1. health and fitness
2. drugs

Bioidentical Hormone
Replacement Therapies
Chris Meletis, ND
Naina Sachdev, MD
Erik Lundquist, MD
Nayan Patel, PharmD
Workshop Guide
CentralDrugsRx.com
877.447.7077
Dear Practitioner,
Welcome to the Bioidentical Hormone Replacement Therapy Workshop presented
by Central Drugs Compounding Pharmacy.
Interest in BioIdentical Hormone Replacement Therapy (BHRT) has grown
dramatically in the past decade as men and women are seeking healthier options
for restoring vitality and energy in their active lifestyles. Natural replacement of
hormones is making a difference in the quality of patients lives and we are excited
that you are becoming a resource for preventative healthcare patients.
Central Drugs Compounding Pharmacy is proud to have the opportunity to
partner with these exceptional speakers for this extraordinary workshop. Each of
our speakers is a leader in their field as practitioners, authors and speakers. After
attending this workshop, you will have the tools needed to address a larger variety and scope of patient cases uses BHRT. This knowledge will give you a strategic advantage in growing a more effective, sustainable, and profitable healthcare
practice.
Congratulations on making a commitment to strengthening your practical
knowledge of BHRT. and becoming one of the sought out physicians capable of
providing this advanced therapy. Your patients will thank you for coming.
Course Objectives:
t Discuss the principles and foundation of hormones and bioidentical
hormone replacement therapy
t Learn how to recognize and diagnose hormone deficiencies, including Thyroid and
Cortisol in female and male patients
t Learn how to interpret laboratory tests to confirm diagnoses and monitor therapies
t Learn how to formulate customized medication therapy regimens for
patients with hormone related diseases
t Learn Nutritional Supplements complimenting bioidentical hormone
replacement therapy
t Learn what to look for when working with a compounding pharmacy
Central Drugs Pharmacists Team
Nayan Patel, PharmD; CEO
Dr. Nayan Patel is a recognized expert in
clinical pharmacy services. Dr. Patel is
a frequent guest lecturer internationally
on topics such as hormone replacement
therapy, menopause and andropause,
osteoporosis, and breast cancer. He is
passionate about working together with
physicians, nutritionists, and patients to
develop a comprehensive plan to improve
each patient’s overall health and quality of
life. In addition to his work with patients and practitioners at Central
Drugs, Dr. Patel is involved with the USC School of Pharmacy as a
guest lecturer and faculty member.
Ashwin Patel, PharmD, CCN; COO
As a Certified Clinical Nutritionist (CCN),
Dr. Ashwin Patel is an expert in nutritional
health. He is passionate about the role that
alternative medicine can play in people’s
health, especially when including a diet
that emphasizes whole foods and nutrient
supplements. His emphasis on patient care
extends throughout Central Drugs, which
unlike most pharmacies works directly with
physicians to solve problems for patients, and
gives both physicians and patients more treatment options.
Peggy Chan, PharmD
Keyur Patel, PharmD
Dr. Peggy Chan graduated from the
University of the Pacific in Stockton, CA
in 2010. She worked for a number of years
in retail pharmacy before joining Central
Drugs. Dr. Chan has experience operating
immunization and blood pressure clinics
and has a comprehensive knowledge of
pharmaceuticals, OTC medications, and
nutraceuticals.
and ancillary staff.
Manisha Patel, PharmD
Dr. Manisha Patel graduated from Nova
Southeastern University in Fort Lauderdale,
Fl. Manisha has had over 17 years of
retail experience. Her roles have included
District Management,Immunization
training, Management Rotation preceptor,
Advisory Board positions with local
pharmacy schools and technician schools.
Manisha is certified as an Immunization
trainer. Manisha is passionate about
promoting medication compliance and educating patients to drive
quality of life.
Dimpi Patel, PharmD
Dr. Dimpi Patel received her Bachelor of Science in Chemistry from La Sierra University
and Doctor of Pharmacy degree from Loma
Linda University. Dr. Patel has a variety of
experience in pharmacy including retail,
managed care, compounding, management,
and hospital. She is also trained to give immunizations to pediatric and adult patients.
Dr. Keyur Patel received his Doctor of
Pharmacy degree from University of the
Pacific, School of Pharmacy in Stockton,
CA in 2001. He completed his 4th year
clerkship rotations in Ventura County,
and is licensed to practice pharmacy in
CA. Keyur is involved with prescription
processing, providing drug information
to doctors, patient counseling, non-sterile
compounding, and supervising technicians
Sheryll Castro-Ieng, PharmD
Dr. Sheryll Castro-Ieng earned her Bachelor
of Science degree in Physiology from
UCLA and her Doctor of Pharmacy degree
from Western University of Health Sciences
in Pomona, CA. Dr. Castro-Ieng adds a
wealth of valuable industry knowledge
to the Central Drugs team through her
experience in a variety of pharmacy settings
including retail, HMO, and managed
care. She has taught at Cerritos College
in Norwalk, CA, worked as a clinical
consultant for a managed-care consulting firm in Irvine, CA.
Ilham Hassan, PharmD
Dr. Hassan earned her Bachelor of Science
degree in Biological Sciences from the
University of Southern California and her
Doctor of Pharmacy degree from Western
University of Health Sciences. Ilham is
committed to delivering the best possible
pharmaceutical care. She is passionate
about providing patient education and
customizing drug therapy to meet each
patient’s unique needs.
Helping Practioners Build their Practices Through Education
Central DrugsRx.com 877.447.7077
Creating Health
One Person - One Family - One Community at a Time
Chinh Tran, RPh, PhD
Dr. Chinh Tran received his Pharmacy Degree
from Saigon University, School of Pharmacy in
1978. He received his PhD from the University of
Southern California, Department of Physiology
and Biophysics in 1993. His research has
focused on utilizing Photo labile nucleotides
analogues to study the relationship of structures
and functions of various important biological
enzymes. Dr. Tran’s work has been published in
many international Journals such as the Journal of
Biological Chemistry, Biochemistry, Biophysical Journal, etc. He has helped
establish Central Drugs as one of the nation’s leading companies in the
compounding pharmacy industry.
