Frequently Asked Questions about Compounding, Hormone Balancing and Saliva Testing
What is compounding and why is it needed?
“Compounding is the creation of a particular pharmaceutical product to fit the unique needs of a patient. To do this, Compounding Pharmacists combine and/or process appropriate ingredient(s) utilizing various tools. This may be done for medically necessary reasons, such as to change the form of the medication from a solid pill to a liquid, to avoid a non-essential ingredient that the patient is allergic to, or to obtain the exact dose needed. It may also be done for voluntary reasons, such as adding favorite flavors to a medication.” (http://en.wikipedia.org/wiki/Compounding)
What are the different dosage forms used in compounding?
An advantage of compounding is that not only can we dose very precisely, we can also prepare your medication in a variety of dosage forms. For example, if a pill isn’t working, we can prepare it in a cream. If a child couldn’t swallow a pill, we could make a liquid, with your choice of flavors. Other options are troches (lozenges) or tablet triturates that dissolve under the tongue, suppositories, vaginal creams, nasal sprays, and more. Essentially, you tell us the way you prefer to deliver the drug, and our hormone balancing pharmacy in Salt Lake City will take care of the rest.
What are the Human Hormones?
Estrogen, Progesterone, Testosterone, and DHEA are the primary human sex hormones. Cortisol or hydrocortisone is a stress hormone that is regulated by the adrenal glands.
What does BHRT or HHRT mean?
HRT is Hormone Replacement therapy in general. BHRT stands for Bioidentical Hormone Replacement Therapy, meaning that the hormones used have the same 3-D shapes as those found naturally in your body. HHRT means Human Hormone Restoration Therapy, in practice, it is a more specific description of BHRT.
What is the difference between natural and synthetic hormones?
Natural hormones, used in BHRT are chemically identical to those found in the body. Synthetic hormones have similar effects as those found in the body, but since they are not chemically identical to those found in the body, they can have many unwanted side effects.
What are the costs, and what about insurance?
Generally, we start at $36.95 per month for a single hormone compound. For multiple hormones, our price is usually $63.95 per month. Roughly half of insurance plans pay for compounded medications. Come in to our hormone balancing pharmacy in Salt Lake City and ask about your own plan.
What is Saliva Testing?
Saliva testing is an easy, painless, noninvasive method that simply requires spitting into a tube and sending it to a lab (we use ZRT Labs). About a week after you send in your test you get back the test results, which you can then review with a doctor or nurse practitioner to evaluate your hormone needs. This helps the doctor more precisely prescribe you the dose you need.
What is tested?
Generally, a five-hormone panel is tested, which includes, Estradiol (E2 a form of Estrogen), Progesterone (Pg), Testosterone (T), DHEA (DS, Dehydroepiandrosterone Sulfate) and morning cortisol (C1). Each hormone is $30, for a total of $150. It does not require a prescription, but with a prescription, if you have insurance, we can supply you a form to submit to them for reimbursement. Please be aware that insurance reimburses less than 50% of the time.
Premenstrual syndrome (PMS) is a collection of physical and emotional symptoms related to a woman’s menstrual cycle, such as bloating or breast tenderness, defined as a consistent pattern of emotional and physical symptoms that are of “sufficient severity to interfere with some aspects of life”, occurring during the ten days prior to menses and vanishes either shortly before or shortly after the start of menstrual flow. A common treatment for PMS is progesterone taken the last two weeks of the cycle, along with a good vitamin supplement.
Menopause is defined as one year with no periods. Onset is generally in the late 40s to early 50’s. At this stage women’s hormones are often unbalanced, and women commonly experience hot flashes, night sweats, vaginal dryness, sleep disturbances, and decreased libido (sex drive). Menopausal symptoms should first be documented by either saliva or blood testing. We prefer saliva testing because it gives us more precise, useful information. In most cases, women with symptoms will show signs of low progesterone and often low estradiol (a form of estrogen) as well. Less commonly, they will show signs of low Testosterone or DHEA.
Treating Menopausal Symptoms
As a pharmacy, we would work with you and your practitioner to supplement these hormones back to minimum levels for your body to perform normal functions. Generally, this reduces symptoms. Sometimes, the treatment works within one day, and sometimes it takes a period of 3 to 4 months. We encourage people to try it for at least 4 months. We can make changes as needed. We prefer that you use our pharmacy, and can ship it to you if you are not able to come in. If you can’t come to Jolley’s Compounding Pharmacy, we would recommend you use a PCCA trained compounding pharmacy that you can trust—not all compounding pharmacies are created equal. For hot flashes, night sweats, and similar menopausal symptoms, if the patient is found low in all four tested hormones, she is usually prescribed a topical cream applied to the thighs or other areas of the skin once or twice daily. Alternatively, lozenges or troches are used. This would usually be priced at $63.95 for a 30-day supply. In addition, a progesterone capsule is given at night to help with sleep. Your body processes it differently than the cream, so both forms are typically needed. It usually runs at $36.95 for a 30-day supply.
Perimenopause is the term used to describe the menopause transition years, from around 35 to early 50’s. Some symptoms include hot flashes, mood changes, insomnia, fatigue, and memory problems.
For those who have had frequent miscarriages, and have what is called “Luteal Phase Deficiency” supplementing progesterone from time of ovulation to the 13th week of pregnancy is often prescribed.
Low sex drive (libido)?
Topical Testosterone in low doses applied vaginally (a method made popular years ago by Oprah) has been prescribed to help in this area. We have other treatment options that we can discuss if you are interested.
If a saliva test shows high cortisol, phosphatidylserine capsules are often recommended to help with stress and mental acuity. Adrenotone capsules three times a day is often recommended to support the adrenal glands with high or low cortisol for people dealing with stress over long periods of time, often resulting in adrenal exhaustion.
How else can compounding help?
Compounding has many applications, only one of which is BHRT. Our hormone balancing pharmacy can also prepare pain medication in various dosage forms if a pill isn’t working, or if you have particular needs. We can prepare prescriptions for pets in a similar way with flavors to help, such as tuna fish flavor for cats or liver for dogs. We have MANY different flavors, ranging from mint and orange to piña colada.