Hi Everybody,

I'm trying to figure out what is the determining factor for starting BHRT.

Is the determining factor based on what your hormone levels are at any point in time.... or do you go by whether you are having hormone declining symptoms.. ??... like hot flashes or ~whatever. And what if you do NOT have hot flashes or other symptoms...does that mean that you don't need BHRT .. ??..

I'm 55...and beginning to see / feel the changes -- [cycle has become more erratic...I'm feeling more irritable...] -- but I'm just confused about HOW I make the decision to use BHRT or not. I think I've concluded that there is benefit to keeping my hormone levels at a level higher than '0'....but what do I use to measure what IS a good level. .. ???

I'm so confused... I feel like I'm the only one that's not understanding this... like I missed this topic discussion somehow. You know...like back in school when they taught 'percentages'... I swear I must have been out sick the entire time they covered it.

I've got my well-woman checkup next month and I want to be able to talk about this with the doctor so any comments, suggestions, links....will be appreciated.

Many thanks,

Jann

Sorry about the text color on my earlier post.... I can't seem to find how to 'edit' a post that was submitted...

????

Jann
I'm with you. I'm confused about this whole hormone replacement thing too. I've been post for 6yrs with no known symptoms to report. My doctor says only if I have annoying symptoms I could get relief from hrt. But then coming here so many women are on something or other. I do suffer anxiety and mild depression but is there a connection 6yrs later?
char

This is from Dr. Vliet's book "Screaming to Be Heard" She advises that hormones be started when a women becomes symptomatic & quality of life is affected or when actual disease is present-osteopenia, osteoporis, high cholesterol or any combination of the above.

In my case, I wish I hadn't waited so long to start hrt. I waited about 6 years before starting because I didn't like the options the doctor was offering.By the time I began treatment, I had the start of osteopenia, hot flashes, insomnia & mild depression, low libido. I felt I could continue on like this & get by with the help of fosamax or the like, AD's, benzo's & ambien for sleep or I could treat the root of problem by replacing the missing hormones my body use to produce.

I'm a big fan of Vliets books and also Redmonds (The Hormonally Vulnerable woman) too. However, I made the decision to start hrt (during peri) to alleviate symptoms (flashes, insomnica etc. ) and Before experiencing osteo, high cholesterol etc.... I have always been one to treat the root cause of the problem - so that meant hrt instead of taking several drugs to treat symptoms only. Just my choice and I'm happy with it. I plan on remaining on hrt for life. Regards to all, JZZ btw - sleeping pills never touched my hormone (loss) induced insomnia. hrt did.

Couldn't agree more with JZZ's post. I don't believe there is a magical number you must reach before starting replacement. I would have started immediately after my hysterectomy if I had a doctor who understood transdermals. I also plan to be on hrt for life.

Oh just wanted to add a little more info. I feel the current attitude among docs is to withhold hrt due to the fallout from the flawed WHI hrt study. Study was ended abruptly in 02. Anyway, current guidelines (that were influenced due to that flawed study) state that hrt should be used "at the lowest dose possible for the shortest duration possible." Soooooo, end result is that many docs are trying to force women to "tough it out" without hrt. And, "see how you do". Well, my response to that is "let's see how you do if we remove your testicals". They get my point. Also, more informed docs and experienced docs are willing to prescribe.

Anyway, the lowest dose doesn't always work to alleviate symptoms or disease states for many women. And, frankly I'd rather take one or 2 types of hrt than a whole host of meds to treat several problems. (But that is my choice and works for me.) And, although some risks might climb with longterm use......they jury is still out. A good book to read is "Sex, lies and Menopause." It does a good job of explaining why we have not fully evolved to live without hormones and why disease states occur.

I also have several SIL's, in their 60's, who have been on hrt from when they first started skipping periods. They never had to endure the "tough it out" attitude that is being handed out to current peri or meno women. And, they are happy and healthy too. I believe there is a current study being done on early peri/meno women with the hrt being added sooner rather than later in post. (Think I saw a blurb on pubmed. Will try to locate, but was just started if I remember it correctly.)