Helena Nguyen, PharmD
Dr. Nguyen received her Doctorate of
Pharmacy degree from the University
of the Pacific Thomas J. Long School
of Pharmacy and Health Sciences.
She has extensive knowledge in
multiple facets of pharmaceutical
compounding including non-sterile
and sterile compounding. She has
gained this knowledge through work
experiences in three compounding
pharmacies in Northern California. Helena is always looking to
improve her patient care by gaining more knowledge in creating
specialized and individualized medications for her patients.
Alexander Semis, RPh, M.Sc., MHA
Dr. Semis graduated from The Hebrew
University in Jerusalem, School of Pharmacy.
Dr. Semis received his Master’s Degree from
Tel-Aviv University , School of Medicine, with
major in Pharmacy and Microbiology. His
research focused on Combination anti-fungal
therapy for systemic fungal infections. Dr. Semis
has also earned Master of Health Administration
Degree from Tel-Aviv University Business
School. He has extensive experience in nonsterile compounding as well as in pharmacotherapy.
Stephanie Gaherty, PharmD
Dr. Stephanie Gaherty is a 1994 graduate
of the University of Southern California
School of Pharmacy. She is a registered
pharmacist in both Nevada and California
and has more than 20 years of experience
in community pharmacy practice. Dr.
Gaherty first developed an interest in the art
of compounding while working as an intern
at a teaching hospital exploring alternative
dosage forms for pediatric patients.
Eric Buu, PharmD
Dr. Eric Buu graduated from University
of California, Irvine with a Bachelor’s in
Biological Sciences. He received his Doctor
of Pharmacy degree from Jefferson School
of Pharmacy in Philadelphia. He has great
interest in research, precepting, and clinical
pharmacy as a result of exposure to different
scopes of practice within pharmacy. His
experience includes inpatient hospital,
independent community pharmacy, as well
as pharmaceutical marketing. Eric is passionate about his practice and
enjoys collaborating with his colleagues to optimize patient healthcare
and education.
Along with our Pharmacy & Lab
Technicians, Customer Services,
and Support Staff We are Committed to Providing
Quality Services and Products for
our Practitioners and our Patients.
Two Locations to Serve You
Central Drugs
Compounding Pharmacy
Central Drugs
Pharmacy
520 West La Habra Blvd.
La Habra, CA, 90631
Phone (877) 447-7077
Fax (562) 694-3869
1955 Sunnycrest Dr #100
Fullerton, CA 92835
Phone (714) 515 1530
Fax (714) 515-1535
IV Nutrition
Sterile & Non Sterile Compounding
BHRT
Vitamins, Full Service prescriptions
Servicing Nationwide
Non Sterile Compounding
BHRT
Vitamins, Full Service prescriptions
Servicing California
Bioidentical Hormone Replacement Therapy
Course Outline - Day One
7:00 am
Registration and Breakfast
8:00am
Introduction to Bioidentical Hormone
Replacement Therapy
Chris Meletis, ND
9:00am
Functional Adrenal & Thyroid
Replacement
Nayan Patel, PharmD
10:00am
BREAK
10:30am
Thyroid and Cortisol Protocols and Lab Erik Lundquist, MD
Test Uses and Interpretations
12:30pm
LUNCH
1:30pm
Estrogen, Progesterone, and
Testosterone Therapies in Women
Chris Meletis, ND
2:30pm
Womensʼ Early Years..
PCOS, PMDD, PMS
Nayan Patel, PharmD
3:30pm
BREAK
4:00pm
Mensʼ Health: “Post Puberty”
Nayan Patel, PharmD
Bioidentical Hormone Replacement Therapy
Course Outline - Day Two
7:00 am
Registration and Breakfast
8:00am
Estrogen, Progesterone, and Testoster- Naina Sachdev, MD
one Therapies in Women
(Menopause)
9:30am
BREAK
10:00am
Estrogen, Progesterone, and Testoster- Naina Sachdev, MD
one Therapies in Women
(Menopause)
11:30am
Nutritional Supplements used in BHRT
12:30pm
LUNCH
1:30pm
Pre - Post Reproductive Years :
“The Change”
3:00 pm
BREAK
3:30pm
Hormones and Their Effect on
Memory
Review of Medication Therapy
Management of Erectile Dysfunction
Chris Meletis, ND
4:30pm
30/30 Prescriber Success Consulting
Service
Nayan Patel, PharmD
Chris Meletis, ND
Nayan Patel, PharmD
Appendices
How to Work With Central Drugs
We Invite You to Reach Out to Our Pharmacists
30/30 Enrollment Form
Sample Patient Consent Form
S t e ro i d H o r m o n e M e t a b o l i s m
L a b Va l u e s - Ma l e a nd Fema l e
Fe m a l e H o r m o n e S y m p t o m s
Fe m a l e B H RT Qu e s t i o n n a i re
Fe m a l e B H RT S y m p t o m E va l u a t i o n
Ma l e H o r mo n e S y m p t o ms
Ma l e B H RT Qu e sti o nna i re
Ma l e B H RT S y m p t o m Eva l ua ti o n
C D S ma r t Pe n
C D S ma r t Pe n RX Pa d
Ma l e R x Pa d
Fe m a l e R X Pa d
T hy ro i d C o nve rsi o n Cha r t
How to Work With Central Drugs
We know how important it is for patients to receive their prescription medications on time.
We’ve worked hard to develop efficient processes to ensure that patients and practitioners receive
medications when they expect them and in perfect condition.
For Physicianʼs Office Orders:
The first step is to set up your account with us. Each Physical Address must have an active account
with Central Drugs. Complete the Account Information form and provide us a photocopy of your
DEA and State License. We will notify you to confirm that your account has been established and
provide you with our pricing, order form, and patient specific information form, if mandated by
your state.
