Human HRT Leads Compounding Renaissance

SEPTEMBER 01, 2007
Shannon W. Fields, BA, CPhT

Compounding has had a tremendous impact on the practice of pharmacy over the years, but as pharmaceutical companies gained the technology to mass-produce their products, the art of compounding played a somewhat smaller role. Currently, compounding is experiencing something of a renaissance, thanks in large part to increased interest in human hormone replacement therapy (HHRT, previously referred to as BHRT).

When the Women?s Health Initiative study was halted abruptly in July 2002, long-held ideas about hormone replacement therapy were suddenly challenged and, in some cases, even abandoned by patients and clinicians. Many women, however, were unwilling to suffer menopausal symptoms in silence and began to look for alternative therapies. As a result, the practice of compounding rose exponentially.

HHRT refers to hormones that are derived from plants and are identical in structure to human steroid hormones. A chemical conversion process is applied to these plant derivatives, producing pharmaceutical-grade hormones that are a direct match to their biological counterparts.1 The benefits of HHRT for most patients are considerable. In addition to reducing symptoms of hormone imbalance, HHRT is thought to reduce the risk of cardiovascular disease and osteoporosis.2-5

Many pharmacists are taking on the role of educating clinicians and patients about the origins and benefits of HHRT.6 Some pharmacists are acting as consultants, meeting with patients individually to discuss symptoms and treatment options, which are then passed along to clinicians for consideration. Continuing education programs on HHRT are available for pharmacists seeking to expand their knowledge, and many of these offer guidance on implementing patient consultations into practice. Most patients embrace the idea of a treatment plan tailored specifically to their individual needs.

Because those needs are going to be patient-specific, the compounding laboratory should be able to produce a wide variety of dosage forms and combinations. Commonly used HHRT components include the following2:

  • DHEA?a precursor to testosterone, available both by prescription and over the counter; plays a part in energy levels and libido
  • Estradiol?the second most important component of tri- and bi-estrogen formulas and the primary estrogen secreted by the ovaries; protects against osteoporosis and cardiovascular disease
  • Estriol?a weak estrogen, produced primarily in the liver; benefits the lower urogenital tract by improving incontinence and vaginal dryness; typically the largest component of tri-estrogen and bi-estrogen formulations
  • Estrone?the third and often smallest component of tri-estrogen formulations, a precursor to estriol and estradiol
  • Progesterone?a hormone prevalent during pregnancy, needed to oppose the stimulatory effects of estrogen; often decreases symptoms such as headache, fluid retention, and depression
  • Testosterone?present in both men and women; plays a major role in maintaining energy levels and libido

Dosage forms are individualized to each patient, and because absorption rates vary, dosage forms vary from one patient to the next. Commonly used dosage forms include the following2:

  • Capsules?typically made with micronized powder
  • Sublingual drops?hormone suspended into an oil-based liquid
  • Suppositories?most often vaginally administered and well-absorbed. Progesterone vaginal suppositories often are prescribed for pregnant women with luteal-phase defect.
  • Transdermal creams?can be a very effective route of administration for specific therapies (such as testosterone cream for enhancing libido; tri- and bi-estrogen formulations; and progesterone)
  • Troches?hormones suspended in a semisolid medium

HHRT has successfully brought the art of compounding back to mainstream pharmacy, particularly in the past 5 years. Experienced pharmacists can be an invaluable resource for patients, from preparation of compounded formulations to counseling patients to marketing HHRT to clinicians.


1. Francisco L. Is bio-identical hormone therapy fact or fairy tale? Nurse Pract. 2003;28(7 pt 1):39-44.

2. Drisco JA. ?Natural? isomolecular hormone replacement: an evidence-based approach. International Journal of Pharmaceutical Compounding. 2000;4(6):414-420.

3. Granfone A, Campos H, McNamara JR, et al. Effects of estrogen replacement on plasma lipoproteins and apolipoproteins in postmenopausal, dyslipidemic women. Metabolism.1992;41(11):1193-1198.

4. Ettinger B, Genant HK, Steiger P, Madvig P. Low-dosage micronized 17 beta-estradiol prevents bone loss in postmenopausal women. Am J Obstet Gynecol. 1992;166(2):479-488.

5. Prior JC. Progesterone as a bone-trophic hormone. Endocr Rev.1990;11:386-398.

6. Hu FS, Reed-Kane D, Draugalis JR. Patient satisfaction with pharmacist intervention and consultation in hormone replacement therapy: an update. International Journal of Pharmaceutical Compounding. 2006;10(3):187-192.