The role of a pharmacist when treating hormone imbalances

Five things you didn’t know about pharmacists and how they can help with hormone-related conditions 

The origin of pharmacists is ancient and stems from the first person who extracted juice from a leaf to apply it to a wound. Since then, this art has been practiced, leading to certain people mixing ingredients together to form remedies and as of today we know them as an apothecary or a pharmacist. The development of the pharmaceutical industry led to the discovery of new and effective drug substances, which in turn also changed the role of the pharmacist. The choice for extemporaneous compounding of medicines was much lessened and with it the need for the manipulative skills that were previously applied by the pharmacists. The pharmacist continues, however, to fulfil the prescriber’s intentions by providing advice and information through formulating, storing, and providing correct dosage forms, and by assuring the efficacy and quality of the dispensed or supplied medicinal product.​(1)​ 

Fast forward to today, not only can you find pharmacists in hospital and community settings, but also working in areas such as research, academia, public health, veterinary pharmacy, and even the military. Pharmacists can also specialise in a specific discipline, such as hormones, and their expertise is becoming increasingly sought after, as GP appointments are becoming ever more difficult to book.  

Hormone imbalances affect many women and even men at various points throughout their lifetime. The healthcare provider may prescribe conventional hormone replacement therapy (HRT), available on the NHS, or bioidentical hormone replacement therapy (BHRT) available from a compounding pharmacy such as Specialist Pharmacy. Compounded hormones are a great option for patients who cannot tolerate HRT, due to reasons such as allergy to one or more of the ingredients or even the inability to adhere to the specific dosage form, as they can be created to meet unique hormone needs. 

With so many options for BHRT available, what role should pharmacists play in treatment management of men and women suffering from hormonal imbalances? Let’s look at five things you may not know about pharmacists and how they can specifically help you with hormone related conditions: 

1. Pharmacists can formulate new hormone formulations.
   Pharmacists can formulate a personalised hormone medication with the best delivery method for the patient. From a patient being allergic to one or more of the excipients in their usual hormone preparation to being unable to take a certain dosage form, a pharmacist can work with the prescriber to understand the patient’s specific needs.  This is a truly personalised approach and empowers patients by giving them the opportunity to discuss their needs directly with a pharmacist. Therefore, leading to improved compliance and therefore better overall treatment outcomes. 
2. Pharmacists can offer you hormone-free alternatives to help manage your symptoms.
   For various reasons, such as a family history of hormone-related cancers, one may not wish to use hormone replacement therapy. There are alternatives for some of the common symptoms, such as vaginal dryness. For example, pharmacists can create a vaginal gel compounded from vitamin E and hyaluronic acid, to help combat dryness. Bespoke facial creams which include various vitamins can be formulated to manage menopause-related dehydration and wrinkling and to improve elasticity and help with hyperpigmentation. Whatever a patient’s symptoms or concerns are, a pharmacist can look at different hormone- free options available and suggest alternatives. 
3. Pharmacists can offer advice about hormone-related conditions and medication. 
   In addition to the regular checking of prescriptions, verifying the product, dosage, frequency and duration of treatment, pharmacists can also counsel on side effects and any other questions about your medication. When a patient is prescribed a medication for the first time, they will receive a patient information leaflet with full information about their hormone medication. If they have any concerns about side effects, they can speak directly with a pharmacist who can advise what to do if any are experienced, as well as recommending the best time to take the medication, to further minimise any potential side effects. Having a pharmacist to direct these questions to, helps relieve the burden on busy doctors and prescribers. Pharmacists are highly trained so are very well-placed to answer any questions about hormone conditions. 
4. A pharmacist could save you money.
   Pharmacists can review prescriptions and advise whether there are any cheaper alternatives available. A compounding pharmacist who specialises in BHRT would be able to suggest combining the hormones into one formulation where suitable, which would help reduce the cost. Furthermore, pharmacists can compare prices of licensed medications and see if there is a similar product with the same strength, at a cheaper price. 
5. A pharmacist can offer peace of mind and reassurance.
   Pharmacists can talk to patients about the associated risks vs benefits of each hormone and look at whether any of them will interact with any current medication being taken. They look at scientific studies to decide on the optimal route of administration, absorption, and best time of day to use the medicines, resulting in the best possible outcomes. This sort of counselling ensures safe and effective use of BHRT and offers peace of mind to patients who may feel apprehensive about trying hormone therapy. 

