NHRT prescribing information for practitioners
Basic prescription order sheet for Bio-Identical Natural Hormones (Print, Fill Out, and Fax)
Triiodothyronine (Thyronine or T-3)
Through the use of plant-derived hormones that are biologically identical to those naturally occurring in humans, relief from imbalance and physical discomfort is within your reach. Bio-identical hormones can be adjusted to your individual needs by a qualified team consisting of your doctor an/or nurse and your compounding pharmacist. With appropriate testing of hormone levels and symptom analysis, your health care team can help to slow the progression of age-related conditions such as osteoporosis (brittle bones) and cardiovascular degradation (heart disease). Relief of menopausal symptoms, endometriosis, PMS, libido loss, and vaginal dryness (&/or vaginitis) are other conditions which respond to bio-identical hormone replacement.
With customized natural bio-identical hormone therapy, your body will respond in a more natural and predictable way to supplementation that could add years and quality to your life.
For our contribution to the medical team, we offer different dosage forms to suite patient needs and the requirements set by the prescriber.
Transdermals consist of creams, gels and ointments to deliver the appropriate hormones. With new delivery devices, we can prepare a product that is easy to use and gives an accurate measurement.
Sublingual dosing may be in the form of drops or lozenges (troches). With a choice of sugar-free flavorings and proper selection of vehicles, we can customize a formulation that is both palatable and medically reasonable.
Capsules (usually in olive oil or safflower oil) are another option for those cases where oral dosage is the preferred route. We also prepare slow release capsules.
Acology (ah-kol'o-je)[Gr. Akos cure + -logy] The study & application of remedies and therapeutics.
It's our name and it's what we do. In fact, compounding is all we do.
Mike Coppedge, Pharm. D., R.Ph., Compounding Specialist
Back to top
What are hormones?
In simplest terms, hormones are chemical messengers that course through our bloodstream and enter tissues where they turn on switches to the genetic machinery that regulate everything taking place in our bodies. Hormones can be thought of as the life giving force that controls our physical, mental, and emotional well being.
Where are hormones made in the body?
Different glands and organs throughout the body produce hormones. For example, the pancreas produces the hormone insulin, whereas the ovaries produce estrogens and progesterone. Other glands such as the pituitary and hypothalamus in the brain secrete hormones such as FSH (follicle stimulating hormone) and LH (luteinizing hormone) that control how much estrogen and progesterone are produced by the ovaries. LH stimulates production of testosterone in the testes for men.
Where do these natural hormones come from when prepared by a compounding pharmacy?
Natural hormones are obtained from sterol analogues found in many varieties of plants, primarily soybean and wild yam. These estrogen and progesterone like compounds are then transformed in the laboratory to the human bio-identical natural hormones.
What is estrogen?
There is no one hormone called estrogen. Estrogen is actually the name of a class of hormones. The three major estrogens produced by women are estriol, estradiol and estrone. Estradiol is the most potent of the three, is the most stimulating to the breast tissue, and is the strongest symptom reliever for hot flashes, night sweats and other deficiency symptoms.
What is natural progesterone?
Progesterone, a naturally occurring hormone in both men and women, is essential for many vital functions in the human body. The ovaries produce the majority of progesterone, but only if ovulation occurs. As women approach menopause, less progesterone is produced. Progesterone deficiency is responsible for many of the symptoms associated with menopause. Progesterone's many functions include improving sleep, naturally calming, balancing body fluids, improving fat metabolism, promoting bone formation, possible protection against breast cancer and protecting the uterus against cell proliferation. Progesterone also balances the effects of estrogen and should always be taken in conjunction with estrogen therapy even after hysterectomy.
What are androgens?
