The Weird World of Compounding Pharmacies
The intersection of wellness and compounded drugs
Testosterone, optimization drugs, peptides, therapies, GLP-1s, sermorelin, retatrutide, cjc-1295, TB-500, cardarine, GHK-Cu, and so much more.
I’ve talked about compounding therapies previously, but less on the specifics of the pharmacies that produce them.
There’s a few things that make compounded drugs, and the pharmacies themselves, super interesting.
For one: they make drugs that are either name brand and difficult to get, or less known (and equally difficult to get) easily accessible to the somewhat educated individual who is willing to pay cash for their health.
This “somewhat educated individual” represents the rise in people willing to do their own research, find their own doctors, and pay out of pocket for remedies to ailments they just don’t want to deal with insurance with. Or, for example, the standard doctor would just write a prescription for a standard over the counter drug that comes with a plethora of side effects. And wouldn’t even solve the problem to begin with.
The discussion and growth of taking control of your own health is a discussion in and of itself with tons of debate. Because, as we learned with covid, some people don’t like it when you say “trust the science”. Trust the science carries its own implications. Meaning ok maybe I trust (or don’t) the science, but do I trust the doctor who will see me for less than 20 minutes and give me a prescription and call it a day. Of course there are plenty of excellent healthcare practitioners who take the time to identify the root problem and treat to the best of their ability. But I think there is one thing we can agree on - that a large amount of Americans’ experience at the doctor’s office consists of treating the symptom, not the cause. This is CERTAINLY a problem with TRICARE and military health as a whole. What’s the minimum we can do to get you back to “healthy” and showing up to work.
BUT. What this resulted in is the MAHA movement. Doing your own research. Learning about alternative remedies that may help your ailment, whatever it is. And a lot of people don’t like that. But why? Why would you not want a population more educated and willing to understand what’s going on with their bodies. I think a lot of it stems from the underlying judgement you can hear from both sides when we heard the party line “trust the science” in 2020.
If you haven’t picked up from literally any of my articles. I like to do research. I like to understand what’s going on. I think it’s awesome. I also like to talk to the doctor and get their expert advice given they’ve literally trained for a lifetime to do this job.
That being said - I see why there is a large movement towards owning your own health. And I think there is a blurred line where it crosses over from I can handle this myself to “I ABSOLUTELY NEED A SPECIALIST.”
So going from “I can handle this myself” to somewhere in the middle before needing a specialist is the world where compounding pharmacies and wellness clinics popped up.
Of course - I will caveat this with there are TONS of uses of compounding pharmacies outside of the educated-patient-wellness-clinic world. But the topic of today is focused on how individuals are learning about new or existing products and seeking doctors who will prescribe them outside of the traditional “just take these pills” healthcare model. This is the growth of consumer interest in preventative healthcare and the dissatisfaction with traditional approaches. I am not here to dispute the value of “traditional healthcare” or the value of preventative healthcare in the cash pay world. I think when done correctly, meaning actually taking time to diagnose the patient and provide the best possible remedy, both are extremely valuable. Both provide benefit to the patient in different ways, with some crossover.
But back to the main discussion: there are distinct differences between the use of wellness clinics and compounding pharmacies.
Wellness clinics can use both standard pharmacies for traditional prescriptions, as well as compounded drugs.
Compounding pharmacies are used both by wellness clinics and by standard hospitals, private clinics, and really anywhere medical intervention is conducted by healthcare practitioners.
The intersection of the two: wellness clinics and compounding pharmacies is where it gets interesting, as a simple investigation and how it applies to the average American. It really started to pop off in the 2000s and 2010s - intersecting at the growth of hormone therapies.
Since then it’s grown to cover weight management, anti-aging treatments, functional medicine, vitamin formulations, injury/pain management, and more.
I’ll give you an example. Say you tear your ACL in your early 40s. Traditionally, this would be managed by evidence based protocols. Conduct an MRI confirmation, and discuss 2 main paths:
conservative management for a partial tear with bracing, physical therapy, modification of daily activity and pain mangement
OR: surgical reconstruction for complete tears. This includes replacing the torn ACL with a graft (typically patient’s own tissue or a donor), followed by 6-9 months of rehabilitation.
Recovery would be methodical and progressive and continuously measuring improvement with knee stability tests, strength measurements, and functional assessments.
As part of this, prescriptions would be written and could contain some or all of these:
Pre-surgery:
NSAIDs like ibuprofen or naproxen for inflammation and pain management, or prescription NSAIDs or even opioid pain medications
topical analgesics (essentially just target pain relief using creams, gels, sprays, etc)
Muscle relaxants like cyclobenzaprine
Post Surgery:
Opioid meds (again) for immediate post-op pain - hydrocodone, oxycodone, or tramadol
Anti-nausea medications - because opioid pain management meds can cause nausea
Stool softeners like docusate, because opioids can also cause constipation
Even sleep aids like zolpidem (ambien) if the pain disrupts leep
All that being said - there has been a recent trend of doctors prescribing lower doses and fewer quantities (only days worth vs weeks/months) of opioids following major surgery.
