Hormone Replacement Therapy Compounding: A Patient's Guide
An educational resource for women managing menopause and perimenopause, working with their prescribers on hormone therapy decisions.
Many women experience changes during perimenopause and menopause that affect daily life — sleep, mood, energy, comfort, and overall wellbeing. If you're experiencing symptoms that may be related to hormonal changes, the first step is a conversation with your physician or nurse practitioner. They can help determine whether hormone replacement therapy — including compounded preparations when appropriate — fits your situation.
This site is an educational resource. It is not a substitute for medical advice, diagnosis, or treatment from a qualified healthcare provider.
What "Bioidentical" and "Compounded" Actually Mean
Two terms get used a lot in this area, often interchangeably and sometimes inaccurately. It helps to separate them.
"Bioidentical" refers to molecular structure. Hormones described as bioidentical have the same molecular structure as certain hormones the body produces. Both Health Canada–approved commercial products and compounded preparations can contain bioidentical hormones — the term describes molecular structure, not how the medication is prepared.
"Compounded" refers to how the medication is prepared. A compounding pharmacy prepares custom medication for an individual patient based on a specific prescription, rather than dispensing a commercially manufactured product.
Compounded hormone replacement therapy may be appropriate when a prescriber wants to tailor the dose, combination, or delivery form to an individual patient in ways commercial products don't allow — for example, when a patient has sensitivities to ingredients in approved products, or needs a non-commercial dose.
Important context: Compounded hormone preparations are not Health Canada–approved drug products. The decision to use a compounded preparation versus a Health Canada–approved hormone product is a clinical decision made between you and your prescriber. For most women considering hormone therapy, a Health Canada–approved hormone product is the typical starting point. Compounded preparations fill specific gaps when an approved product isn't suitable.
How the Process Works
Talk to Your Prescriber
Your physician or nurse practitioner assesses your symptoms, reviews your history, orders any appropriate testing, and decides whether hormone therapy is right for you.
Get Your Prescription
If a compounded preparation is appropriate, your prescriber writes a prescription specifying the active ingredients, dose, vehicle, and directions.
We Prepare Your Compound
Our pharmacy prepares your custom formulation following your prescription, with documented batch records and pharmacist verification at each step.
Ongoing Adjustments
Your prescriber monitors your response and may adjust the dose or formulation. We prepare each refill consistently with the prescription.
Forms of Compounded Hormone Therapy
Compounded hormone preparations can be made in several forms. Each has different properties — how absorption occurs, how the medication is used day to day, and what's most practical for the patient. Your prescriber chooses the form based on your clinical situation.
Topical Creams
Applied to the skin once or twice daily. Hormones absorb through the skin into circulation, bypassing first-pass metabolism by the liver.
Oral Capsules
Taken by mouth and absorbed through the gastrointestinal tract. Familiar and convenient for many patients.
Sublingual Troches
Lozenges that dissolve under the tongue, allowing absorption through oral mucosa. Partially bypasses first-pass liver metabolism.
Vaginal Preparations
Creams, suppositories, or capsules for vaginal application — used for genitourinary symptoms, with relatively low systemic absorption at typical doses.
About Our Pharmacy
This site is an educational resource published by Humber Bay Compounding Pharmacy, a Level C non-sterile compounding pharmacy in Etobicoke, Ontario. Compounded hormone replacement is one of our specialty focus areas.
Specialty Focus
Compounded hormone replacement is one of our specialty focus areas. We have established processes for preparing custom hormone formulations as ordered by prescribers, with documented quality standards.
Quality Standards
Level C non-sterile compounding certification by the Ontario College of Pharmacists. Pharmaceutical-grade ingredients with full lot tracking. Documented batch records for every preparation.
Pharmacist Counselling
Our pharmacist takes time to explain how to use your medication, what to expect, and what to monitor. We're available for follow-up questions about your formulation.
Prescriber Communication
We work directly with your prescriber on prescription clarifications and formulation questions. Coordinated with your clinical care, not isolated dispensing.
Our pharmacy is led by Nader Danyal, PharmD, RPh (OCP Lic. 604484), with extensive compounding experience and ongoing professional education.
Have a hormone therapy prescription, or formulation questions?
For questions about our compounded preparations, ingredient sourcing, or how to use a specific formulation, call us. For clinical decisions about whether hormone therapy is right for you, your prescriber is the appropriate starting point.
Call (647) 348-2323 How to Get Started