Androgens (testosterone, DHEA, androstenedione) play an important role in tissue regeneration, especially the skin, bones, and muscles. The principal androgen in both men and women is DHEA. DHEA levels decline with age, and in some cases, supplementation with DHEA can restore energy, improve immune function, lift depression and improve mental function. Testosterone is involved in maintenance of lean body mass, bone density, skin elasticity, sex drive and cardiovascular health in both sexes. Men make more of this hormone, accounting for their greater bone and muscle mass. Androstenedione is a precursor for both estrogens and testosterone, especially in females. It can be produced in excess by the ovaries, especially during early menopause, and can cause some of the "androgenic" symptoms such as scalp hair loss and facial hair growth. This is somewhat over simplified. Scalp hair loss is believed to actually be caused by a metabolite of testosterone.
Why do I need testosterone?
Women's ovaries and adrenal glands do produce testosterone. Every woman will experience a drop in estrogen and testosterone production during menopause. Testosterone is important in maintaining sexual desire, as well as strength and integrity of skin, muscle and bone. Low levels of testosterone will result in a decreased sex drive, fatigue and decreased sense of well being.
Testosterone levels start decreasing at about the age of 30. It is called andropause. Since it is a slower change than what women experience, men typically do not see these changes occurring. Symptoms include loss of muscle mass, sex drive, energy, and sense of well being. In some cases, it can even effect ambition and competitive spirit.
Can Natural Hormone Replacement Therapy (NHRT) cause side effects?
Bio-Identical NHRT's goal is to restore and maintain a physiological status. If hormone levels were normal from age 20 to 40, replacing them to restore the same level that was well tolerated for 20 years is unlikely to cause any serious side effects in later life. The risk is further reduced if only natural hormones are used. However, any type of medication can have side effects if not administered properly. The scientific studies show that the potential benefits of HRT are great, whereas, overdosing to excessive level causes most problems reported from HRT. To insure safety, hormone levels should not be raised above a normal youthful range, and side effects can often be relieved with a dosage adjustment.
How Are Natural Hormones Available?
Bio-Identical Natural hormones can be prepared in a dosage form convenient to each individual patient. We are no longer limited by the "one size fits all" medications that pharmaceutical manufacturers sell. Natural hormones can be made as capsules, topical creams, vaginal suppositories, injectables and sublingual liquids or tablets.
How long should I take hormones?
The best answer is "as long as it is needed". The length of time will be different for each person, depending upon their current health and the chances of developing other serious diseases later on in life. That's one reason why it's so important to have regular health check-ups.
How do I get started on Natural Hormone Therapy?
Natural Hormone Replacement Therapy must be customized for each person. Only after a thorough review of symptoms and history can an effective regimen be designed. You may want to discuss your interest in Bio-Identical Natural Hormone Therapy with your current health practitioner to determine if he/she is comfortable with it. Some are already very knowledgeable, others are interested and want to learn more and still others are closed minded and do not want to be bothered with it. If you need help finding a practitioner that will work with you, call us for a referral to one who will. We are available to help educate your practitioner and help him/her to determine appropriate dosing. A triad between patient, physician and pharmacist is essential to achieving optimal therapy.
What alternatives exist?
Certain herbs mimic some of the symptom relief characteristics of natural hormones. Several pharmaceutically manufactured hormones also help. However, they are not as close to bio-identical as we would like for them to be. Bio-identical means that the hormone is exactly the same as what your body produced in greater quantity when you were younger. Your body has thousands of receptor sites that are found in all areas. That is why bone density, cardiovascular health, headaches, mood, bruising, night sweats, hot flashes, depression, libido, weight, fluid retention, energy and so on are affected by hormone levels. If you were ever pregnant, think about how many body and mind alterations occurred with the hormone changes that took place.
Here is an analogy that helps to visualize why bio-identical is important.
Imagine your body organs as being thousands of doors that open and close to control body functions. Think of receptor sites as being locks on those doors that can either allow the doors to open (to let something happen) or stay locked (to prevent things from happening). Now let's imagine hormones as being the keys that may or may not work in these door locks.
Several kinds of keys can exist.
Bio-identical hormones are like #3- they fit lock and allow it to open.