Now let’s contrast this to the wellness clinic approach. There would be an emphasis on holistic recovery. Meaning surgery would be (hopefully) only required in a major, full tear. The goal would be full recovery without any surgery and optimizing the body’s natural healing capacity with the goal of improving time to recovery by 20-40% (or more) and return the body to 100%. There is a common idea that when you have surgery on a major ligament/muscle/tendon, you never really return to 100%.
The holistic strategy could include IV nutrient therapy, peptide treatments, red light therapy, hyperbaric oxygen sessions, hormone optimization, PRP injections, stem cell treatments, and even electromagnetic field therapy.
If you watched the latest season of Quarterback, Kirk Cousins literally underwent a number of these treatments when he tore his achilles. Aaron Rogers underwent a similar barrage of treatments. They both also had traditional treatments as well.
In addition, the holistic approach would likely utilize a mix of off-label prescription medicatoins, compounded therapies, and supplements that are not part of the standard orthopedic protocols. This is because these treatments: (1) aren’t readily available in the United States, (2) don’t have a ton of scientific literature (evidence supported) to back up the treatments (usually only studies on rats/lab animals), or (3) insurance does not cover them (because of points 1 and 2).
These therapies could include:
Peptide Therapies:
BPC-157 for tissue repair and accelerated healing
TB-500 to promot muscle and tendon healing
Growth hormone release peptides like CJC-1295 or ipamorelin
Thymosin Beta-4 for tissue regeneratoin
Hormone Treatments:
Testosterone replacement
Growth Hormone
Peptide hormones to boost natural GH production
Injectable Treatments:
NAD+ injections for cellular energy and recovery
High dose vitamin C IV therapy
Glutathione injections for antioxidant effects
B-Complex and B12 injections
Compounded Medications:
Anti-inflammatory compounds
Topical compounded creams (combinations of ketamine, gabapentin, NSAIDs, and/or others)
An infinite supply of others up to the creativity and up-to-date experience of the prescribing Doctor
Weight Loss Medications:
Semaglutide, Tirzepatide, or a combination of both - to manage weight pre-surgery and improve the body’s ability to recover post surgery
The important note on many of these - they lack robust clinic evidence for ACL recovery specifically. An orthopedic surgeon is not likely to prescribe many of these because there simply aren’t many, or any, studies showing improved recovery in humans pre- or post- surgery of an ACL injury. This is not to say they will not be beneficial - as we’ve seen with tons of professional athletes. The problem is how long it takes to conduct a study, and education of doctors. Doctors and surgeons have reputations. One bad prescription can ruin a reputation and their business. They also have a way of doing things. They have tons of cases per week or per month. They likely do not have time to be doing independent research on the latest and greatest peptide therapy. And this is the hole that compounding pharmacies and wellness clinics aim to fill.
This side of healthcare exposes treatments previously reserved for the wealthy or for professional athletes to the average American. The normal guy or girl who just wants to get back to being healthy as fast as possible.
My argument is not to say one is better than the other. There are so many variables on an individual human given their current activity level, overall health, age, willingness to use alternative treatments, the doctor’s willingness to use alternative treatments, and more.
The goal of this is to propose thinking outside of the box. To recognize that healthcare is NOT one size fits all. And we have a duty to take care of ourselves. At the end of the day many doctors just want to do their job. But that does not necessarily overlap with your own health goals. I trust doctors, and I also trust my ability to research alternative means of wellness.
That being said. Both have an ugly side. Both have massive upside. But that’s life. The decisions we make carry risk. And depending on my, or your situation, is how we combine our life experience and understanding of emergent treatments and technologies to treat an injury or event should it come.
And this all ties back to our current health. Our current physical capabilities. I think there is no argument at all to be had that being in peak physical fitness would allow you to recover faster than an individual who is 50 pounds overweight and couldn’t lift a barbell over their head.
AG has always been about aiming to be the best that you can be given your current life circumstances. As I wrote yesterday, I’m in a maintenance phase. That DOES NOT mean I allow myself to become a fat slob. I still want to look good with my shirt off. Lift heavy weights, run at any given time for any distance, or take off on a sprint at a moment’s notice.
As always.
Don’t be a loser. Learn more. Get in the gym.
Happy Friday
ACIDGAMBIT.
Really appreciated the thoughtfulness of the post and ability to apply reason rather than vilify any one side