I am not pushing hrt, just an informed decision. I did not win the "genetic lottery" and am not one of the women who breeze thru peri and settle comfortable into post. Kind regards, JZZ

Sigh -- what a relief! I'm happy to hear that I'm NOT the only one that is confused by this whole topic.

The reason why I think I'd like to maintain healthy / optimal hormone levels is because it can't be coincidental that disease starts to creep in when the hormones are no longer optimal. Someone mentioned that Suzanne Somers mentions this in her books -- well I agree with her. I know that at least one of the reasons men get prostate cancer is because of having too low testosterone level....so I'm thinking that the same would hold true for women.

I don't want my estrogen levels to drop any lower than they are now. I'm already dealing with dry eyes...that get worse just before I start my period. My lips also get REALLY dry before starting my period -- this has to be the estrogen connection. And I've been dealing with insomnia issues for the last 10yrs that I suspected were related to hormones but just wasn't sure what to do about it other than melatonin. I've also had fibrocystic breasts too...however some rx progesterone cream helped me overcome that issue.

Someone mentioned Dr Vliet -- I went to one of her seminars hoping to get more clarification about the whole BHRT...well I didn't. It seemed to me that she's pretty much AGAINST what most of us regard as "bioidentical"...ie; Compounded HRT. Now she certainly believes in HRT, but she wants you to use the prepackaged drugs that are FDA approved. At least this is what I came away with. Also she had made a comment about estrogen dominance or ~something that prompted me to ask her about progesterone creams. I asked her about using progesterone cream on day 14 of my cycle for my fibrocystic breasts and she said that it was silly to do that....that some doctor had made up the term 'estrogen dominance'.... that on day 14 and later in our cycle is when our progesterone is highest. Well yes...it's true...that progesterone SHOULD be pretty high at that point..but what if it isn't...????....Then there really is an imbalance and there is an estrogen dominance issue...and as I understand it, it's the imbalance in the two hormones that causes that breast tenderness. ??? All I know is that the progesterone cream worked to alleviate the pain I was getting from fibrocystic breasts. So...anyway...I came away not sure of Dr Vliet.

OK -- so I had my hormones tested on my own through HealthCheck USA back in January. On day 4 of my cycle -- which if I understand this correctly was the "follicular phase" -- my progesterone was "4" which seems right for being on day 4. REf range says "0.2 - 1.4". My estradiol was "233". The LabCorp reference range is "19 - 528". So I guess I'm just a little under mid-range. Is that where I should WANT to be...?? Should I WANT to be at the higher end of the range ??

I'm appreciating the comments and perspective...it's helpful. Thank you.

Jann

I think that replacing what is lost is the best plan of action rather than treating the affects of aging ie bp problems, heart disease, diabetes, osteoporosis etc...

You should start BHRT when your hormones are declining and you are feeling the affects of that imo.

Here are my numbers from my initial blood work and a basic run down of my second set of labs after two months on only biodentical P. At this stage I am also supplementing T because the P lowered it a lot!


Estradiol 74 range 50-100
Progesterone 2.5 range 10-20
SHBG 33 range 1-114
Testosterone Total 282 range 15-70
Testosterone free 29.30 range 6-8.5
DHEA 335 range 350-430
TSH 1.6 range <2
Free t3 299 range 365-420
Free t4 1.60 range 1.3-1.8
Vitamin D and B-12 low

Second set of labs after two months on BHRT 150mg of oil caps progesterone.
Total Testosterone is now down to 32 from 282
Free Testosterone is now 4 down from 29.3
Progesterone is 10.6 up from 2.5
Dhea is at 415 up from 335
Vitamin D has doubled as has my B12

So as you can see your P is very low! Yes you do want to be at the higher end and not the lower end of your ranges. Sure you are in range but that doesn't mean you are optimal, which is a term a good BHRT doctor will use! Your lab ranges are nuts on the E! Heck anyone could fit in that catagory and be deemed normal lol!

