Compounded Testosterone Troches TO OPTIMIZE HEALTH AND THE TESTOSTERONE CONTROVERSY.

As men age, testosterone levels progressively fall and inflammatory biomarkers increase. The gradual decline in testosterone production with aging, known as andropause, is common and may have deleterious effects on men including decreased overall well-being, increased sarcopenia, increased risk of cardiovascular disease, reduced sexual function, and bone loss. Therefore, it comes as no surprise that an increasing number of men worldwide have begun requesting testosterone replacement therapy from their physicians. Occasionally, physicians discourage male patients from getting testosterone replacement therapy based on a few recent studies indicating the therapy causes cardiovascular events, including myocardial infarctions. Yet, an extensive review of the testosterone replacement therapy literature reveals that the majority of clinical studies show that properly administered testosterone replacement therapy, in which estradiol and dihydrotestosterone levels are also controlled, has no adverse effects on myocardial infarction risk. The current state-of-the-art in testosterone replacement therapy comprises compounded testosterone troches; an aromatase inhibitor, such as generic Anastrazole, to control estradiol levels; and a 5α-reductase inhibitor, such as beneric Dutasteride or Finasteride, to control dihydrotestosterone. Compounded testosterone troches easily raise serum testosterone levels to the optimal range, are highly cost effective at $82 for a 180-day supply, and provide affordable access to testosterone replacement therapy to millions of men requesting it. Yet, the Blue Cross Blue Shield-associated firms have largely denied requests for coverage of compounded medications, including testosterone troches. Despite data demonstrating strong links between testosterone deficiency and significant comorbid conditions (including Type 2 diabetes and other metabolic syndrome diseases) as well as the health benefits of testosterone replacement therapy, some physian have been swayed against prescribing testosterone replacement therapy to their aging male patients. The testosterone controversy stems largely from poorly designed clinical studies in which patients were subjected to testosterone replacement therapy without having their estradiol and dihydrotestosterone levels properly controlled.

COMPOUNDING PHARMACIES' POTENTIAL TO CREATE Graft Storage Solutions for Bypass Surgeries.

Several studies have addressed the optimal storage conditions for vascular grafts during bypass surgery. These studies have repeatedly shown that placing vascular graft conduits in isotonic saline solutions, and to a lesser extent in heparinized autologous blood, leads to a profound decline in endothelial cell viability. Endothelial damage to vein grafts can occur at multiple points during a coronary artery bypass graft surgery procedure: graft harvesting, handling, flushing, storage, anastomosis, and arterialization (e.g., damage caused by exposure to arterial blood pressure). This damage to endothelial cells causes the release of pro-inflammatory chemical signals that trigger thrombosis, intimal hyperplasia, and accelerated graft atherosclerosis, all of which ultimately contribute to graft failure. Cardiothoracic surgeons performing coronary artery bypass graft surgery and vascular surgeons performing peripheral artery bypass graft surgery have attempted to overcome the damage to the vascular grafts by using buffers to maintain the physiological pH of the storage solution. However, the endothelial layers in the grafts would benefit from having proper oxygenation and antioxidants added to the storage solution. Compounding pharmacies can perform a vital role in ensuring the patency of the vascular grafts by creating compounded flushing and storage solutions that have an optimal mix of nitric oxide substrates, antioxidants, and other nutrients for the endothelium. Maintaining structural and functional viability of the endothelia in grafts by using an appropriate vessel storage medium would lead to improved long-term graft patency.