Once your account is approved, you may place an order. We will always call to confirm receipt of
an order and discuss the cost and estimated delivery date. Shipping options will also be arranged
at the time of confirming your order. We process orders between 9 am and 6 pm Monday through
Friday, Pacific Standard Time.
Have a question? Your Account Representative can answer your pricing questions and provide
standard and customized order forms. For questions regarding your order you can reach a Pharmacy Tech/Customer Service Representative at 877 447 7077. Please ask to speak with someone
to place an “Office Order.”
If you prefer, you may leave a message at #104 or #105. You may email [email protected] providing no patient information is disclosed. We can email you price lists, but
please understand that the price of compounds are subject to change.
All orders must be faxed to 562.694.3869. Order forms are available from your Account Representative or for download on our website. Please indicate the date on which you would like to
receive the medications. We will do everything we can to deliver your medications by the requested date. Compounded Medications can take around 5-7 business days in production.
For Patient Prescriptions:
When the prescription is submitted to Central Drugs, via, fax, e-script or phone, a pharmacy clerk
calls the patient in under an hour to verify insurance information, discuss pricing and payment
options, and confirm the patient’s preferred method of shipment. We offer very competitive
pricing and help your patients with insurance coverage and questions.
Our compounding lab team can usually fill each prescription within 3-5 hours (during normal
operating hours).
Shipping Options:
a. Standard U.S. Mail: 3-5 business days and FREE for 3 or more compounded medications
( $3.00 flat fee for 1-2 medications)
b. Golden State Overnight (GSO) available in CA, NV, and AZ
c. Federal Express – ground, overnight, 2nd day, 3rd day
Over 99% of our prescriptions ship within 24 hours and arrive at your patient’s home in 3 days.
We Invite you to Reach Out
to Our Pharmacists
Central Drugs Compounding Pharmacy has a nationwide reputation for innovative and forward
thinking in the field of compounding medications. Lead by Nayan Patel, we have grown over the
past 13 years and our team is dedicated to applying our knowledge and innovation to help develop
easier solutions and advances in medication delivery and compounding.
We value the relationships that we have established with our physicians as together we learn,
challenge and enhance the lives of our patients. We welcome creativity - If you have questions
about custom compounds or want to know if we can create something especially for you, we
want to hear from you! We are fortunate to have an experienced staff of over 14 PharmD’s with
combined compounding experience of over many years. We can utilize their compounding
expertise to find a solution that is just right for you.
If you would like to speak with a Pharmacist on Staff
we have several options for you:
1. Call the main line and ask to speak to a Pharmacist - Let us know what is the nature of
your question or inquiry and we will connect you with a pharmacist to your discuss options and
solutions.
2. Request a personal IV Nutrition or Bioidentical Hormone Replacement Consultation with
our Clinical Pharmacists by dialing extension 150. These services are of charge and scheduled for
your convenience.
3. If you are local, or visiting Southern California, please visit us at our pharmacies in La Habra
and Fullerton. We would be proud to offer you a tour and a consult with one of our Pharmacists.
4. Join our 30/30 BHRT Prescriber’s Success Program. We have many Doctors across the nation
who have benefited from our training and expertise by enrolling in our 30/30 program. We will
review your BHRT patient cases and assist you in designing their bioidentical hormone therapy.
You will become confident and proficient at prescribing BHRT within 30 days.
5. Participate actively in our upcoming Central Drugs Academy. Beginning in Late 2015. You
will be contacted and invited to participate since you already are a workshop attendee.
ENROLLMENT FORM
Patients 1-10:
Beginner Training Phase
Patients 11-20:
Intermediate Application Phase
Patients 21-30:
Advanced Discussion Phase
Patients 31+:
Expert Support Phase
Specialty:________________________________ Years in Practice:____________
Practice Name: __________________________ Office Mgr: _________________
Address: ____________________________________________________________
Your Practice
Name:___________________________________ Degree (if applicable): ______
City: ________________________________ State: _________ Zip: ___________
Country (other than U.S.): ______________________________________________
Email: _______________________________________________________________
Your Confidence
Phone: ______________________________ Cell: ___________________________
l
Do you have any previous training in BHRT?
If so, specify training?
o Yes
o No
If so, how long have you been working with BHRT?
l
What are your goals for this program (write on the back if needed)?
How to Enroll:
For California Doctors Only
Fax: 714- 515-1538 (Attn: 30/30)
Call: 714-515-1530
Cheryl Foster, M.A., Business Development
Email: [email protected]
Fax: 888-372-0328 (Attn: 30/30)
Call: 562-691-6754 x150
Kathy Dunne, Accounts Management
Email: [email protected]
Contact us for information and product lists for
BHRT
l
Women’s Health
l
Men’s Health
Central Drugs in La Habra
520 W. La Habra Blvd., La Habra, CA 90631
l
IV Nutrition
l
Topical Glutathione
CentralDrugsRx.com
l
Dermatology
l
Pain Management
877.447.7077
PATIENT CONSENT FORM
Bio-Identical Hormone Replacement Therapy
Please read and review this consent form and ask questions for clarification if needed.
Then, Initial each statement indicating understanding and agreement, and sign at the bottom of the form.
Statement of Patient:
____ I understand that along with the benefits of any medical treatment or therapies, there are both risks and potential complications to
treatment, as well as not being treated. Those risks and potential complications have been explained to me. I have not been promised or
guaranteed any specific benefit from the administration of these therapies and no warranty or guarantee has been made regarding the
results of treatment. I agree to proceed with treatment and to comply with recommended dosages.
____ I agree to comply with requests for ongoing testing to assure proper monitoring of my treatments that may include laboratory
evaluation of all aforementioned hormone levels or other diagnostic testing by a physician, my primary care physician, or other specialist. I
agree to see my primary care physician, gynecologist, or other practitioner for regular monitoring and for preventative measures that may
include but are not limited to complete physicals, rectal examinations and/or colonoscopy, EKG, mammograms, pelvic/breast exams, pap
smears, prostate exams, PSA levels, etc.
