Letter to the Editor: You’ll Find What You’re Looking For If You Know Where to Look

This letter to the editor is in response to this article by Pharmacy Times Editor-in-Chief Troy Trygstad, PharmD, PhD, MBA, published in the Pharmacists’ Guide to Menopause Management in November 2025.

Dear Troy,

First, thank you. On behalf of the estimated 50 million women currently navigating perimenopause and menopause in the United States, thank you for shining a light on a population that has been overlooked, dismissed, and underserved for far too long.¹ In your November 2025 Pharmacy Times piece, you called us to a higher standard, and that call deserves a response.

Your observation that a 15-mile radius search of zip code 27514, home to Duke and UNC Health, returned only 13 practitioners and zero pharmacists from The Menopause Society’s provider list is striking. But Troy, I’d gently suggest you may have been looking in the wrong place.

The Practitioners Are Out There in the Functional Medicine Space

When women can’t find answers in conventional medicine—and too many can’t—they turn to functional and integrative medicine practitioners who are willing to dig deeper, look at the whole picture, and yes, discuss bioidentical hormone replacement therapy (BHRT). And the pharmacists who serve these women? We’re there too.

Consider what a search of the functional medicine certification directories reveals for your very own zip code, 27516:

• The American Academy of Anti-Aging Medicine lists 38 practitioners in your area, including 1 pharmacist.
• The Institute for Functional Medicine lists 113 practitioners, including 1 pharmacist.
• The School of Applied Functional Medicine lists 443 practitioners nationally, 22 of whom are pharmacists, 3 of whom are right there in North Carolina.

These aren’t practitioners who squeezed in a weekend certification and moved on. These are clinicians who have invested years in advanced training, who understand the nuanced interplay of hormones, lifestyle, and long-term health, and who are showing up every day for women who have nowhere else to turn.

You will always find what you’re looking for. You just have to know where to look.

A Fish Out of Water…Until I Wasn’t

I’ll be honest with you. The first time I walked into a functional medicine conference, I felt like a complete outsider. I was a pharmacist surrounded by physicians, naturopaths, and nutritionists, and I genuinely questioned whether I belonged at that table. The conversation felt foreign. The frameworks were unfamiliar. I wondered if I had made a mistake.

And then the discussion shifted. Suddenly, the room was talking pharmacokinetics, bioavailability, absorption profiles, dosage forms, transdermal vs oral, pellets vs troches, compounded preparations, and their clinical implications. And every head in that room turned toward the pharmacists.

In that moment, I knew exactly where I belonged.

We don’t just belong at that table; we are essential to it.

We’ve Made the Observation. Now What?

Troy, your article does something important: It names the gap. But naming it is only the beginning. The real question is: How do we get more pharmacists practicing at the top of their license in the hormone health space?

It starts with accessible, practical, clinically relevant education, including continuing education modules specifically on BHRT, perimenopause physiology, and functional hormone management; webinars that bridge the gap between traditional pharmacy training and integrative practice; and partnerships between professional organizations and functional medicine certifying bodies to create pharmacist-specific pathways.

And it must start sooner. Pharmacy school curriculum must evolve. Students need to see menopause management as a core competency, not a footnote. They need to understand that this isn’t a niche; it’s 50 million women and counting.

I dream of the day we have a functional medicine board certification designed specifically for pharmacists. A formal, rigorous credential that says: This pharmacist understands hormone physiology, compounding pharmacology, integrative treatment approaches, and how to serve this population with excellence. It doesn’t exist yet. But it should.

My Magic Wand Vision

If I could wave a magic wand, here’s what the future looks like:

Once a woman has been cleared by her primary care physician, she is referred to a hormone specialist pharmacist, a credentialed clinician with prescriptive authority to initiate, manage, and optimize her BHRT protocol. Her pharmacist collaborates with her care team, monitors her labs, adjusts her compounded formulations, and guides her through the transition with expertise that no one in the room can match.

Here is the reality: That is essentially what I am doing right now. I provide clinical guidance and recommendations to prescribers on behalf of women who need BHRT. I am the pharmacokinetics expert in the room. And in many cases, those prescribers are relying entirely on my guidance because they were never trained in menopause management either. The knowledge is there. The formal authority just hasn’t caught up yet.

We are doing the work. We just aren’t getting the formal recognition, the autonomous authority, or the compensation that reflects it.

Progress Is Possible, and We Have Proof

Speaking of change that takes concerted effort, let’s pause and give credit where it is due. Kudos to the FDA for removing the black box warning from transdermal estradiol products.² That decision is a meaningful step toward reversing the damage done by the deeply flawed Women’s Health Initiative study, which cast a shadow over hormone therapy for decades and left millions of women without access to care that could have protected their hearts, their bones, and their brains. Reversing that kind of institutional inertia is not easy. It takes researchers, clinicians, advocates, and, yes, pharmacists, pushing consistently in the same direction. It is possible. The FDA just proved it.

And here’s where it gets particularly interesting for our profession: That FDA decision, wonderful as it is, has contributed to a surge in demand for transdermal estradiol products, and with that surge has come a very real estradiol patch shortage.³ Women who finally have a willing prescriber and a green light from updated guidance are finding empty shelves.

Thank goodness for compounding pharmacists. Compounding pharmacists have the training, the creativity, and the clinical knowledge of dosage forms to step in precisely when the commercial supply chain cannot. Transdermal gels, creams, troches, customized strengths—these are not inferior alternatives. For many patients, they are better options. Not every provider directory will point a patient in this direction, and some professional guidelines remain firmly oriented toward FDA-approved commercial products alone. But pharmacists who have trained in functional and integrative medicine understand the full landscape, and they are ready to serve patients who fall through the cracks of a shortage that conventional channels cannot resolve.

Thank You for Starting the Conversation

Troy, thank you for writing about a forgotten population that is finally coming out of the woodwork to demand safe, effective, responsible treatment for their natural hormone decline. Thank you for challenging our profession to do better.

And thank you for giving those of us on the front lines of this work an opportunity to raise our hands and say: We are here. We are trained. We are making waves in the functional medicine space, one patient at a time.

The pharmacists are out there, Troy. We’re just not always where you’d expect to find us.

With professional admiration and shared purpose,

Melinda Fowler, RPh

The Hormonal Pharmacist

https://hormonalpharmacist.com/

REFERENCES

1. Menopause at work: why it’s important. Menopause Friendly US. Accessed March 17, 2026. https://menopausefriendlyus.com/home/menopause-at-work/#social-responsibility-case

2. HHS advances women’s health, removes misleading FDA warnings on hormone replacement therapy. News release. FDA. November 10, 2025. Accessed March 17, 2026. https://www.fda.gov/news-events/press-announcements/hhs-advances-womens-health-removes-misleading-fda-warnings-hormone-replacement-therapy

3. Aubrey A. Why the ‘mad scramble’ to fill hormone therapy prescriptions for menopause. NPR. March 10, 2026. Accessed March 17, 2026. https://www.npr.org/2026/03/10/nx-s1-5742817/menopause-hormone-therapy-shortages