Similar hormones can be like #2- they fit lock but will not allow it to turn to open. Additionally, they occupy the keyhole so that the right key (hormone) can't get into keyhole to unlock the door.
Useless hormones can be like #1. No value but at least no harm.
Certain Herbs and pharmaceutical synthetic hormones are a mixed bag of keys. A little of #1, 2, and 3. That is why they can cause unnatural side effects and discomfort. Premarin for example contains equine hormones (natural to horses not humans) in additional to some hormones that are common to both humans and horses. Many herbs are the same way- a little of this and a little of that- some good some not so good.
Can I get Natural Replacement Hormones from any pharmacy?
Most pharmacies will not compound medications because they do not have the training, time, equipment or staff to manage the special demands of the patients and physicians. The Acology Prescription Compounding Center has a highly trained staff and state of the art equipment to provide quality compounding services.
Back to top
Estriol is the weakest of the three major estrogens. In fact it is 1000 times weaker in its effect on breast tissue. Estriol is the estrogen that is made in large quantities during pregnancy and has potential protective properties against the production of cancerous cells.
An important article in the 1966 Journal of the American Medical Association by H.M. Lemmon, M.D., reported a study showing that higher levels of estriol in the body correlate with remission of breast cancer. Dr. Lemmon demonstrated that women with breast cancer had reduced urinary excretion of estriol. He also observed that women without breast cancer have naturally higher estriol levels, compared with estrone and estradiol levels, than women with breast cancer. Vegetarian and Asian women have high levels of estriol, and these women are at much lower risk of breast cancer than are other women. Estriol's anticancer effect is probably related to its anti-estrone properties-it blocks the stimulatory effect of estrone by occupying the estrogen receptor sites on the breast cells.
Estriol is the estrogen most beneficial to the vagina, cervix and vulva. In cases of vaginal dryness and atrophy, which predisposes a woman to vaginitis and cystitis, intra-vaginal estriol is the most effective and safest estrogen to use. Because of the increase in secretions and reduction of pH, estriol is better than estradiol for the prevention of recurring urinary tract infections. It can be of significant help in cases of dry or uncomfortable sexual activity.
None of the American drug products contain Estriol, so it is not available in most drug stores, although it has been used widely in Europe for over fifty years. Because estriol cannot be patented it does not hold much interest for the pharmaceutical industry. Its availability through compounding has caused its use to grow rapidly throughout the country.
Back to top
Estrone is the estrogen most commonly found in increased amounts in post menopausal women. The body derives it from the hormones that are stored in body fat. Estrone does the same work that estradiol does, but it is considered weaker in its effects.
Back to top
Tri-est is a combination of three estrogens: estriol, estradiol and estrone. It is most commonly found in a ratio of 80:10:10, estriol, estradiol, and estrone. This combination is very popular and contains all of the three major circulating estrogens. It is slightly weaker in its effect when compared to the same total mg of bi-est since it is only 10% estradiol. However, this can be compensated for by increasing the strength. Tri-est is also frequently written as 1:1:8 (estrone, estradiol, estriol). The 1:1:8 ratio is the same as that found naturally occurring in the female human body.
Back to top
Bi-est is a combination of two estrogens: estriol and estradiol. It is most commonly found in a ratio of 80:20, estriol to estradiol. However, 50:50 or 90:10 ratios are prefered by some practitioners. This combination allows for all of the protection of estriol while providing the cardiovascular and osteoporosis benefits along with the vasomotor symptom relief of estradiol.
There is growing consensus that bi-est may be a better choice than tri-est because the estrone is of no real known value. It is produced by natural metabolic breakdown of estradiol so may not really need to be supplemented.
Back to top
What is natural progesterone?