You need to have your blood work done again and elsewhere I just don't understand the ranges that company is using!

Did you go watch the Suzanne Somers videos on you tube? She is a great speaker and kind of puts things in laymans terms. This is the first of six from this conference and I do encourage watching them all. http://www.youtube.com/watch?v=yTijQmsCiFQ

Thanks for the link to the Suzanne Somers YouTube videos -- very interesting. I picked up on something she said about "Rythmic BHRT" -- which is, according to Suzanne, using estrogen as nature designed by dosing more heavily at the beginning of the month and then decreasing gradually to what I'm presuming would then be application of the progesterone dose. I like the idea of that....makes sense.

I think the real challenge is going to be finding a doctor that understands the intricacies that are involved in getting this right. I wonder if Suzanne Somers has a doctor listing on her website... I know she mentioned in the videos that she does have a list in her books.
....

So the LabCorp reference ranges didn't look right ?? ...maybe I'm not interpreting the lab sheet correctly ??

This is what my lab sheet has on it.

I don't get what this "Follicular (-12) 19 - 83" means....???... 12 days BEFORE the LH Peak which is around day 23 of your cycle so that would mean 'day 11' ?? Huh ?? I had blood drawn on day 4 of my cycle, but the only place my results correlate with any of their reference range is "midcycle" -- which day 4 is NOT. ??

Geeeeez -- I feel dumb....but I guess I'll eventually get this stuff.

Jann

Our levels change all of the time so don't put much into the numbers. You need a doctor that will treat symptoms and not numbers.

Rhythmic cycling doesn't appeal to me but then I don't have a uterus so it doesn't really matter a whole lot in my case. She does the Wylie Protocol which is based in cycling the body like we would have done during cave man days lol. I think it is based on the moon etc. This causes women to actually have periods etc. You should read up on it again not something that appeals to me but works for her I guess.

I'm in the camp that believes that cycling/varying the hormone levels (mimicking what nature intended) is the way to go. (Another good book to read is Sex, Lies and Menopause - they talk about "mimicking nature and why.") Book also talks about other health issues and why our hormones are important too. What I've decided to do is keep/and take a steady, dose of supplemental E, and cycle in a P when necessary. The P is necessary to protect the uterine lining from hyperplasia. I am in Peri and still have my own periods. As long as I have a period then I don't have to take the P. If I skip 2 or 3 periods then I will have to cycle in some type of P for 10 days to 2 weeks. Then the 3 month clock starts over and I don't have to worry about P again. (I am very intolerant of P. 2 bad experiences with Prometrium) My docs have established this timeline based on several transvaginal ultrasounds of my uterus.

Also, many women don't want to cycle in the P because they don't want a "period". Well the further we get into meno the more the uterus, and other girly parts, will continue to atrophy. So, the "bleed" will be minimal, if any should even occur. The goal is to get enough P onboard your body to protect the uterus and not necessarily to bleed. (many docs still get this wrong.)

Don't understand the last part of your labs referencing cycle and LH. Never have seen that one and I've had numerous bloodwork over the past 2 1/2 years. The rest of your labs seem to be within a normal range for day 4 of your cycle. However, your symptoms are just as important as the numbers. If these are too low for you to feel well than it just shows (once again) how arbritary the lab values can be. Both of my gyns (2 diff practices) believe in symptoms while only one also relies heavily on bloodwork. (he is an infertility endocrinoligist and ob/gyn). 3 times we have taken a weekly blood draw (once a week, same time, same lab for an entire month). Guess what? Although I'm in peri there still in a fairly consistent pattern to my ovarian hormone levels. However, they can still vary. He does blood on peri women the same way he does for his infertility patients. (As I just outlined). Whatever you do, just don't let a doc tell you that your numbers are "normal" when you feel awful. The lab values/ranges are an arbitrary range that does not reflect where you felt your best. Also, no one ever got a baseline on us when we DID feel well. THAT would definitely give number that would have been more accurate.

