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Prescribing patterns for compounded HT differ across specialties
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In the United States, general practitioners and obstetrician/gynecologists are more likely to prescribe FDA-approved hormone therapy, whereas wellness practitioners are more likely to prescribe compounded hormone therapy, according to recent survey data.
“Some physician specialties are more likely to perceive a need to prescribe FDA unapproved products, that data from this survey may help to better understand the need for additional products to fill the gap that may lead some physician groups to prescribe products that are not fully studied or regulated,” Ginger D. Constantine, MD, of EndoRheum Consultants in Malvern, Pennsylvania, told Endocrine Today.
Constantine and colleagues evaluated survey responses from 440 physicians in the United States to determine the prescribing patterns of menopausal HT for both compounded and FDA-approved products among them. The physicians included 171 general practitioners, 170 OB-GYNs and 83 wellness physicians; a “wellness physician” was defined as a physician who reported specialty as “anti-aging/wellness or regenerative care” or who was not an OB-GYN, gynecologist or endocrinologist and reported seeing more than 25% of female patients for HT. Physicians were eligible to complete the survey if they prescribed HT for at least six patients per month.
Ginger D. Constantine
Compared with general practitioners, wellness practitioners and OB-GYNs were more likely to prescribe HT; menopausal symptom relief was the main reason for prescribing HT across the three groups. HT was prescribed for cardiovascular benefits or overall wellness by wellness practitioners 28% of the time compared with 13% of the time by general practitioners and 10% of the time by OB-GYNs. Compounded estrogen and progesterone was prescribed by more wellness practitioners compared with the other two groups, but compounded dehydroepiandrosterone and testosterone (prescribed alone) were more likely to be prescribed by OB-GYNs compared with the other two groups.
Compared with general practitioners and wellness practitioners, OB-GYNs were less likely to consider compounded HT safer or more effective than FDA-approved HT.
“While all physician specialties who participated in this survey prescribe HT, differences in prescribing compounded HT vs. FDA-approved formulations by medical speciality/practice exist,” Constantine told Endocrine Today. “Of those surveyed, OB-GYNs and [general practitioners] more commonly prescribed FDA-approved HT while wellness MDs were more likely to prescribe [compounded] HT.” – by Amber Cox
Disclosure: Constantine reports consulting for TherapeuticsMD. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
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JoAnn V. Pinkerton, MD, NCMP
One-third of prescriptions for HT may be for compounded HT. Constantine and colleagues found that OB-GYNs and general practitioners prescribed more FDA-approved HT, primarily for menopausal symptom relief, whereas wellness physicians prescribed more compounded HT, primarily for well-being and CV benefits. Education is needed for providers and their patients about the availability of FDA-approved bioidentical HT. Concerns about compounded HT include lack of FDA monitoring and regulation, possibility of over- or underdosing, lack of scientific studies on efficacy and safety, and the lack of a label. The North American Menopause Society, the Endocrine Society and the American Congress of Obstetricians and Gynecologists recommend FDA-approved therapies and the use of compounded HT for medical indications such as allergy or need for nonstandard dosing, formulations or preparations and recommend against routine serum or salivary hormone testing.
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