____ I agree to immediately report to my physician any adverse reaction or problem that might be related to my therapy. I understand that
along with the benefits of any medical treatment or therapies, there are both risks and potential complications to treatment, as well as to
not being treated. Those risks and potential complications have been explained to me and I agree that I have received information
regarding those risks, potential complications and benefits, and the nature of bio-identical and other hormone treatments and have had all
my questions answered. Furthermore, I have not been promised or guaranteed any specific benefit from the administration of bio-identical
hormone therapy.
____ I have been informed that insurance companies may not pay for physician evaluation, laboratory testing, and medications. I therefore
agree to pay for all services including physician evaluation, laboratory tests and pharmacy charges, with the understanding that I may not
be reimbursed by my insurance company.
____ I certify this form has been fully explained to me, that I have read it or have had it read to me. I have been educated on the
benefits, risks, and possible adverse reactions associated with bio-identical hormone replacement therapy. I have been given the
opportunity to ask any questions about hormone replacement therapy, potential complications, required testing, and costs and have
had them answered to my satisfaction. I agree not to undergo any treatments unless I fully understand the treatment and have
discussed possible risks and benefits. I fully understand what I am signing and hereby request and consent to treatment using bioidentical hormone replacement therapy.
Signature of Patient: __________________________________________________________ Date: ___________________________
Name (PRINT): _______________________________________________________________________________________________
If patient is a minor,
Parent/Legal Guardian Signature: ________________________________________________ Date: ___________________________
Name (PRINT): ________________________________________________________ Relationship: ___________________________
Statement of Prescriber:
I have explained the therapy, its intended benefits and risks, and possible reactions to the patient. I have confirmed that the patient
understands the risks and benefits, has no further questions and gives consent to initiate bio-identical hormone replacement therapy.
Signature of Prescriber: _______________________________________________________ Date: ___________________________
Name (PRINT): _______________________________________________________________________________________________
CentralDrugsRx.com
877.447.7077
Central Drugs Compounding Pharmacy
877.447.7077
CentralDrugsRx.com
Date
Test Done
Normal Labs Initial Labs Results
Estradiol (pg/ml)
Estrone (pg/ml)
Estriol (pg/ml)
PSA
DHEA-S (ng/ml)
Testosterone Total (pg/ml)
Testosterone Free (pg/ml)
AM Cortisol
Fasting Insulin
TSH
Free T3
Free T4
rT3
SHBG (nmol/l)
FSH (mIU/ml)
LH (mIU/ml)
Prolactin (ng/ml)
Homocysteine
Highly Sensitive CRP's
Cholesterol Total
Triglycerides
HDL
LDL
IGF-1
Date
Results
Lab Values (MALE)
Date
Results
Date
Results
Date
Results
Date
Results
Central Drugs Compounding Pharmacy
877.447.7077
CentralDrugsRx.com
Date
Test Done
Normal Labs Initial Labs Results
Estradiol (pg/ml)
Estrone (pg/ml)
Estriol (pg/ml)
Progesterone (ng/ml)
DHEA-S (ng/ml)
Testosterone Total (pg/ml)
Testosterone Free (pg/ml)
AM Cortisol
Fasting Insulin
TSH
Free T3
Free T4
rT3
SHBG (nmol/l)
FSH (mIU/ml)
LH (mIU/ml)
Prolactin (ng/ml)
Homocysteine
Highly Sensitive CRP's
Cholesterol Total
Triglycerides
HDL
LDL
IGF-1
Date
Results
Lab Values (FEMALE)
Date
Results
Date
Results
Date
Results
Date
Results
Female Hormone Symptoms
Estrogen Deficiency
Estrogen Excess
Hot Flashes
Night Sweats
Water Retention
Heavy, Irregular Menses
Sleep Distrubances
Vaginal Dryness/Atrophy
Breast Swelling and Tenderness
Fatigue
Dry Skin
Headaches
Craving for Sweets
Weight Gain
Foggy Thinking
Memory Lapses
Fibrocystic Breasts
Mood Swings
Heart Palpitations
Yeast Infections
Uterine Fibroids
Low Thyroid Symptoms
Painful Intercourse
Depression
Nervousness/Anxiety/Irritability
Low Libido
Bone Loss
Progesterone Deficiency
Low Thyroid Function
Swollen Breasts
Weight Gain
Fatigue (Especially Evening)
Low Stamina
Headaches
Low Libido
Cold Extremities
Low Body Temperature
Anxiety
Mood Swings
Low Libido
Headaches
Irregular Menses
Depression
Dry Skin
Intolerance to Cold
Cramping
PMS
General Aches and Pains
Weight Gain
Infertility
Fuzzy Thinking
Depression
Anxiety
Acne
Joint Pain
Scalp Hair Loss
Swollen, Puffy Eyes
Brittle Nails
Decreased Swelling
Low Pulse Rate/Blood Pressure
Poor Concentration
Memory Lapses
High Cholesterol
Heart Palpitations
Infertility
Constipation
Fibromyalgia
Testosterone Deficiency
Testosterone Excess
Fatigue, Prolonged
Mental Fuzziness
Acne
Mail-Pattern Hair Growth
Memory Problems
General Aches/Pains
Deepening of Voice
Clitoral Enlargement
Decreased Libido
Depression
Irritability/Moodiness
Insomnia
Muscle Weakness
Blunted Motivation
Loss of Scalp Hair
Heart Palpitations
Diminished Feeling of Well Being
Bone Loss
Thinning Skin
Incontinence
Vaginal Dryness
Fibromyalgia
Low Corisol
High Cortisol
Fatigue
Allergies
Same symptoms as Low Cortisol, Including:
