What is Compounded Testosterone?
Just as with the ancient Apothecary that prepared medications one at a time for each person, the compounding pharmacist today carries out that tradition.
Here at National HRT, many of our clients look to save money on the cost of their hormone replacement therapy. We often suggest compounded testosterone for men and women with Low T.
What is compounded testosterone and how does it differ from regular testosterone?
Compounded testosterone is identical in preparation to “regular” or brand name testosterone. The difference is that compounded testosterone is produced in small batches to fulfill a prescription. Pharmaceutical companies manufacture brand name testosterone in large quantities, often with preservatives to extend their shelf life.
We know you have many questions about the testosterone compound products available, and we want to answer as many as possible in this report.
Is it safe to take compounded testosterone made by a small pharmacy rather than a large pharmaceutical company?
Until the 1950s, the majority of medications came from compounding pharmacies. It was not until the 1950s that pharmaceutical companies began producing mass quantities of medications. Before that time, most pharmacists compounded drugs based on the doctor’s prescription.
Is compounded testosterone safe to use?
Yes, when you receive compounded testosterone from a fully regulated and licensed US compounding pharmacy, it is as safe to use as brand name testosterone. Before you can get any type of testosterone in the US – compounded or brand name – you will need a prescription. No doctor will provide you with a prescription without first running comprehensive blood tests and requiring you to undergo a physical examination.
The results provided in these reports will ensure the safety of testosterone replacement therapy for you. Unless you have medical contraindications, such as cancer, you will be able to receive testosterone in the dosage calculated for your body’s needs. Only testosterone received in this way is safe to use.
If you purchase testosterone illegally from someone else or from a website that does not require a prescription, you will not be using testosterone safely. The medication you receive could be counterfeit, dangerous to use, and could lead to problems.
What is compounded testosterone made of and is it the same as brand name testosterone?
All testosterone, both compounded and brand name, starts as raw testosterone USP which is then mixed to the specification of the doctor’s prescription. Testosterone USP is a bulk, natural bio-identical chemical that a compounding pharmacist uses to produce various types of testosterone medications.
Testosterone injections use an ester of either cottonseed or sesame oil as their base. Testosterone gels and creams may utilize an alcohol or non-alcohol base. Testosterone in any form consists of 19 carbons.
Compounded testosterone has the same chemical makeup as brand name testosterone – at a lower cost.
What Are the Types of Compounded Testosterone Available for Men?
Men and women have very different needs when it comes to testosterone replacement therapy. The reason is simple – males have higher concentrations of testosterone in their bloodstream than females, requiring a much higher dosage when testosterone levels are too low.
What is compounded testosterone that a man can use?
There are multiple types of compounded testosterone available for men, including:
- Testosterone cypionate injections
- Testosterone enanthate injections
- Testosterone gel – alcohol based
- Testosterone gel – non-alcohol based
- Testosterone cream – not recommended due to lower dosage
- Testosterone pellets – expensive surgical procedure
- Sublingual testosterone troches – more expensive and not as effective as testosterone injections
Testosterone cypionate and enanthate injections are the most widely prescribed forms of testosterone replacement therapy for men. They are significantly lower in cost than all other options and require fewer treatments.
With compounded gels, the application is daily. Testosterone gel also increases the risk of cross-contamination to others who come into contact with the treated skin.
Absorption rates for testosterone gel differ from one man to the next based on internal metabolism and skin thickness. We typically see better results from injectable compounded testosterone.
Although not available in the compounded form, expensive testosterone patches also pose a cross-contamination risk, require shaving of the skin, may cause skin rash or irritation, and have a reduced absorption rate as compared to injectable testosterone.
Is it possible to get testosterone compounded with anastrozole?
Men who use implantable pellets can get combination of testosterone/anastrozole pellets compounded by a pharmacy. Separate testosterone and anastrozole pellets can also be placed under the skin. Anastrozole can also be provided in a capsule, but not mixed in with testosterone injections.
The compounding pharmacy can also combine clomiphene and anastrozole into one daily capsule which can help block estrogen conversion while increasing testosterone levels.
