Clinical Protocols Reference by Specialty

Compounded hormone preparations exist primarily to solve a fit problem: a strength unavailable commercially, a combination in one preparation, or a base that avoids an excipient a patient reacts to. Route materially changes pharmacokinetics, and serum monitoring is interpreted differently for transdermal, oral, sublingual, and pellet delivery — timing relative to the last dose matters as much as the interval since starting.

For men, the primary-versus-secondary distinction drives everything downstream, because secondary hypogonadism opens fertility-preserving options that replacement forecloses. For women, cycle phase determines whether a hormone panel is interpretable at all.

Incretin therapies have the strongest human outcome evidence in this category. The compounding position is the constraint rather than the clinical one: availability depends on shortage status and on whether a documented clinically significant difference applies to the individual patient.

The consideration most often missed is lean mass. Rapid incretin-driven loss includes a substantial proportion of lean tissue, which matters most in the perimenopausal and older patients who frequently present for it. Protein intake and resistance training are part of the protocol, not an afterthought.

This category has the widest gap between enthusiasm and evidence. BPC-157 and TB-500 have substantial animal literature and almost no controlled human data, and their compounding status has moved repeatedly.

Two practical points: both have angiogenic activity to some degree, which warrants specific discussion in patients with malignancy or a recent oncological procedure; and both are prohibited in tested sport, BPC-157 by name.

Desire and vascular response are separate mechanisms, and matching the agent to the failing mechanism is most of the clinical work. PDE5 inhibitors amplify a physiological response and do nothing for absent desire; PT-141 acts centrally on desire and is FDA-approved only for HSDD in premenopausal women, so use in men is off-label.

New-onset erectile dysfunction over 40 warrants cardiovascular assessment. Penile arteries are smaller than coronary arteries and frequently become symptomatic first.