Sorry you had that experience with Vliets. Her books are well written imo. Vliets does use standardized fda hrt but many are bioidentical and can be "tweaked" to each womans needs. Each doctor does seem to have their own philosphy on this peri/meno stuff. I do agree that this whole concept of E or P dominance was just developed inorder to be unique and sell hormone product (ie P creams.) and books. Yes, we hear about E or P (lesser known is Her2) driven cancers, but no one has studied WHY it occured. Was it an imbalance of hormones, loss of hormones or what? Otc, compounded and even fda P's are being touted as "safe". Many women take the otc on their own (without a doc) and run into probs, while others swear by the stuff in alleviating their symptoms.

At the same time E has gotten "bad press". Again, cancers can be E, P or HER2 receptive or a combination thereof. My own feeling is to listen to what your body needs and go from there. I am a high E kind of gal. Without enough I cannot function. Prometrium was toxic, in every way, for my body and brain. I won't take it again just because it's being pushed as a great "bio identical" progesterone. When the time comes I will find and take whatever P my body will tolerate (be it bio or synthetic.) Oh, and the jury is out on whether bio is any safer than synthetic.

And, no you are not dumb in regard to this hrt and peri/meno stuff. It is very complex and most docs don't even understand. I've had the crash course over the past 2 1/2 years. Hope I've helped. Regards, JZZ

Thanks Jzz.... You have been helpful... I think just talking through some of this stuff 'outloud' is helpful...sort of solidifies what I'm thinking.

I'm going to check into getting that book you recommended.


Jann

I agree with J in that you aren't dumb to this hormone stuff it is just so much to take in and we are all different and to top that off our own bodies change daily. Also like J I would take any hormone I wanted if I thought it would work. I started with BHRT because it seemed like the lesser of two evils. Despite very little testing it has been used in Europe for years, I think I have read since back in the 50's and we aren't hearing horror stories out of that. Seriously BHRT is the best thing I have ever done for myself through this crap!

Thanks Davinci...

I have to admit it sure is nice to be able to commiserate with y'all that are going through this too. You know... I really thought that they would have figured all this out by the time I needed it....but this hormone stuff is just too complex..too many variables. So...here we all are just doing the best we can with the information available.

I'm actually feeling pretty good...I do have autoimmune issues -- vitiligo and Hashi's...and it looked like I was getting Sjogrens. ugh. A couple of years ago I was in a conversation with a naturopath and he suggested I investigate LDN Therapy (Low Dose Naltrexone) -- to stop the progression of my autoimmune disease. LDN is an off-label use of an older, FDA approved drug. Well, I did the research...talked to my doctor (an osteopath) asked her opinion...she said she was 'fascinated' and that if I wanted to try it she would prescribe it. I've been using LDN for over a year now...my antibodies are lower...I require less THR (thyroid hormone replacement) and am getting better thyroid labs than before LDN...and in general I've been just feeling more 'normal'....that autoimmune dread feeling had evaporated. So I feel good about the autoimmune issues being addressed. This summer is when I'm noticing a change in my cycles...and so NOW I'm realizing that I've got another 'project' to figure out --> my hormones. What do I want to do about my hormones. The BHRT just makes more sense to me...right now anyways...so that's what I'll be talking to my doctor about.

Thank you for your comments...they've been helpful.

