Last week, I received a call from a compounding pharmacy with a very apologetic pharmacist on the other end. After taking a closer look, he realized they had been filling one of my patient’s hormone prescriptions incorrectly—for six months.
That explained a lot.
This patient had been doing everything right. She applied her hormones consistently and correctly. She completed appropriate testing at regular intervals. Yet her symptoms never fully resolved, and her lab results never quite matched what they should have been showing. Even as I adjusted her doses, it felt like we were chasing our tails.
As it turned out, her hormones were working—and her body was responding. The issue wasn’t physiology or compliance. It was a math error due to lack of attention to detail—not exactly reassuring when you’re dealing with hormones.
Custom Compounding Pharmacies
I’m not sharing this to scare you into tossing your bioidentical hormones in the trash. And while this doesn’t happen often, it also isn’t the first time I’ve seen a patient’s BHRT “fail” because of a disconnect at the compounding pharmacy level.
Let me be clear: I’m genuinely grateful for compounding pharmacies. Without them, women wouldn’t have access to truly customized hormone therapy. They’d be limited to rigid, conventional doses—many of which aren’t biologically identical to what the female body actually produces.
That said, compounding hormones is not simple.
Each prescription is uniquely formulated and typically prepared fresh as it’s ordered. It requires specialized ingredients, precise equipment, and a knowledgeable pharmacist to ensure that what comes out the other end matches exactly what was prescribed. With that level of complexity, it’s easy to see how errors can occasionally occur.
When to Suspect a Problem
An experienced practitioner should always perform a thorough medical history, symptom assessment, and appropriate testing before prescribing BHRT. Once treatment begins, regular follow-up and monitoring are non-negotiable.
If you’re following dosing instructions carefully and working with a practitioner who knows what they’re doing, you should notice slow, steady improvement over time.
But if symptoms like hot flashes, night sweats, poor sleep, brain fog, or unexplained weight gain persist, it may not be what you’re using—it may be whether what you’re using has been prepared correctly.
Choose Wisely—and Double Check Everything
We’re all human, and no system is flawless. Still, there are ways to reduce risk and stay on the safe side of BHRT:
• Choose a reputable, properly certified compounding pharmacy. Just because a pharmacy claims to compound doesn’t mean they do it well. Ingredient sourcing, equipment quality, and staff experience matter. A reputable compounding pharmacy should be PCCA-certified or affiliated with a recognized professional compounding organization. “We compound medications” on a website isn’t enough.Training standards, sourcing, and protocols matter.
• Avoid newcomers. Compounding hormones correctly takes time and expertise. Pharmacies that are newly dabbling in BHRT—or “branching out” into hormones—often lack the necessary experience. Hormone compounding has a learning curve, and pharmacies that have been doing BHRT consistently for years tend to have tighter systems and better quality control.
• Make sure they specialize in human hormones. Some pharmacies compound for both humans and animals. That’s not inherently wrong—but bioidentical hormone therapy requires a different level of precision than compounding a pain cream for a horse. I’ve seen more issues come from pharmacies that split their focus.
• Always verify your prescription label. Ask your practitioner for a copy of your BHRT prescription. When you receive your hormones, make sure the label matches the prescription exactly—dose, concentration, and formulation.
• Pay attention to how they communicate. A good compounding pharmacy is accessible, responsive, and willing to answer questions—yours and your practitioner’s. If communication feels rushed, vague, or dismissive, that’s a red flag.
How to Find an Experienced Compounding Pharmacy
If you’re working with a practitioner who has solid experience prescribing BHRT and
consistently good patient outcomes, it’s usually reasonable to rely on their recommendations.
That said, geography still matters. Some areas simply don’t have a reliable compounding pharmacy nearby. In those cases, I routinely work with well-established compounding pharmacies in other states that can safely ship prescriptions.
You can also do your own vetting. PCCA maintains a public directory of pharmacies that have completed structured compounding education and follow standardized preparation protocols. It’s one of the most dependable places to start when you’re looking for experience—not just convenience.
The Bottom Line
Hormone therapy isn’t simple—but when it’s properly dosed, prepared, and monitored, it can be both life-changing and health-sustaining.
If your BHRT isn’t working for no clear reason, it’s time to look beyond the usual suspects.
Occasionally, the issue isn’t your hormones—or your body at all—but an overlooked detail most people never think to question.
And as this case shows, those details matter more than most realize