Cravings for Sweets
Irritability
Bone Loss
Anxiety
Chemical Sensitivites
Symptoms of Hypothyroidism
Sleep Distrubances
Depression
Low Libido
Hair Loss
Symptoms of Low Progesterone
Elevated Triglycerides
CentralDrugsRx.com
fax: 877.447.7977
ph: 877.447.7077
Female BHRT Questionnaire
Patient Info
Name______________________________________________________________________________________________________________
Last
Middle
First
Phone_____________________________________
DOB___________________________
Mild
Moderate
Severe
(Please Circle)
Sleep Disruption
NA
1
2
3
4
5
6
7
8
9
10
Irritability
NA
1
2
3
4
5
6
7
8
9
10
Nervousness
NA
1
2
3
4
5
6
7
8
9
10
Mood swings
NA
1
2
3
4
5
6
7
8
9
10
Depression
NA
1
2
3
4
5
6
7
8
9
10
Cramps
NA
1
2
3
4
5
6
7
8
9
10
Breakthrough bleeding
NA
1
2
3
4
5
6
7
8
9
10
Hot flashes
NA
1
2
3
4
5
6
7
8
9
10
Night sweats
NA
1
2
3
4
5
6
7
8
9
10
Vaginal dryness
NA
1
2
3
4
5
6
7
8
9
10
Painful intercourse
NA
1
2
3
4
5
6
7
8
9
10
Breast tenderness
NA
1
2
3
4
5
6
7
8
9
10
Fluid retention
NA
1
2
3
4
5
6
7
8
9
10
Headaches
NA
1
2
3
4
5
6
7
8
9
10
Decreased sex drive
NA
1
2
3
4
5
6
7
8
9
10
Harder to reach climax
NA
1
2
3
4
5
6
7
8
9
10
Decreased motivation
NA
1
2
3
4
5
6
7
8
9
10
Decreased self-confidence
NA
1
2
3
4
5
6
7
8
9
10
Fatigue
NA
1
2
3
4
5
6
7
8
9
10
Loss of recent memory
NA
1
2
3
4
5
6
7
8
9
10
Dry skin
NA
1
2
3
4
5
6
7
8
9
10
Arthritis
NA
1
2
3
4
5
6
7
8
9
10
Hair loss
NA
1
2
3
4
5
6
7
8
9
10
Urinary incontinence
NA
1
2
3
4
5
6
7
8
9
10
Weight gain
NA
1
2
3
4
5
6
7
8
9
10
Patient Signature____________________________________Date___________
CentralDrugsRx.com
fax: 877.447.7977
ph: 877.447.7077
Female BHRT Symptom Evaluation
Symptoms
Estrogen
Progesterone
Testosterone
Sleep Disruption
iE
iP
hT
Irritability
hE
ihP
Nervousness
ihE
iP
Mood swings
hE
iP
Depression
iE
iP
Cramps
hE
iP
Breakthrough bleeding
hE
iP
Hot flashes
ihE
iP
Night sweats
iE
Vaginal dryness
iE
Painful intercourse
iE
iP
Breast tenderness
hE
ihP
Fluid retention
hE
iP
Headaches
ihE
ihP
Decreased sex drive
hE
Harder to reach climax
iE
Thyroid
hC
iTH
ihC
iT
iT
iT
iTH
iT
iP
Decreased motivation
iC
iTH
iC
iTH
iT
iT
Decreased self-confidence
iT
Fatigue
hP
Loss of recent memory
iE
Dry skin
iE
Arthritis
Hair loss
ihE
Urinary incontinence
iE
Weight gain
hE
h=Caused by High Levels
iT
Cortisol
iT
iT
iTH
iP
iT
ihP
hT
ihTH
iT
ihP
i=Caused by Low Levels
iTH
ih=Caused by Fluctuating Levels
Note: This is not an all inclusive list of possible causes.
CentralDrugsRx.com
fax: 877.447.7977
ph: 877.447.7077
Male Hormone Symptoms
Testosterone Deficiency
Estrogen Excess
Decreased Body Hair
Fatigue
Prostate Problems
Central Obesity
Weight Gain
Breast Development (Gynecomastia
Decreased Muscle Mass
Depression
Impotence
Osteoporosis
Decreased Ability to Concentrate
Weight Gain
Decreased Libido
High Cholesterol
Low Sex Drive
Erectile Dysfunction
Low Corisol
Low Thyroid Function
Fatigue
Allergies
Fatigue (Especially Evening)
Low Stamina
Cravings for Sweets
Irritability
Cold Extremities
Low Body Temperature
Chemical Sensitivites
Symptoms of Hypothyroidism
Low Libido
Headaches
Dry Skin
Intolerance to Cold
General Aches and Pains
Weight Gain
Depression
Anxiety
Scalp Hair Loss
Swollen, Puffy Eyes
Brittle Nails
Decreased Swelling
Low Pulse Rate/Blood Pressure
Poor Concentration
Memory Lapses
High Cholesterol
Heart Palpitations
Constipation
High Cortisol
Same symptoms as Low Cortisol, Including:
Bone Loss
Anxiety
Sleep Distrubances
Depression
Low Libido
Hair Loss
Elevated Triglycerides
CentralDrugsRx.com
fax: 877.447.7977
ph: 877.447.7077
Male BHRT Questionnaire
Patient Info
Name______________________________________________________________________________________________________________
Last
Middle
First
Phone_____________________________________
DOB___________________________
Mild
Moderate
Severe
(Please circle)
Sleep disruption
N/A
1
2
3
4
5
6
7
8
9
10
Irritability
N/A
1
2
3
4
5
6
7
8
9
10
Depression
N/A
1
2
3
4
5
6
7
8
9
10
Breast development
N/A
1
2
3
4
5
6
7
8
9
10
Decreased morning erections
N/A
1
2
3
4
5
6
7
8
9
10
Decreased sex drive
N/A
1
2
3
4
5
6
7
8
9
10
Harder to reach climax
N/A
1
2
3
4
5
6
7
8
9
10
Reduced testicular size
N/A
1
2
3
4
5
6
7
8
9
10
Decreased motivation
N/A
1
2
3
4
5
6
7
8
9
10
Decreased self confidence
N/A
1
2
3
4
5
6
7
8
9
10
Abdominal fat
N/A
1
2
3
4
5
6
7
8
9
10
Muscle atrophy
N/A
1
2
3
4
5
6
7
8
9
10
Fatigue
N/A
1
2
3
4
5
6
7
8
9
10
Loss of recent memory
N/A
1
2
3
4
5
6
7
8
9
10
Dry skin
N/A
1
2
3
4
5
6
7
8
9
10
Arthritis
N/A
1
2
3
4
5
6
7
8
9
10
Hair loss
N/A
1
2
3
4
5
6
7
8
9
10
Weight gain
N/A
1
2
3
4
5
6
7
8
9
10
Patient Signature____________________________________Date___________
CentralDrugsRx.com
fax: 877.447.7977
ph: 877.447.7077
Male BHRT Symptom Evaluation
Symptoms
Estrogen
Sleep disruption
Irritability
hE
Progesterone
Testosterone
iP
ihT
iP
ihT
Depression
Breast development
iT
hE
iP
iT
Decreased sex drive
iT
Harder to reach climax
iT
Reduced testicular size
iT
Decreased motivation
iT
Decreased self confidence
iT
hE
iP
Thyroid
hC
iTH
iC
iTH
iC
iTH
iT
Decreased morning erections
Abdominal fat
Cortisol
iT
Muscle atrophy
iT
Fatigue
iT
Loss of recent memory
iT
Dry skin
iT
Arthritis
iT
Hair loss
hT
ihTH
iT
iTH
Weight gain
h=Caused by High Levels
hE
i=Caused by Low Levels
iTH
ih=Caused by Fluctuating Levels
Note: This is not an all inclusive list of possible causes.
