Bio-identical Hormone Replacement



Bio-identical Hormone Replacement

Throughout a woman’s lifetime she may encounter numerous hormone-related symptoms or problems

Women’s bodies go through mountains and valleys of hormonal changes from puberty on. As menopause embarks, the normal chaos is no longer normal and most times, intolerable. Southern Maryland Compounding Center (SMCC) is here to help you ride out the waves peacefully. We offer Biologically Identical Hormone Replacement, Breastfeeding products and rentals, formulations for PMS relief and more!

Throughout a woman’s life, she may encounter numerous hormone related symptoms or problems. The pharmacists at SMCC specialize in compounding bio-identical hormone prescriptions that can help with:

Dysmenorrhea (painful menstruation)
Mood swings
Premenstrual Syndrome (PMS)
Fibrocystic breasts
Prememopausal symptoms
Weight gain
Low libido
Heart disease

Today there is an alternative to traditional synthetic hormone replacement (conjugated equine, or horse, estrogens and medroxyprogesterone).  It’s bio-identical hormone replacement therapy (BHRT) or natural hormone replacement therapy and SMCC has it for you. 

BHRT includes estrogens (estrone, estrodiol & estriol), progesterone, testosterone, DHEA and pregnenolone.

We offer private consultations with our specially trained pharmacists. Private consultations allow patients with concerns or questions about natural hormone replacement therapy to have their questions answered. We will work with you and your physician to develop a customized hormone replacement plan that best suits you.

In order to customize your BHRT, it is necessary for you to fill out a patient questionnaire.  To access the BHRT patient questionnaire, click on BHRT patient questionnaire.  Once you have filled it out completely, you can fax it to us at (301)476-0382 or mail it. The information will be reviewed at your consultation.

With SMCC’s Personal Consultation Program, we can help you find the answers to questions like:

Should I be on hormone replacement?
How is “natural” hormone replacement different from traditional hormone replacement?
How will I deal with my body’s changes?
How effective is proper diet and exercise?

Our menopause consultation is designed to empower you to make informed choices. Your private consult lasts one-half hour to one hour and is conducted by one of our trained pharmacists who specialize in women’s health.  Your consult can take place either in person or over the phone.

The pharmacist will discuss . . .

traditional versus bio-identical or “natural” hormone replacement
phytoestrogens and soy products
nutritional support
dietary and life-style interventions
The importance of baseline hormone levels

What to expect . . .

Our pharmacist will make a variety of specific nutritional, dietary and lifestyle recommendations based upon the information you provide.
Offer options to relieving menopause symptoms. Make personalized dosage recommendations to your physician, if necessary.
Work with you and your physician to meet your individual needs.
Help you find a physician who will work with you.

If you suffer from fatigue, low sex drive, hot flashes, foggy thinking, stress, mood swings, sleep disturbances, anxiety or depression, it could be your hormones. Saliva testing can help identify hormonal imbalance. It can also be used by your Doctor to help identify and restore hormonal imbalance. 

Saliva testing is the most reliable way to measure free, “bio available” hormone activity – hormones actually doing their job at the cell level. Most blood tests do not measure “bio available” hormone levels. Saliva hormones more accurately reflect tissue uptake and response of hormones delivered through the skin in creams, gels or patches. Blood and urine assays significantly underestimate hormones delivered topically, often resulting in overdosing.  Saliva collection is painless – no needles. It negates the need for blood drawing, which often causes stress that can alter test results.

Saliva test kits designed to measure hormone levels are available. Saliva collection is easy and can be done any place at your convenience.  

How do you get started?

Come to the pharmacy and pick up a saliva test kit
Perform the saliva test in the privacy of your home
Results are mailed to SMCC
You come into the Pharmacy for a consult with our Pharmacist
Pharmacist makes recommendation to your health care provider
Health Care Provider either approves the recommendation or makes his/her own changes.
We fill your prescription and you begin to feel better
No pills to take, No harmful side effects, easy to administer creams.
If you have any questions, please feel free to contact a pharmacist at (301)645-2400




If you would like to download our female hormone questionaire, please CLICK HERE.

Conversion Guidelines Synthetic to Bio-Identical

  • Giving new BHRT patients the smallest effective starting dose allows great flexibility in titrating doses to meet individual needs.
  • Bio-identicalHRT is uniquebecause it can be customized specifically for an individual patient.
  • BHRTcan be compounded in any combination, any ratio, any strength, and any dosage form.
Bi-est (oral) (80/20)
Tri-est (oral) (80/10/10)
Micronized Progesterone(oral)
1OOmg – 150mg
Micronized Progesterone(oral)
1Omg – 25mg

Micronized Estradiol
 Methyltestosterone (oral)
1.25Micronized Testosterone (SL)
0.5mg – 1.0mgMic. Testosterone (topical)
1.0mg – 2mg aDAndrogel®
25mg/2.5g pack
50mg/5.0g pack
Micronized Testosterone
0.625mg Premarine@ + 5mg Provera@
Bio-Identical (oral)
Tri-est 2.5mg + Mic. Progesterone 100-150mgEstratest®
Estrified Estrogens 0.625 + Methyltestosterone 1.25Bio-Identical (oral)
Tri-est 2.5mg
Mic. Testosterone (separate – topical 1 mg QD)

NOTE: Standard Estrogen (synthetic) dosages have been established based on response to estrogen-only therapy. Addition of natural progesterone may increase synthesis of estradiol, the quantity of estrogen receptors, and the sensitivity of estrogen receptors, thereby making endogenously produced or exogenously administered estrogens much more efficient in their activities in the body. Also, proper regulation of thyroid function monitoring free T4 and free T3 level and providing restoration therapy as needed to produce optimal individual thyroid response also increases the efficiency of the body’s response to estrogens. Therefore, both the standard doses of synthesizedestrogen historically prescribed and the listed conversion of bio-identical estrogens are more than properly hormonal balanced women will require. These equivalencies are for use in comparing estrogen potencies and to aid in conversion from synthetic to bio-identical hormones only.

Protocol for converting women who have been on synthetic and/or strong estradiol therapy for a sufficient period:

1. Start natural progesterone (stop any synthetic progestin) for 2-4 weeks, while tapering off synthetic estrogen.
2. Treat low free thyroid levels and/or subclinical hypothyroid symptoms with T41T3combination therapy pm.
3. Dose Silybum Marianum (milk thistle) 220mg help eliminate synthetic metabolites.
4. After 3 – 4 weeks, convert to bio-identical estrogens, and if maximum dosage listed in dosing guidelines does not resolve symptoms, increase the percentage of estradiol in Tri-est or Bi-est.

Please Note: Conversion guidelines are meant to be used as a reference only. They are in no way indicating a recommendation for any product, for any patient, or for any clinical situation. Individual dosage should be determined based on results of a hormone/total health evaluation of each patient. Conversion guidelines given are the opinion of the author based on his experiences. Compiled by Jim Paoletti, Consultant Pharmacist.


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