[NP-Clinical] compounding bioidentical hormones

[Julie]

Hello,
I am interested in finding out more about prescribing hormone 
replacement compounding agents.  I seem to remember there is a saliva 
test that is given to determine how to dose the hormones, is that 
correct?  There are a few pharmacies in my area that do compounding.  Do 
I just contact them to find out if they provide the test and then they 
analyze it and compound it for the patient?  I wasnt sure if there were 
set amounts in addition that you can start with the lowest doseages and 
then advance as tolerated?  I have been doing some research into it and 
I cant find that much out but it seems like estrogen, progesterone and 
testosterone hormones are the most commonly used, is that correct?  Are 
these actual hormones or bioidentical hormones which I assume are plant 
based.  Does anyone know the approximate monthly cost for the 
medications?  I have a few patients that dont tolerate regular hormones 
for perimenopausal symptoms that would like to try this.  I do not know 
of any providers in my area that do it and my personal gynecologist said 
he doesnt believe in it so I am trying to get as much information as 
possible.  It is also my understanding that these compounds are often 
self regulated by the patient according to how they feel.  In addition I 
know there are various forms.  One person I spoke to thought that often 
they are in a cream that is applied topically such as to the wrist.  Any 
information would be appreciated.
Thanks in advance,
Julie Worley, FNP, PMHNP