health problems.
Talk to our compounding pharmacist to learn how we can help in your journey to live well.
J Endocrinol. 2014 Jan 27;220(3):R37-55.
The use of hormones for rejuvenation is increasing with the aging of the Baby Boomer population. Exogenous testosterone and anabolic androgenic steroids suppress intratesticular testosterone production, which may lead to decreased sperm production. Men desiring children at a later age may be unaware that treatment with testosterone and use of anabolic androgenic steroids has well-established detrimental effects on sperm production, but sperm production may recover after therapy is stopped.
When male fertility is a concern, the following approaches may be considered:
• Change in lifestyle to include strength training, a healthy diet, and decreased consumption of alcohol and nicotine
• Weight management
• Use of aromatase inhibitors such as anastrazole, chrysin, resveratrol and/or zinc to decrease aromatase activity and conversion of testosterone to estradiol, simultaneously affecting two potential causes of male infertility
• Use of 5-alpha-reductase inhibitors such as progesterone and/or saw palmetto to decrease 5-alpha reductase activity and conversion of testosterone to DHT
It is important to consider additional endocrine imbalances, including all hormones and cortisol, along with stress evaluation and reduction, to have a complete picture of factors contributing to sexual dysfunction.
Fertil Steril. 2013 Jun;99(7):1814-20.
Erectile dysfunction (ED) is highly prevalent, affecting up to half of men in their 50-70s. General interest toward ED has exploded since the introduction of “phosphodiesterase type 5 inhibitor” (PDE5i) drugs such as sildenafil (Viagra®). In the last decade, the time lapse between first symptoms of sexual disorders and seeking of medical advice has greatly decreased. However, none of the PDE5i drugs are curative, but only treat the symptoms of ED. ED is associated with unhealthy lifestyles, such as smoking or overweight, and other health problems such as hypertension, diabetes mellitus, and neurological disorders. It is well accepted that testosterone levels are a good marker of sexual and physical health, and lower levels of testosterone often correlate with poor health. However, several other hormones, including LH, prolactin, TSH, and FT4 are involved in sexual functioning and should be investigated in men with ED.4
In contrast to women who experience a sudden drop in estradiol levels around the time of menopause, the age-related drop in testosterone in men is more gradual at 0.5–2.0% per year from early adulthood onwards. Sex hormone binding globulin (SHBG) binds hormones, and as levels of SHBG rise with age by 1–2% per year, the decline in free testosterone (the active form) is 2–3% per year.5
Male hypogonadism (low testosterone levels), caused by problems within the hypothalamic-pituitary-testicular (HPT) axis that regulates testosterone production, is an under-diagnosed condition. By contrast, late onset hypogonadism (LOH), where low testosterone levels are associated with age-related illness, may be less common than previously believed. Testosterone levels are commonly lower in men with metabolic syndrome, type 2 diabetes mellitus, obesity, depression, obstructive sleep apnea, chronic kidney disease or anorexia nervosa. In addition, certain medications, in particular cortisone-like drugs and opiolds (painkillers such as morphine, oxycodone or methadone), reduce testosterone levels. It is important to consider other hormones and cortisol, along with stress evaluation, to have a complete picture of factors contributing to sexual dysfunction.6
Testosterone replacement is recommended for treatment of symptoms of testosterone deficiency, after the physician excludes contraindications following physical examination and lab work. Men with low testosterone levels typically respond very well to testosterone replacement therapy and show a marked improvement in sexual function, sense of well-being and energy levels, and maintenance of secondary sexual characteristics.
Testosterone therapy may suppress sperm production. When male fertility is a concern, the following approaches may be considered:
• Change in lifestyle to include weight management, strength training, a healthy diet, and decreased consumption of alcohol and nicotine
• Use of aromatase inhibitors such as anastrazole, chrysin, resveratrol and/or zinc to decrease aromatase activity and decrease conversion of testosterone to estradiol, simultaneously affecting two potential causes of male infertility
• Use of 5-alpha-reductase inhibitors such as progesterone and/or saw palmetto
Our compounding pharmacist will work together with each patient and practitioner to customize therapy to meet individual needs.