Conclusion 

In summary, pharmacists can play a vital role in managing hormone-related conditions and providing appropriate advice to patients. An ever-increasing number of hormone replacement preparations are becoming available on the market, which can seem like a minefield for doctors and patients alike. Having studied pharmacy at university, pharmacists are the experts in understanding the pharmacokinetics and pharmacodynamics of drugs, so are best placed to advise on how they work. 

Compounded hormone medications are prescribed for patients based on the levels of deficiency of their endogenous hormones, including oestrogen, progesterone, and testosterone. Although there may be risks associated with taking BHRT, there are also many clinically significant benefits, such as improved cardiovascular health. The nature of compounded medication means that hormone medications can be altered in small increments to alleviate symptoms, while simultaneously minimising any risks associated with larger doses.​(2)​ 

Pharmacists should be utilised more to assist with BHRT management, as their extensive knowledge can take pressure off prescribing professionals, and they are often best placed to answer questions about medication and can advise on appropriate products based on their current symptoms and pathology results. Not only can they be helpful in an NHS setting, but also in a private setting where healthcare professional is looking to prescribe compounded medication. Pharmacists can collaborate directly with the prescriber to formulate an appropriate prescription, so really are key to hormone restoration and optimisation in men and women experiencing hormonal imbalances.​(3)​ 

References: 

​​1. Pharmacy | Britannica [Internet]. [cited 2023 Feb 9]. Available from: https://www.britannica.com/science/pharmacy 

​2. Ottesen B, Sørensen MB. Women at cardiac risk: is HRT the route to maintaining cardiovascular health? International Journal of Gynecology & Obstetrics [Internet]. 1997 [cited 2023 Feb 9];59(SUPPL. 1):S19–27. Available from: https://onlinelibrary.wiley.com/doi/full/10.1016/S0020-7292%2897%2990195-8 

​3. Bajorek B, Lemay K, Gunn K, Armour C. The potential role for a pharmacist in a multidisciplinary general practitioner super clinic. Australas Med J [Internet]. 2015 [cited 2023 Feb 9];8(2):52. Available from: /pmc/articles/PMC4354025/ 

​ ​ 

Author: (pictured) Rizvan Faruk Batha MPharm, PGDip GPP, IPresc, MRPharmS, submitted by Specialist Pharmacy

Superintendent Pharmacist and Director of Operations at Specialist Pharmacy 

Rizvan Faruk Batha (MPharm, PGDip GPP, IPresc, MRPharmS) is the Superintendent Pharmacist and Director of Operations at Specialist Pharmacy. With over 14 years of experience within the pharmacy sector. He has an extensive portfolio of experience ranging from working within GMP facilities, quality assurance & quality control roles, clinical trials & research GCP and within many specialities as a clinical pharmacist. Rizvan’s broad experience and background of working in licensed and unlicensed MHRA facilities has led him to now manage and drive his team to successfully lead the compounding industry in the UK, increasing access to medicines for patients needing a more personalised approach to their therapy. Rizvan has many years of experience working within large NHS Teaching Hospitals. He completed his Master of Pharmacy Degree at The School of Pharmacy, University of London and completed a Postgraduate Diploma in General Pharmacy Practice (PG Dip GPP) at UCL. He is currently working towards becoming a Clinically Enhanced Pharmacist Independent Prescriber specialising in Menopause with King’s College London.
 

Staff Writer