Progesterone, a naturally occurring hormone in both men and women, is essential for many vital functions in the human body. The ovaries produce the majority of progesterone, but only if ovulation occurs. As women approach menopause, less progesterone is produced. Progesterone deficiency is responsible for many of the symptoms associated with menopause. Progesterone's many functions include improving sleep, naturally calming, balancing body fluids, improving fat metabolism, promoting bone formation, possible protection against breast cancer and protecting the uterus against cell proliferation. Progesterone also balances the effects of estrogen and should always be taken in conjunction with estrogen therapy even after hysterectomy since there are progesterone receptor sites throughout the body.
Progesterone is also produced by the adrenal glands in women and, in smaller amounts, in the testes and the adrenal glands in men. One of its most important functions is in the female reproductive cycle. Progesterone prepares the lining of the uterus for implantation of a fertilized egg, then helps to maintain it during pregnancy. If pregnancy does not occur it signals the uterus to shed this lining.
Progesterone also plays an important role in brain function and is often called the "feel good hormone" because of its mood enhancing and antidepressant effects. Optimum levels of progesterone can mean feelings of calm and well being, while low levels of progesterone can mean feelings of anxiety, irritability and even anger. Current research shows that progesterone may play a role in the maintenance of the nervous system, the sense of touch, and motor function.
For reliable absorption, the progesterone must be micronized before being incorporated into pharmaceutical and nutraceutical products.
The term "progesterone" is frequently used (in error) to describe all progestins. Progesterone is a progestin but the rest of the progestins are NOT progesterone.
There is only one real progesterone- it is produced by the human body or in a laboratory from plant hormones into bio-identical progesterone. Otherwise, it is not progesterone- just a progestin. For absorption to take place, the progesterone that is given to a person needs to be micronized. This means that it is milled to a very small particle size to allow the progesterone to pass into cells and distribute though out the body. USP indicates high purity and a product has to meet many standards of excellence to wear the name.
Back to top
Usually considered a male hormone or androgen, women also produce testosterone
although in much smaller amounts than men do. Testosterone works differently in the bodies of men and women, but
it plays a very important role in the overall health and well-being of both sexes. Often called the "hormone
of desire" because of its powerful effect on libido, testosterone is also important in building strong muscles,
bones, and ligaments as well as increasing energy and easing depression. Low levels of testosterone have been known
to cause fatigue, irritability, depression, aches and pain in the joints, thin and dry skin, osteoporosis, weight
loss, and the loss of muscle development.
As with all of the hormones, testosterone must be dosed properly to be effective without causing unwanted side effects. The dose in women is generally one-tenth that used in men. Because testosterone is not effective when it is taken orally it is usually prescribed as a topical gel, cream or as a sublingual tablet. Although testosterone was discovered more than sixty years ago, only very recently have we begun to fully understand and appreciate the power of testosterone.
Back to top
Short for Dehydroepiandrosterone, DHEA is a steroid hormone distinguished
from others by its unique chemical structure. DHEA is produced by the adrenal glands (located just above the kidneys)
as well as by the brain and the skin, and is the most abundant steroid in the human body.
As newborns, we have an extremely high level of DHEA, but within a few days after birth, our DHEA level drops to nearly zero. Then between the ages of six and eight, we experience the event called "adrenarche" in which our adrenal glands begin to stir and gear up for puberty. At the same time our DHEA level begins to rise steadily and continues to rise until it peaks at around age twenty-five to thirty. From that point on it declines at a rate of about 2 percent a year, and we begin to feel the result of this decline in our mid-forties. By eighty our DHEA level is only fifteen percent of what it was when we were twenty-five. This drop in DHEA levels correlates dramatically with the signs and "symptoms" associated with aging.
DHEA is currently the focus of some of the most exciting medical research of this century.
Researchers at distinguished medical centers all over the country are studying the properties and promise of DHEA. It is proving to be a potent protector against cancer. It protects against heart disease by lowering blood cholesterol and preventing blood clots. Studies also demonstrate that DHEA improves memory, strengthens the immune system, prevents bone loss, and may even protect us from diabetes and autoimmune disease. It has been shown to fight fatigue and depression; it enhances feelings of well-being and increases strength. DHEA alleviates symptoms of menopause, reduces body fat, and is even known to enhance libido .