CentralDrugsRx.com
fax: 877.447.7977
ph: 877.447.7077
CD Smar tpen
TM
* Length is
4.5 inches.
Holds 6ml
cream and
each 0.15ml
accuation
is based on
specific gravity
- dispenses
1.4 to 2.0
grams per
push.
520 W. La Habra Blvd.
La Habra, CA 90631
877.447.7707
Call for your Free
Consultation
CentralDrugsRx.com
CDSmartpen.com
“Changing the Way We Do Hormones”
Bioidentical Hormone
Replacement Patients
will LOVE the Ease
and Convenience of
the CD SmartpenTM
- Precise doses every time
- Convenient travel size
- No up-charge for device
- Color-coded meds
- Antimicrobial silicon tip
- Simple to dispense
- Elegant design
- Calibrated - only 0.15ml
- Replaces syringes and
clicker devices
- Use for cream based or
sublingual medication
Let Our Team Help You
with Your First 30 BHRT
Patient Cases and Beyond
We have helped 100’s of Doctors build up their confidence
and their practices through our 30/30 program.
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Ongoing Case by Case reviews & support provided for our
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CD Smart Pen RX Pad
Doctor:
Address:
City, State, Zip:
Phone & Fax #:
DEA# & State lic (CA only):
Patient Name:
Date Of Birth:
Address:
Telephone Number:
Cell #
Email:
Estrogen □ Estradiol □ Estriol □ Biestrogen(E2:E3 20:80) □Biestrogen (E2/E3 ___/___%)
□ Slow release caps □ Cream □ Special cream base ______________
□ SIG: Apply _____ actuation to skin ____ time(s) daily - CD Smart Pen (0.15ml/actuation)
□ SIG: Apply 0.1ml to inner labia daily
□ SIG: Apply ___ gm ____ times daily
□ SIG: Apply 1 gm (applicatorful) vaginally _______
Progesterone □ Capsules (□ SR □ SB) □ Cream □ Supp
□ SIG: Apply _____ actuation to skin ____ time(s) daily - CD Smart Pen (0.15ml/actuation)
□ SIG: Take _____ cap(s) at HS
□ SIG: Apply _____ gm to skin _____ times a day
□ SIG: Apply 1 suppository vaginally _______
Testosterone
□ Cream/Gel □ Sublingual tablets
□ SIG: Apply _____ actuation to skin ____ time(s) daily - CD Smart Pen (0.15ml/actuation)
□ SIG: Apply 0.1ml to inner labia daily
□ SIG: Apply _____gm to skin _____ times a day
Special note: Add progesterone and/or chyrsin with high dose testosterone
DHEA Or Pregenenolone/DHEA sustained release capsules (circle one)
□ SIG: Apply _____ actuation to skin ____ time(s) daily - CD Smart Pen (0.15ml/actuation)
□ SIG: Take _____ caps _____ times daily
□ SIG: Apply 0.1ml to inner labia daily
□ SIG: Apply ___ gm ____ times daily
(Suggested dose of Pregnenolone/ DHEA: 25/5, 25/10, 25/25, 50/50, 75/75mg)
Other: ____________________________________
□ SIG: ______________________________________
_____________mg
______mg/0.15ml crm
________mg/0.1ml
________mg/gm
# ______________
Refill ____________
______mg/0.15ml crm
___________mg/gm
_________mg/0.1ml
______________mg
# ______________
Refill ____________
______mg/0.15ml crm
_________mg/0.1ml
___________mg/gm
# ______________
Refill ___________
______________mg
______mg/0.15ml crm
_________mg/0.1ml
___________mg/gm
# ______________
Refill
# ______________
Refill ____________
Physician Signature:
520 W. La Habra Blvd., La Habra, CA 90631
Tel: (562) 691-6754 Fax: (562) 694-3869
"Feel good about your compounding pharmacy knowing that your patients do"
Your prescription has been faxed to Central Drugs at (562) 694-3869.
Please call at 1-562-691-6754 for any shipment or address changes.
