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Compounding Pharmacies and Testosterone

Compounding pharmacies can be a life saver for some guys on Hormone Replacement Therapy (HRT).  This is because both of the blockbuster HRT gels, Testim and Androgel, don't work for all guys.  Some guys could bathe in these two drugs and still not get enough testosterone into their blood stream. 

This is where a compounding pharmacy comes in.  A good compounding pharmacy takes the same bioidentical testosterone and puts into a gel or cream at the dosage the doctor specifies.  (This is generally much cheaper than either Testim or Androgel as testosterone is a relatively cheap molecule to manufacture.)  Many guys who cannot seem to get past the 200's or 300's with Testim or Androgel break those barriers easily with compounding.  (Most docs will try to get you right around 500 from what I have seen.)

The reasons that compounding is so much more effective are likely twofold:  the delivery system, called PLO, which is discussed below and the ability to put as much testeosterone into the cream or gel as needed.  With Androgel or Testim, there is no variation in concentration.  If you're not getting enough testosterone, all you can do is smear on more product.

Are there any downsides to compounding?  Well, there is always the possibility for math errors.  However, in the case of testosterone, the caclulations are quite straightforward.  Most doctors will specify a certain number of grams/day to the compounding pharmacy and so it is a simple matter of days times grams/day for the overall quantity.  The pharmacy must also come up with the concentration for the PLO (Pluronic Lecithin Organogel), but this is something they do quite frequently as many drugs are delivered in PLO. 

What is PLO?  PLO is a "penetration enhancer", i.e. it helps the drug pass through the stratum corneum, a big name for the upper layer of your skin.  PLO is usually made from soy but can be made from eggs as well.  It is composed primarily of lecithin, isopropyl palmitate and Pluronic F127.  Isopropyl palmitate helps the testosterone penetrate the skin and is also a solvent.  It can definitely cause skin irritation, clogged pores, etc. and this is one of the potential downsides to PLO.

The Pluronic F127 is a "surfactant", which means that it spreads the product out evenly so that it does not bind or coagulate together.  I have not been able to find absorption rates nor side effects other than what I mentioned above.  These two chemicals are considered safe, but no one has tested any of this long term.

Realize, though, that Testim and Androgel use their own absorption system and it may actually be similar to PLO. You can't patent a simple, "old" molecule like testosterone, so the manufacturers actually patented their delivery system in this case, boosting the sales price they can charge.  And charge they do:  both medications are quite expensive. 

The only other disadvantage that I know with compounded testosterone is that its effect on family members is undocumented.  After reports of children being affected through their father's topical application of testosterone therapy, the FDA asked for the manufacturers to do additional testing to make sure this wasn't an issue with their product. 

Personally, I doubt that Testim or Androgel has unusual potent penetration capabilites as a significant percentage of guys find they get little to no penetration.  Plus, again from what I have heard, these cases are usually from fathers who are being careless. Androgel, for example, is applied to the chest and upper arms.  Some dads go shirtless or forget to wash off the product before doing physical things with their family. 

If you thoroughly wash the area of application, your family members should be safe, i.e. your wife and kids should not be overabsorbing supplemental testosterone.  However, you should realize that the FDA is only working with the mainline manufacturers and not with compounding pharmacies. Talk to your doc, of course, about all of the above. CAUTION:  Be careful about love make sessions with your woman unless you've thoroughly washed the product off:  her testosterone is just a fraction of yours!

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