Jann

The LH peak occurs around 12 to 48 hours before ovulation, so if you are on a 28 day cycle and you ovulate on Day 14, that would be the equivalent of day (+1 or +2) from the LH peak. Day (-12) would be 13 to 14 days before ovulation or what we usually refer to as Day 1 of your cycle. Although the overall range of estradiol can run from 19 to 528, it depends on what day of the cycle your blood work is drawn. Estradiol is the lowest on Day 1 and then rises to a peak until just before the LH peak, at that point estradiol levels fall dramatically. You can see on the luteal (+2) range, which should be roughly the day of ovulation (or Day 14 of the cycle) that the normal range is much lower, because of the estradiol drop. The estradiol level rises again, a bit later in the cycle, but not to the same height as you reach prior to ovulation. It then drops again on (+12), which would be roughly 13-14 days after ovulation...or about Day 28. Hope this helps!

What are you taking for your thyroid? Syntrhoid or armour?

And to further clarify, using your lab's style of reporting, your Day 4 would be about day (-9) on this scale...but that is if you are on a perfect 28 day cycle. So you might be a little high for that time range, or your cycle could have varied a bit that month...but at least you know your estradiol is not too low...for that time period, that month.

Back to your original questions...I think it depends on your individual thoughts on the benefits you see in hormone use. If you are only looking to prevent severe hot flashes, painful vaginal dryness, etc and you aren't really bothered much by symptoms then you probably wouldn't see much point in taking hormones. Or if you are bothered a bit more, maybe you would look into a very low dose....just enough to hold the symptoms at bay. But if you've done some research and see all the health risks that tend to happen when estradiol disappears...osteoporosis leading to fractured hips and collapsed vertebrae, high cholesterol leading to clogged arteries and an increased risk of heart attack or stroke, etc. then you may decide to use hormones just to help prevent some of these serious illnesses whether you have symptoms or not.

My personal feeling is that every system in the body is affected in some way and may show a host of symptoms from the loss of estrogen. I can't help but feel it may not be just a coincidence that women tend to have thyroid problems, autoimmune disorders, fibromyalgia, chronic fatique syndrome and increased allergies more often than men and more often around the time that hormones begin to decline.

While you can't hold back time forever, with an adequate estradiol level you can slow down the loss of skin elasticity, muscle tone, hair loss, gum & tooth loss, sinus drainage, dry eyes, joint pain, loss of flexibility, fatique, memory issues, thinking skills, mood levels, urinary incontinence, sprouting chin hairs, anxiety issues...the list is quite long! None of these alone may be enough reason to start hormones for many women, but reducing these annoyances can be a nice perk if you have decided to go with BHRT for other issues anyhow.

Keeping your estradiol level above 80 to 100 should help prevent bone loss and hold your cholesterol in a better heart-protective range. If you choose not to use hormones you just have to be extra vigilant in making sure you are protecting your bones and heart in other ways. I personally think Dr. Vliet is one of the most credible and accurate sources out there on hormone issues and I also prefer using FDA-approved bioidenticals for myself. I did a lot of research before making my decisions on BHRT and I'm comfortable with my choices but everyone has to make that determination for themself. My small town family doc is great to work with, although not an "expert" on hormones he does know "women just plain feel better with hormones."

Nite Owl,

Very well said and I totally agree. Tried saying some of this in other posts and got slammed.

I also really recommend (besides Vliets), a book called Sex, Lies and Menopause. It lays out why disease occurs in our bodies with the loss of hormones. Also makes a fascinating case for why drugs like statins can't differentiate between the good cholesterol our brain needs and the bad artery clogging cholesterol that should be removed. Book also talks about why it could be the loss or fluctuation of hormones (in our 40/50's) that contributes to aggressive breast cancers in this age group. A most fascinating read and is co authored by 3 people.