99.99% Accurate
Each dose dispenses 0.15 mL ± 0.014 mL per accuation
✔
✔
✔
✔
✔
✔
Precise doses every time
Use with all cream bases
Anti-microbial silicon tip
Easy to carry
No more accidental discharges
No more struggling to decipher lines & numbers
on the side of the syringe
Prescriber Name: __________________________________________
Address, City, Zip: ____________________________________________________________________
Phone:__________________________________
Fax:_________________________________________
DEA#:___________________ State Lic.#:__________________________ NPI#:______________________
Patient Name:
Date:
Address:
Email:
Phone Number:
Cell Number:
DOB:
Testosterone
□ SIG: Apply _____ ml to skin ____ time(s) daily
□ SIG: Apply _____ packet to skin ____ time(s) daily
Commonly prescribed: Testosterone 50mg/ml, 75mg/ml, 100mg/ml
PACKETS: Available in 50, 75, 100 mg/pkt
______mg/ml crm/gel
______mg/packet crm
Qty # ______________
Refill ____________
Testosterone Cypionate (in Sesame Seed Oil)
□ SIG: Inject _____ ml intramuscularly _____ time(s) per week or ___________________
Commonly prescribed: Testosterone Cypionate 180mg/ml, 250mg/ml
Pregenenolone/DHEA
□ Pregnenolone/DHEA
□ DHEA
_________mg/ml
Qty # ______________
Refill ____________
□ Pregnenolone
Preg___/DHEA___mg/cap
□ SIG: Take _____ cap(s) by mouth _____ time(s) daily
Qty # ______________
Refill ____________
Commonly prescribed: Pregnenolone/DHEA 25/25 mg/cap, 50/50 mg/cap
Anastrazole
□ SIG: Take _____ cap(s) by mouth _____ time(s) __________________
Commonly prescribed: Anastrazole 0.1mg/cap, 0.25mg/cap, 0.5 mg/cap. 0.75 mg/cap, 1mg/cap; QOD, 2x/Week
Chrysin/Zinc
□ SIG: Take _____ cap(s) by mouth _____ time(s) daily
Commonly prescribed: Chrysin/Zinc 250/30mg/cap
____________mg/cap
Qty # ______________
Refill ____________
C_____/Z_____mg/cap
Qty # ______________
Refill ____________
Bio-Thyroid (T4/T3)
□ IR □ SR
□ SIG: Take ___ cap(s) by mouth ____ time(s) daily ____ minutes before meals
Commonly prescribed: Bio-Thyroid T4/T3 19/4.5 mcg/cap, 38/9 mcg/cap, 57/13.5 mcg/cap, 76/18 mcg/cap
Melatonin/Tryptophan
□ Melatonin/Tryptophan
□ Melatonin
□ Tryptophan
□ SIG: Take _____ cap(s) by mouth at bedtime or _____time(s) daily
Commonly prescribed: Melatonin 1mg/cap, 2mg/cap, 3mg/cap; Melatonin/Tryptophan 2/500mg/cap, 3/500mg/cap
Hydrocortisone
□ IR □ SR
□ SIG: Take _____ cap(s) by mouth _____ time(s) daily
Commonly prescribed: 2.5mg/cap, 5mg/cap, 7.5mg/cap, 10mg/cap, 15mg/cap
Ketoprofen
□ SIG: Apply _____ml to affected area _____ time(s) daily as needed for pain
Commonly prescribed: 100mg/ml (10%), 200mg/ml (20%)
Glutathione
□ SIG: Apply _____ spray(s) to skin _____ time(s) daily and rub until dry
Commonly prescribed: 4 sprays BID (TDD 200mg/day)
Syringe w/ Needle
□ 3ml
Needle
Syringe w/o Needle □ 1ml □ 3ml
Insulin Syringe
□ 3/10ml □ 1/2ml □ 1ml
_____ Gauge _____ Inches
_____ Gauge _____ Inches
_____ Gauge _____ Inches
Other _______________________________________________________________
□ SIG: ______________________________________________________________
Physician Signature
T4____/T3____mcg/cap
Qty # ______________
Refill ____________
X
Total # Drugs Prescribed
520 W. La Habra Blvd., La Habra, CA 90631
Tel: (877) 447-7077 Fax: (877) 447-7977
M_____/T_____mg/cap
Qty # ______________
Refill ____________
____________mg/cap
Qty # ______________
Refill ____________
__________mg/ml gel
Qty # ______________
Refill ____________
____25___mg/spray
Qty # ______________
Refill ____________
Qty # ______
Qty # _______
Qty # _______
Qty # _______
Refill ____________
____________________
Qty # ______________
Refill ____________
___________
Prescriber Name: __________________________________________
Address, City, Zip: ____________________________________________________________________
Phone:__________________________________
Fax:_________________________________________
DEA#:___________________ State Lic.#:__________________________ NPI#:______________________
Patient Name:
Date:
Address:
Email:
Phone Number:
Estrogen
Cell Number:
DOB:
□ iestrogen (E2/E3 20/ 0 ) □ iestrogen (E2/E3 ___/___ )
□ Estradiol (E2)
□ Estriol (E3)
______mg/0.1ml crm
______mg/ml crm
______mg/packet crm
______mg/ml crm
□ SIG: Apply _____ ml to inner labia ____ time(s) daily
□ SIG: Apply _____ ml to skin ____ time(s) daily
□ SIG: Apply _____ packet to skin ____ time(s) daily
□ SIG: Insert ____ ml intra aginally _______ time(s) daily with applicator
Commonly prescribed: Biestrogen (20/80%) 0.625mg/0.1ml, 1.25mg/0.1ml, 1.5mg/0.1ml, 1.75mg/0.1ml, 2mg/0.1ml, 2.5mg/0.1ml;