For those who do not know, anastrozole blocks the conversion of free testosterone in the bloodstream into estradiol – the body’s most abundant form of estrogen. Too much testosterone conversion can lead to testosterone deficiency, and a condition called estrogen dominance.
Is compounded injectable testosterone different from anabolic steroids?
Yes, compounded testosterone, in any form, is made from natural, bioidentical testosterone USP. Illegally purchased anabolic steroids are often produced from synthetic derivatives such as methyltestosterone or stanozolol and can cause testosterone overdose.
Anabolic steroid use can lead to many side effects and health risks, including decreasing good HDL cholesterol and increasing bad LDL cholesterol. Synthetic testosterone requires a conversion process in the body before it is available for the androgen receptors to use.
Bioidentical testosterone has the same chemical properties as natural testosterone, allowing for its immediate use by the androgen receptors.
Compounded testosterone is available as an injectable, gel, cream, implantable pellet, or sublingual troche.
What Types of Compounded Testosterone Can Women Use?
There are two primary types of compounded testosterone for women:
- Testosterone cream
- Testosterone pellets
What is compounded testosterone cream and how does it benefit women?
Compounded bioidentical testosterone cream is formulated by the compounding pharmacist to the precise strength and dosage prescribed by the hormone specialist. It starts with bioidentical testosterone USP the same as with male formulations.
Compounded testosterone cream is beneficial for most women dealing with menopausal symptoms. Women who have breast cancer and receive aromatase inhibitors (AIs) which provide excellent outcomes often suffer from serious side effects – especially in terms of sexual quality of life.
They experience vaginal and urogenital issues that can benefit from compounded testosterone cream.
What is compounded testosterone with letrozole or anastrozole used for in women?
Testosterone pellets, either with or without anastrozole or letrozole are an option for breast cancer survivors suffering from menopausal symptoms. Unlike estrogen replacement therapy which can increase cancer risk, testosterone, when used with an estrogen blocker, is extremely safe – and effective.
Even women without breast cancer risks can benefit from this treatment rather than using synthetic estrogen and progestin therapies. According to Dr. Rebecca Glaser, “menopausal symptoms can be quite severe in breast cancer survivors.”
Since estrogen therapy is contraindicated for these women, testosterone with anastrozole can reduce symptoms such as memory loss, fatigue, muscle and joint pains, vaginal dryness, sleep problems, depression, and more.
Compounded testosterone cream is a more common and significantly more affordable treatment option for women dealing with menopausal symptoms. Testosterone deficiency left untreated can increase a woman’s risk of:
- Osteoporosis
- Dementia
- Obesity
- Type 2 diabetes
- Cardiovascular disease
- Atherosclerosis
- Metabolic syndrome
Testosterone is important for women because it is breast-protective and plays a significant role in protecting bone density, brain functions, heart health, and sexual functions. In Dr. Glaser’s study, the following percentages show the total symptom score reductions:
- Psychological symptom scale – 86% reduction
- symptom scale – 81% reduction
- symptom scale – 74% reduction
- Total symptom scale – 81% reduction
At National HRT, we recommend only compounded testosterone cream for most women with Low T. Testosterone pellets may result in levels of testosterone that are too high for a woman.
Transdermal testosterone cream is easily regulated and adjustable if the dosage requires altering – unlike pellets which are surgically inserted and last for months.
Testosterone cream, compounded to the exact strength prescribed by the hormone specialist, is the most common treatment for women with Low T.
How Is Compounded Testosterone Produced?
The method of compounding testosterone depends on the type of preparation being used. Pellet production varies significantly from that of an injectable, gel, troche, or cream.
A combination of technically advanced equipment, the highest quality chemicals, rigorous quality control, and knowledgeable and educated pharmacists ensure superior compounded testosterone.
Compounding pharmacists today still use mortar and pestles but may also employ an electronic mortar and pestle (EMP) to combine powders into a cream, gel, or lotion.
An ointment slab and spatula may also be used to mix the preparation. Ointment mills can decrease the powder particle size for easier application.
