Bio-identical/natural hormones & compounding pharmacy

Hello,

I had my TAH-BSO a little over 5 months ago. I started on the Climara .1mg patch as soon as I was transferred to my room. The only problem I had with the Climara patch was that it didn't stay on for the full 7 days (no matter what I did). About 3 weeks ago, I switched to the Vivelle Dot .1mg. I love the fact that it stays on.....however, I'm just not feeling quite right. Started having some night sweats, low libido, and really weepy!

I saw my GP on Friday and I had a blood test for a complete hormone study. Yeah! My gyno. is the one who prescribed the Climara and then switched me to Vivelle and even though I've asked/suggested for a blood test to check my hormones, she didn't think it was necessary..??

My GP said she works with a compounding pharmacy and has great success with other patients. I've read here where some of you ladies use the patch in addition to compounded testosterone and/or progesterone.

I guess what I would like to know is, do you get the patch from the regular pharmacy or the compounding pharmacy? The compounding pharmacy becomes necessary if I need testosterone or progesterone? If the .1mg patch isn't the right strength for me, then the blood test will show this and my GP will adjust the dosage? Is there a compounded estrogen (pill or cream?) Or is the .25mg dosage increment the only way to get estrogen (I'm talking about the patch)?

Some good info I've read here was not to have the hormones mixed, so it would be easier to adjust each individual hormone. Sorry this is so long! But, any info would be very helpful.

Thanks,

Sharron

Hi Sharron

The estrogen patches come from the regular pharmacy and the compounded progesterone and testosterone come from a compounding pharmacy. Compounding pharmacies can make estrogen for oral use in the form of drops, troches or pills and they can also be made in the form of a cream for rubbing into the skin.

Vivelle comes in 0.025, 0.0375, 0.05, 0.075 and 0.1 strengths and the estrogen is Estradiol. Compounded estrogens are usually Tri-est which contain Estradiol, Estriol and Estrone and Bi-est which is made of Estriol and Estradiol. The ratios of those estrogens can be changed as well as the strength of the pill or cream. For example, I started out on Tri-est with a ratio of 80/10/10 in a 2.5 mg pill but it was changed to a ratio of 50/40/10 in the same 2.5 mg pill. As you can see, it's quite flexible to allow for individual needs.

Blood tests are good for showing when we're way out of balance but I'm not a big fan of them in general. While my results were all within the range of normal, I felt anything but normal! The tweaking was done based both on symptoms and test results. I had blood drawn again on Friday (over a year later) but I was very clear with my doctor that I didn't care how nice the numbers look on paper, I'm more concerned with how I feel.

Working with a knowledgeable doctor and compounding pharmacist is a great combination! I hope you have success with whatever you decide is right for you!

s

Hi April Dawn,

Thanks for your reply. I had heard of tri-est and bi-est, but didn't realize they were compounded estrogens. I understand that lab results aren't always the answer to the problem and fortunately, so does my GP. She treats me for hypothyroidism and doesn't pay too much attention to what the test results say. We go mostly by the way I feel. And hopefully, this will also be true for my other HRT.

I have an appointment with the Dr. at the compounding pharmacy for a consultation. I suppose he and my GP will decide, based on my symptoms and lab results, what hormone and ratios they think I should start with. Is this pretty much how it goes?

I'm currently paying cash price for my patches because my insurance doesn't cover it. It covers estrace in pill form, but I prefer the patch. About how much do the compounded hormones cost?

I'm glad my GP is willing to take this extra step, but I'm a little nervous about the tweaking phase. But, I guess on the bright side, maybe I'll start feeling better!

Thanks,

Sharron

Sharron,

I had to fill out an extensive questionnaire before I had my consultation. The hour-long consult went over my "score" from how I answered the questions as well as an explanation of hormones and what they do. I didn't have bloodwork done for my first compounds but did after being on them for three months. That's when the tweaking was done.

Compounds will vary in price, I'm sure. Mine run $32 each but I get a discount if I get more than one refilled at the same time. For example, my Tri-est and Progesterone always run out at the same time so I always get refills on both. I pay $32 for one and $16 for the second. On those rare times when I refill all three, I pay the $32 for the first and $16 for each of the other two. Not a bad deal, especially on the testosterone which will last me four months or more! On top of that, I submit my expenses to my insurance company and get refunded at the rate of 60%.

Don't worry about the tweaking phase. I'm waiting to hear what my next tweaks will be but I really trust the team I have working with me so I don't dwell on it.

Let us know how it all goes, okay?

s