I'm currently using fda bio identical estrodial while still having periods (in peri). I just switched from the vivelle patch (wasn't getting great absorbtion) to oral bio estradiol and continue to use the fabulous estrace vag cream (also bio ident). As, one of my docs said...."let's start with what insurance will cover and see what works for you (because there will be trial and error along the way) before "reinventing the wheel" and going the compounded route. Before trying the bio fda Prometrium I had insisted on a script for compounded P. I went to the compounding pharmacy and yooooowwwwwwwwza a months supply would have cost me 160.00 usd!!! Anyway, he was correct. Turns out I couldn't tolerate the prometrium plus I had saved a lot of money by not using the compounding pharmacy. I had many other choices in P when the need will arise. Ultimately, I will use whatever works for my body. Thanks again for your post. Well said, JZZ

Join the happy BHRT users issues on this forum ! You can't attempt to be helpful when it comes to BHRT because the ones that haven't had good results chime in on every single thread to tell you how bad it is! It works for me and I know it could work for others with the right doctor and dosing. So don't let those opinions get you down....this is why you feel great and they don't aye?

I don't see an issue in using FDA approved BHRT. For me personally I was so fed up with doctors and big pharma by the time I found my Doctor that compounded was my first choice. I just felt the need to not contribute further to big pharmas mission if that makes sense. I would use FDA BHRT if that was my only choice. I don't mind paying $45 a month for my P. I think my T runs $45 for five syringes which will last me probably 4 to 5 months. So maybe I spend fifty bucks on my monthly scripts.

Thanks Davinci,

I really think I was getting slammed more so from saying I'd read that we are more at risk being witout our hormones than by supplementing. But, at times, I do hesitate to discuss the aspects/benefits of b/hrt because of potential conflict. And, altough I currently supplement with fda bio estradiol (while in peri) I will take synthetic (if necessary) too. The jury is out on what is safer than the other.

But, yes I do feel GREAT. We just changed my vivelle patch to oral bio estrace tablets and omg WHAT A DIFFERENCE!!!!! JZZ IS BACK!!!!!!!!!!!!!!!
........I've seen some posters ask for success stories -------Well, here I am. JZZ

It seems so obvious that we don't become sick with these diseases until our hormones start declining! Some people would argue that blue is red, so there you have it! Ya know I don't see the argument in what is or isn't safe, everything can cause problems. It is simply down to the individual to decide what choice is best for them and no one should force their negative opinions on someone else. BHRT threads always go in the direction of negative....ALWAYS! It is a shame there can not be one single thread that stays on target of "success story". Negative always out weighs the positive though.

Success story here too! Every extra dime I spend or risk this puts me in is worth it to not feel like doo!

Thank you NiteOwl for you thoughtful response. I appreciate your explanation about the labs reference ranges in relation to the LH peak. My cycle has pretty much always been a 23-25 day cycle. So...I'd have to do some math to figure out where I fall in that chart...but it seems likely that my level was adequate enough at that time. I actually did have some labs done about 3yrs ago so I need to dig those out and compare results to see if there is a significant drop.

I think my decision choice is to keep my hormones at a level sufficient to prevent / alleviate...well --> "D"...all of the above. I don't think I want to experience hot flashes...nor "osteoporosis leading to fractured hips and collapsed vertebrae", or any of the other scary conditions. And it would be nice if my eyes weren't so dry. I really shouldn't complain too much about my dry eyes, I know others have it much worse. My supplement regimen has eliminated my need for daily eye drops, but it's NOT enough for me to be able to wear contacts anymore.

I agree that Vliet seems to know her stuff -- her book on PCOS (Polycystic Ovarian Syndrome) which I bought because my daughter has PCOS...I thought was really well written, informative. I'm still just puzzled by her response to my question about 'estrogen dominance' and using progesterone cream. Ah well.

Also, this issue with FDA-bioidentical vs. BHRT. I understood the BHRT is using FDA approved ingredients....but that the actual dose that gets compounded is NOT FDA approved. And THAT was the advantage of BHRT...that the dose is customized specifically for an individual. ?? So...like someone else commented...if the FDA-Bio comes in a dose that's suitable for you...then everything's cool. But if it doesn't...then you need to go the BHRT route. Am I getting this right ?