Biestrogen (20/80%) 0.625mg/ml, 1.25mg/ml, 1.5mg/ml, 1.75mg/ml, 2mg/ml, 2.5mg/ml;
Estriol 1mg/ml, 2mg/ml, 3mg/ml
PACKETS: Available in 0.625, 1.25, 2.5, 3.75, and 5 mg/pkt
Qty # ______________
Refill ____________
Progesterone
□S
□ SIG: Take _____ cap(s) by mouth at bedtime or _____time(s) daily
□ SIG: Apply _____ ml to skin ____ time(s) daily
□ SIG: Insert _____ suppository aginally ____ time(s) daily
□ SIG: Apply _____ packet to skin ____ time(s) daily
□ IR □ SR
Commonly prescribed: Progesterone 50mg/cap, 75mg/cap, 100mg/cap, 150mg/cap, 200mg/cap;
Progesterone 50mg/ml, 75mg/ml, 100mg/ml, 150mg/ml, 200mg/ml
SB: Capsule will include 100mg Saccharomyces boulardii (Probiotic)
Pregenenolone/DHEA
□ Pregnenolone/DHEA
________mg/cap
______mg/ml crm
______mg/supp
______mg/packet crm
Qty # ______________
Refill ____________
PACKETS: Available in 50, 75, and 100 mg/pkt
□ DHEA
□ Pregnenolone
Preg___/DHEA___mg/cap
□ SIG: Take _____ cap(s) by mouth _____ time(s) daily
Qty # ______________
Refill ____________
Commonly prescribed: Pregnenolone/DHEA 25/5 mg/cap, 25/10 mg/cap, 25/15 mg/cap
Testosterone
______mg/0.1ml crm
______mg/ml crm
Qty # ______________
Refill ____________
□ SIG: Apply _____ ml to inner labia ____ time(s) daily
□ SIG: Apply _____ ml to skin ____ time(s) daily
Commonly prescribed: Testosterone 0.5mg/0.1ml, 1mg/0.1ml; Testosterone 0.5mg/ml, 1mg/ml
Bio-Thyroid (T4/T3)
□ IR □ SR
□ SIG: Take ___ cap(s) by mouth ____ time(s) daily ____ minutes before meals
Commonly prescribed: Bio-Thyroid T4/T3 19/4.5 mcg/cap, 38/9 mcg/cap, 57/13.5 mcg/cap, 76/18 mcg/cap
Melatonin/Tryptophan
□ Melatonin
□ Melatonin/Tryptophan
T4____/T3____mcg/cap
Qty # ______________
Refill ____________
□ Tryptophan
□ SIG: Take _____ cap(s) by mouth at bedtime or _____time(s) daily
Commonly prescribed: Melatonin 1mg/cap, 2mg/cap, 3mg/cap; Melatonin/Tryptophan 2/500mg/cap, 3/500mg/cap
M_____/T_____mg/cap
Qty # ______________
Refill ____________
Scream Cream
□ SIG: Apply a thin layer to clitoris 1 mins prior to se ual acti ity as needed
Qty # ______________
Refill ____________
Active Ingredients: Aminophylline, Ergoloid Mesylates, Pentoxifylline, Isosorbide
Oxytocin
□ SIG: Instill _______ spray(s) in each nostril 1 mins prior to se ual acti ity as needed
Commonly prescribed: Oxytocin 4.5 IU/spray (40 IU/ml), 9 IU/spray (80 IU/ml)
Other _______________________________________________________________
□ SIG: ______________________________________________________________
Physician Signature
X
Total # Drugs Prescribed
520 W. La Habra Blvd., La Habra, CA 90631
Tel: (877) 447-7077 Fax: (877) 447-7977
_____________ IU/spray
Qty # ______________
Refill ____________
____________________
Qty # ______________
Refill ____________
___________
2 ½ grain (162.5 mg)
125 mcg (0.125mg)
11.25 mcg
12.33 mcg
13.5 mcg
15.75 mcg
18 mcg
20.25 mcg
22.5 mcg
27 mcg
36 mcg
45 mcg
47.5 mcg
52.06 mcg
57 mcg
66.5 mcg
76 mcg
85.5 mcg
95 mcg
114 mcg
152 mcg
190 mcg
5 grain (300 mg)
4 grain (240 mg)
3 grain (180 mg)
2 grain (120 mg)
1 ½ grain (90 mg)
300 mcg (0.3mg)
200 mcg (0.2mg)
175 mcg (0.175mg)
150 mcg (0.15mg)
137 mcg (0.137mg)
100 mcg (0.1mg)
5 grain (325 mg)
4 grain (260 mg)
3 grain (195 mg)
2 grain (130 mg)
1 ¾ grain (113.75 mg)
1 ½ grain (97.5 mg)
1 ¼ grain (81.25 mg)
1 grain (65 mg)
CentralDrugsRx.com
Central Drugs Compounding Pharmacy can adjust T4 and T3 dosing for custom strength prescriptions.
To discuss a specific patient case and recommendations, call to speak with a pharmacist.
Note: These conversions are approximate measures
2¼ grain (146.25 mg)
112 mcg (0.112mg)
10.08 mcg
42.56 mcg
1 grain (60 mg)
9 mcg
38 mcg
88 mcg (0.088mg)
½ grain (32.5 mg)
¾ grain (48.75 mg)
7.92 mcg
50 mcg (0.05mg)
75 mcg (0.075mg)
33.44 mcg
½ grain (30 mg)
4.5 mcg
¼ grain (16.25 mg)
6.75 mcg
25 mcg (0.025mg)
T4/T3
Desiccated, Porcine
(Thyroid Tablets)
Nature-Throid/
Westhroid
19 mcg
2.25 mcg
9.5 mcg
T4
Synthetic
(Levothyroxine Tablets)
Synthroid/
Levothroid/
Levoxyl
28.5 mcg
¼ grain (15 mg)
1.8 mcg
7.6 mcg
T4/T3
Desiccated, Porcine
Compounded
T3 (1)
(Thyroid Tablets)
(Immediate Release Capsules,
Sustained Release Capsules,
+/- Conversion Co-Factors)*
T4 (4.2)
Armour Thyroid
Bio-Thyroid
50 mcg
25 mcg
5 mcg
T3
Synthetic
(Liothyronine Tablets)
Cytomel
Thyroid Conversion Chart
Phone: (562) 691-6754
Fax: (562) 694-3869
520 West La Habra Blvd.
La Habra, CA 90631
Central Drugs
3 grain (150/37.5 mcg)
2 grain (100/25 mcg)
1 grain (50/12.5 mcg)
½ grain (25/6.25 mcg)
¼ grain (12.5/3.1 mcg)
T4/T3
Synthetic
(Liotrix Tablets)
Thyrolar