Custom-Compounded Hormones
Custom-Compounded Hormones
Recently, there has been increased interest in custom-mixed (“custom-compounded”) hormone products— recipes containing one or more of various hormones in differing amounts, depending on the individual prescriber’s order.
The recipe contains not only the active hormone (or hormones), but also other ingredients that either hold everything together (in the case of a rectal suppository, an under-the-tongue tablet, or an under-the-skin pellet) or provide a vehicle for applying the product onto the skin (such as a cream or gel) or into the body (such as a liquid for a nasal spray). These custom products have the benefit of individualized doses and mixtures of products that are not available commercially.
However, risks have also been identified. Although the “active ingredients” (the raw estrogen and/or progestogen components) are government approved, the mixtures are not, because they have not been studied to confirm that they are absorbed appropriately or provide predictable levels in blood and tissue. Thus, there is little or no scientific evidence about the effects of these hormones on the body, either good or bad.
Custom-Compounded Hormones : Is it Saffer?
Custom hormones have been promoted as being better or safer than other hormones that are available commercially. For instance, one popular mixture called Tri-Est contains three estrogens, including estriol—a type of estrogen not available in patented products.
Unsubstantiated claims have been made that Tri-Est (or estriol alone) has the benefits of patented estrogen products without increasing certain risks, such as breast and uterine cancer. Although estriol is a weak estrogen, it can still have a stimulatory effect on the breast and uterine lining. Most information promoting these products as safer is not supported by good scientific research. Until more is known, women with a uterus who use estriol containing products in any form except a low-dose vaginal cream for atrophy should also use a progestogen to protect the uterus. Studies have not determined what effect estriol has on the risk of breast cancer or cardiovascular disease.
Although many pharmacies have a long history of providing a wide range of compounded products, the fact that preparation methods vary from one pharmacist to another, and from one pharmacy to another, means that women may not receive consistent amounts of medication. Inactive ingredients may vary and there can be batch-to-batch differences. Reliable sterility and freedom from undesired contaminants are also concerns. Expense is also an issue, as some custom-compounded preparations tend to be more expensive and are not covered by insurance plans.
Custom-Compounded Hormones: The bottom line Notices
Custom-compounded hormones may relieve menopause symptoms, but should be used only by women who cannot tolerate commercially available preparations and who accept the risks. They should not be used to prevent osteoporosis.
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