Back to top
Pregnenolone is a superhormone that is key to keeping our brains functioning
at peak capacity. Some scientists believe it is the most potent memory enhancer of all time. Perhaps what is even
more amazing are the studies that demonstrate pregnenolone enhances our ability to perform on the job while heightening
feelings of well-being. In other words, this superhormone appears to make us not only smarter but also happier.
Like the other steroid hormones pregnenolone is synthesized from cholesterol. In a complex series o steps, cholesterol is broken down into different steroid hormones as the body needs them. It is first synthesized into pregnenolone and used by the body in that form. What is not utilized undergoes a chemical change that "repackages" it into DHEA. DHEA in turn is used by the body as DHEA and is also broken down into estrogen and testosterone. This chain of hormones is known as the "steroid pathway." Because pregnenolone gives birth to the other hormones, it is sometimes referred to as the "parent hormone."
Pregnenolone was studied extensively in the 1940s. It was shown to be beneficial in elevating mood, improving concentration, fighting mental fatigue, improving memory and relieving severe joint pain and fatigue in arthritis. Pregnenolone has vast therapeutic potential and is currently undergoing further studies in these areas.
Want a more technical explanation?
Back to top
For many years physicians prescribed Armour thyroid for hypothyroidism. Then the medical community "modernized" its thinking and changed over to levothyroxine. We are now starting to see that we stepped backwards instead of forward.
Armour thyroid is a combination of triiodothyronine (T-3) and L-thyroxine (T-4) along with various other materials from desiccated thyroid glands of pigs. For many years this was considered good.
Then along came the pharmaceutical companies such as Flint convincing every one of us that the way to treat low thyroid levels was with levothyroxine (Synthroid was their brand- that brand is now owned by Abbott and Forest now markets the Armour thyroid). What a great product- manufactured in the lab so as to achieve consistency and stability. Anyone who had taken Armour thyroid felt blessed by this new product. Armour thyroid smells bad, leaves a bad taste, represents slaughtering of pigs, and is somewhat inconsistent (so they claimed) because every pig’s thyroid is different. Flint even convinced us that we should NEVER substitute a generic brand because the generics are not close enough (FDA allows 10% plus or minus to be considered equivalent). Interestingly enough, "acceptable" dosing levels have changed over the years far greater than 10%. Currently there is a class action suit against Flint (and other owners of the Synthroid brand name) for misleading the medical community about safe substitution. Insurance companies and state medicaid agencies have been paying far too much for name brand Synthroid when generics would have had the same therapeutic results.
Now the treatment of hypothyroidism with levothyroxine by itself has become suspect. In simple terms, levothyroxin (T-4) is a storage form of thyroid. Triiodothyronine (T-3) on the other hand is an immediately active form of thyroid. Generally the body transforms T-4 into T-3 when it is needed. However, many people do not adequately make this transformation. These people can take relatively large doses of T-4 and still feel tired, cold, depressed, and have dry brittle hair and nails.
T-3 can very effectively relieve these symptoms. It can be given in combination with T-4 or by itself. However, the pharmaceutical industry only makes three strengths of T-3. It is called Cytomel. Compounding pharmacies such as Acology can make many different strengths to fit any patient. We also make it slow release to minimize the stimulant affect often encountered with Cytomel. Another way to achieve a T-3 + T4 combination is with the old stand-by: Armour Thyroid.
There are recent studies suggesting that T-3 can be a very potent antidepressant. In fact, the manufacturer of Cytomel is promoting it for that purpose. Seratonin re-uptake inhibitors can take weeks to relieve depression whereas T-3 can achieve almost immediate relief. T-3 in a slow release form also has a more tolerable side-effect profile than do the antidepressants.
Back to top
I N D I V I D U A L I Z E D Natural Hormone Therapy