1 J Sex Med. 2014 May;11(5):1262-70.
3 J Sex Med. 2013 Oct;10(10):2443-54.
4 Endocrine. 2014 Aug;46(3):423-30.
5 Aust Fam Physician. 2014 May;43(5):277-82.
6 Fertil Steril. 2013 Jun;99(7):1814-20.
We want to keep our community up to date on the newest studies and recommendations. In September 2015, the American Association of Clinical Endocrinologists issued a position statement that testosterone replacement should be considered for treatment of symptomatic men who have low total and/or free testosterone levels based on at least two early morning blood samples. Epidemiologic studies (which examine the cause of disease) associate low testosterone levels with cardiovascular events and death and note that testosterone-replacement therapy improves cardiovascular risk factors, including reduced fat mass, increased muscle mass, and decreased insulin resistance.
A multicenter randomized controlled trial found that testosterone replacement therapy was associated with significant decreases in waist circumstance and serum triglyceride; with significant increases in muscle mass, serum hemoglobin, and a positive effect on erectile function.
Another study reported that the benefits of restoring serum testosterone in men with low testosterone levels were similar in men older than 65 years of age and younger men. Also, there were no indications that side effects were more severe in elderly men.
Our compounding pharmacist works together with men and their physicians to customize therapies that meet each individual’s unique needs. If you or a man you care about is experiencing a loss of physical or mental vitality, ask our pharmacist how we can help.
Endocr Pract. 2015; 21:1066-1074
Horm Mol Biol Clin Investig. 2015 Jun; 22(3):111-7.
Asian J Androl. 2015 Mar 10. [Epub ahead of print]
Korean J Urol. 2015 Apr; 56(4):310-7.
As men age, testosterone levels gradually decline. Commonly known as andropause, low testosterone levels (scientifically termed hypogonadism) lead to decreased well-being, increased risk of cardiovascular disease and loss of muscle, increased risk of Type 2 diabetes and other metabolic syndrome diseases, reduced sexual function, and bone loss.
Benefits of testosterone replacement therapy (TRT) are clearly established: improved sexual function, increase in lean muscle mass and strength, mood and cognitive function, with possible reduction in frailty and osteoporosis. Therefore, it comes as no surprise that an increasing number of men worldwide have begun requesting testosterone replacement therapy from their physicians.
There is no evidence that TRT is associated with increased risk of prostate cancer or symptomatic benign prostatic hyperplasia. The cardiovascular issues associated with TRT have been clarified by recent studies showing clearly that increased testosterone levels are associated with reduced mortality. Studies reporting to show increased risk have been subject to flawed designs with inadequate baseline diagnosis and follow-up testing.
An extensive review of the testosterone replacement therapy literature reveals that the majority of clinical studies show that properly administered testosterone replacement therapy, in which estradiol and dihydrotestosterone levels are also controlled, does not increase the risk of cardiovascular events. Testosterone replacement therapy should be monitored, and when needed, an aromatase inhibitor such as anastrazole should be added to control estradiol levels that tend to increase with testosterone therapy; as well as an a 5α-reductase inhibitor, such as dutasteride or finasteride to control dihydrotestosterone (DHT) levels. Dutasteride controls both Type I and Type II 5α-reductase while the older drug finasteride controls only Type II. If a patient receiving testosterone has high DHT levels while taking finasteride, it may be helpful to switch to dutasteride.
At the recommendation of the National Association of Boards of Pharmacy, we suggest that patients should always seek medical attention immediately if symptoms of a heart attack or stroke are present, such as:
• Chest pain
• Shortness of breath or trouble breathing
• Weakness in one part or one side of the body
• Slurred speech
Testosterone therapy is available in many forms, and transdermal preparations that are applied to the skin are quite popular. Creams are easy for the patient to use and many health care professionals and patients prefer daily administration of testosterone to long-lasting pellets and injections.
Another option is compounded troches, which offer these benefits:
• Decreased risk of cross contamination, i.e., men need not be concerned about others contacting the site of application, such as the arm or leg when a child or pet is held.
• Rapid buccal or sublingual absorption means the dose can reduced compared to that required for transdermal forms of testosterone.
• Patients can quickly achieve peak levels when desired.
We welcome your questions. Our compounding pharmacists work together with physicians and their patients to customize medications by prescription based on each patient’s unique needs.
Ther Adv Urol. 2016 Apr;8(2):147-60.
Aging Male. 2015;18(4):205-6.
Int J Pharm Compd. 2015 May-Jun;19(3):195-203.