Jann


BTW: I take Levothroid and Cytomel to supplement my thyroid hormone deficiency. My doctor doesn't suggest Armour for the autoimmune version of thyroid disease (Hashi's) because it can increase the antibodies...being that Armour comes from a pig which would be considered foreign to my body. If I really wanted to take it she prescribe it though. I've just always like having my T4 & T3 meds separate so that I can tweak my dose based on my FTt & FT3 levels.

[quote name='Jann' date='Aug 15 2009, 12:31 PM' post='304278']
I agree that Vliet seems to know her stuff -- her book on PCOS (Polycystic Ovarian Syndrome) which I bought because my daughter has PCOS...I thought was really well written, informative. I'm still just puzzled by her response to my question about 'estrogen dominance' and using progesterone cream. Ah well.

Also, this issue with FDA-bioidentical vs. BHRT. I understood the BHRT is using FDA approved ingredients....but that the actual dose that gets compounded is NOT FDA approved. And THAT was the advantage of BHRT...that the dose is customized specifically for an individual. ?? So...like someone else commented...if the FDA-Bio comes in a dose that's suitable for you...then everything's cool. But if it doesn't...then you need to go the BHRT route. Am I getting this right ?

Jann



Hi Jann, I tried to respond to your comment about Vliets and many others have about "dominance" theory. Imo if you feel good than how can one be "dominant" in anything? Its important to remember that no one individual (Docs included) hold ALL the answers. And, in regard to progesterone, I'm glad you found it helpful. Many of us have problems with it.

Now, in regard to fda approved bio's. I don't understand what you're saying in regard to "the actual dose that gets compounded is not fda approved". If the fda approves a drug than all the ingredients have been tested and approved.

Any drugs that come from a compounding pharmacy are not subject to testing and approval from the FDA. That being said, does not mean that they are not effective or safe. Many women do benefit from what they get from the compounding pharmacies.

Now, in regard to your last point/question...."Advantage of compounded bio meds being customized for the individual versus the FDA only coming in a standard dose". Well, an experienced Doc can customize a FDA bio drug too. Here's just one example. Vivelle patch only comes maximum dose of .1 I needed more estradiol. So we could either add another patch, vag cream or topical gel or spray or oral estradiol. Another example: I can't tolerate Prometrium (and yes, prometrium doesn't come in lower than a 100 mg dose). Choices are to either squeeze out 1/2 dose, try it vaginally, add a combo e/P patch for the 10 - 14 days, use a vag progestin, or take an oral Angelique (which contains both bio e/ and a synthetic P). Or try a p from a compouded pharmacy.

There are many many ways to customize the supposedly "standard" doses of fda ht. And, again many are Bio identical. I am not pushing only fda meds. I think that the compounded pharmacies do a great job. However there seems to be a misconception that only the compounded pharmacies have bio's. This is simply not true. The only reason I keep mentioning the standard pharmacies is because many women rely on insurance to cover their meds. I am lucky in that I can use either type of pharmacy. Good luck in all of this and keep asking the questions. Regards, JZZ

Hi Jzz...

As I understand it...the drugs (ingredients) that the compounding pharmacy (CP) uses are the same FDA approved drugs (ingredients) that a standard pharmacy (SP) uses. The CP gets them from the same pharmaceutical companies as the SP except they buy them in bulk and then mix the drug with the delivery cream etc etc ... to a doctor's prescribed dose. The SP's (Walgreen's etc) get the prepackaged doses -- NOT the bulk quantities.

What I meant about the compounded dose NOT being FDA approved is that during the drug trials only standardized doses are used and those are the doses that are approved. So the dose that a CP may compound may NOT be a standardized dose so therefore it's NOT FDA approved. Again...this is just MY understanding of all the pieces of info that I'm putting together.

Also, I think I just read this -- maybe in this thread in fact ?? -- that some Walgreen's have relationships with CP's and will accept a non-standard dose prescription and have it compounded for you. However, I'm not sure if then the insurance would pay or not... ?? ....

Yes...this is an interesting thread...learning a lot.

Jann