What are compounded testosterone pellets made from?
All compounded testosterone begins as raw testosterone USP. Some compounding pharmacies use E-beam irradiation to sterilize the pellets.
How is injectable testosterone compounded?
The raw testosterone USP is formulated with a unique oil – either cottonseed or sesame, allowing for time-released absorption into the bloodstream. Injectable testosterone must maintain a sterile preparation and requires rigorous production procedures.
Is there more than one type of compounded testosterone gel for men?
Yes, in addition to more traditional compounded gels, there is a new product available called Tervis™ Hydrogel. A benefit to this form of compounded testosterone is that it has no alcohol that can dry the skin.
Tervis™ may offer improved absorption – one of the biggest problems with testosterone gel. It is impossible to know how much testosterone enters the bloodstream through the skin from gels or patches.
That is why our doctors here at National HRT prefer prescribing compounded testosterone injections. The benefits of injectable testosterone include reduced frequency of treatment, longer-lasting results, better blood absorption, and significantly lower cost.
Both testosterone creams and gels can be made with absorption enhancers. Pluronic gel (PLO) is often combined with a lecithin oil base to make testosterone gel.
What are testosterone troches and how are they produced?
Sublingual testosterone troches (lozenges) are made by mixing testosterone USP with silica gel and stevia powder extract. Polyethylene glycol (PEG) 145o (or PEG troche base which contains aspartame) is heated to about 50 to 55 degrees Celsius, and then the powders are sprinkled onto the melted base.
After mixing, a flavor is added, the product is mixed again and then poured into molds to cool. The finished testosterone is placed between the cheek and gum to dissolve, bypassing the liver and potential risks that could occur with oral testosterone.
A benefit of compounded testosterone is that it allows for specialized dosing. Unlike commercially produced testosterone, you are not locked into a specific strength. The hormone specialist can prescribe the dosage and strength of testosterone best suited to the individual’s needs.
How long is compounded testosterone good for?
Compounded testosterone typically has a shorter shelf life than brand name testosterone which often contains preservatives. The expiration date of your testosterone depends on the type used and compounding pharmacy preparation. Please discuss this with a medical advisor at our hormone clinic when determining the best option for your treatment.
Compounding pharmacies follow stringent guidelines when preparing compounded testosterone medications.
How Does the Cost of Compounded Testosterone Compare to Brand Name Testosterone?
The price of compounded testosterone is always less than what you would pay for brand name testosterone. After all, you are not paying for the large overhead or advertising expenses of the pharmaceutical company.
There is a wider gap between compounded and brand name testosterone gels than there is with testosterone injections, which are already extremely affordable. However, you can easily expect to save at least 10% or more on a monthly basis.
Testosterone cypionate injections compounded by a pharmacy run approximately $50 less per month than Watson, and $75 less per month than Depo-Testosterone. That is a significant savings for most men.
What is compounded testosterone going to cost me for monthly treatment?
The cost of compounded testosterone may run you well under $100 per month for injections to over $500 per month for gels and patches depending on the treatment option selected.
Of course, testosterone pellets will be even higher due to the surgical procedure. Testosterone cream for women is an extremely low-cost form of testosterone therapy, with pricing dependent on dosage strength.
National HRT Staff
Please note that the information provided in this article is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.
- Accuracy of testosterone concentrations in compounded testosterone products. Grober ED, Garbens A, Božović A, Kulasingam V, Fanipour M, Diamandis EP.Sex Med. 2015 Jun;12(6):1381-8.
- Compounded Testosterone Troches TO OPTIMIZE HEALTH AND THE TESTOSTERONE CONTROVERSY Int J Pharm Compd. 2015 May-Jun;19(3):195-203. Guth MA.
- Compounded Bioidentical Hormones in Endocrinology Practice: An Endocrine Society Scientific Statement Nanette Santoro Glenn D. Braunstein Cherie L. Butts Kathryn A. Martin Michael McDermott JoAnn V. Pinkerton The Journal of Clinical Endocrinology & Metabolism, Volume 101, Issue 4, 1 April 2016, Pages 1318–1343