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Important Safety Information

Sipra LLC · sipra.com

These are compounded medications. They are not approved or evaluated by the FDA. This is a summary of important risks, not complete information. Talk to your Sipra physician before starting or stopping any medication. In a medical emergency, call 911. To report a side effect, contact [email protected] or report to the FDA at 1-800-FDA-1088 or fda.gov/medwatch.

Weight Loss

Semaglutide

A compounded GLP-1 medication used for weight management, available as an injection, a microdose injection, and an oral tablet (orally disintegrating). As a 503A compounded medication, it is not FDA approved and does not carry FDA-approved labeling.

Boxed warning

In animal studies, semaglutide caused thyroid tumors, including a type of thyroid cancer called medullary thyroid carcinoma. It is not known whether it causes these tumors in people.

Do not use if: you or a family member has had medullary thyroid cancer or multiple endocrine neoplasia type 2 (MEN 2), you have had a serious allergic reaction to semaglutide or any ingredient in the product, or you are pregnant, trying to become pregnant, or breastfeeding.
Important risks: Serious risks can include inflammation of the pancreas (pancreatitis), gallbladder problems, kidney problems (often from dehydration caused by vomiting or diarrhea), low blood sugar (hypoglycemia), especially if you also take insulin or a sulfonylurea, severe stomach and intestinal reactions, a faster heart rate, and serious allergic reactions. Tell your care team and anesthesia team before any surgery or procedure with sedation, because of a risk of breathing stomach contents into the lungs.
Common side effects: nausea, vomiting, diarrhea, constipation, and stomach (abdominal) pain.

By form

InjectionDo not share needles, syringes, or vials with anyone, even if the needle is changed, because of the risk of passing on serious infections. You may have redness, swelling, or itching where you inject.

Microdose injectionDo not share needles, syringes, or vials with anyone, even if the needle is changed, because of the risk of passing on serious infections. You may have redness, swelling, or itching where you inject.

Oral tablet (ODT)Let the tablet dissolve in your mouth.

Call your provider if

you have severe or ongoing stomach pain that may spread to your back (with or without vomiting), signs of an allergic reaction such as swelling of the face, lips, or throat, trouble breathing, rash, or hives, severe vomiting or diarrhea or signs of dehydration, signs of low blood sugar such as shakiness, sweating, fast heartbeat, confusion, or dizziness, pain in your upper right belly, fever, or yellowing of the skin or eyes, or a lump or swelling in your neck, trouble swallowing, shortness of breath, or hoarseness that does not go away.

Tirzepatide

A compounded GIP and GLP-1 medication used for weight management, available as an injection, a microdose injection, and an oral tablet that dissolves in the mouth. It is prepared by a compounding pharmacy, is not FDA approved, and does not have FDA approved labeling.

Boxed warning

In studies in rats, tirzepatide caused thyroid C-cell tumors, including a type of cancer called medullary thyroid carcinoma (MTC). It is not known whether tirzepatide causes these tumors in people.

Do not use if: you or a family member has had medullary thyroid cancer, you have Multiple Endocrine Neoplasia syndrome type 2 (MEN 2), or you have had a serious allergic reaction to tirzepatide or any ingredient in this product; tell your provider if you are pregnant, planning to become pregnant, or breastfeeding
Important risks: inflammation of the pancreas (pancreatitis), gallbladder problems, kidney problems (often from dehydration due to nausea, vomiting, or diarrhea), low blood sugar (especially if combined with insulin or other diabetes medicines), worsening of diabetic eye disease (diabetic retinopathy) in people with diabetes, and serious allergic reactions; tell your provider and anesthesia team before any surgery or procedure with sedation or anesthesia (risk of breathing in stomach contents); it may also make oral (pill) hormonal birth control work less well, so use a non-oral method or add a barrier method
Common side effects: nausea, diarrhea, vomiting, constipation, stomach pain, indigestion, burping, heartburn, fatigue, and hair loss

By form

InjectionNever share needles, syringes, pens, or vials with anyone, even if the needle is changed, because of the risk of passing on infection. You may have redness, swelling, itching, or discomfort where you inject.

Microdose injectionNever share needles, syringes, pens, or vials with anyone, even if the needle is changed, because of the risk of passing on infection. You may have redness, swelling, itching, or discomfort where you inject.

Oral tablet (ODT)Let the tablet dissolve in your mouth; do not chew or swallow it whole.

Microdose injectionYou may have redness, swelling, itching, or discomfort where you inject.

Call your provider if

you have severe or lasting stomach pain (which may spread to your back), a severe allergic reaction (swelling of the face, lips, tongue, or throat, trouble breathing, rash, or fainting), signs of gallbladder problems (pain in the upper right belly, fever, yellowing of the skin or eyes), little or no urination or signs of dehydration, or symptoms of low blood sugar

Men's Health

Testosterone

A compounded testosterone treatment for men with low testosterone, available as an injection (testosterone cypionate), a transdermal cream, an oral capsule, and a compounded oral troche that dissolves in the mouth.

Do not use if: you have breast cancer, or known or suspected prostate cancer, or serious heart, liver, or kidney disease, or you have had an allergic reaction to testosterone or any ingredient in the product.
Important risks: testosterone can raise blood pressure, which can add to your risk of heart attack and stroke over time, so your provider may check your blood pressure during treatment; it can also thicken the blood (raise red blood cell counts), raise the risk of blood clots in the legs or lungs, affect the prostate, and can affect the liver, including serious liver problems, and can lower fertility.
Common side effects: headache, acne or oily skin, mood changes, and a rise in PSA (a prostate blood test).

By form

Injection (testosterone cypionate)do not share or reuse needles, syringes, or vials, and use a new sterile needle and syringe every time, because reuse or sharing can spread infections like HIV and hepatitis; expect possible redness, swelling, or soreness where you inject.

Cream (transdermal)testosterone can transfer to women and children through skin contact, so wash your hands after applying, keep the treated skin covered, and avoid skin-to-skin contact at the site; mild redness or irritation can occur where the cream is applied.

Oral capsule (Kyzatrex)Kyzatrex, the oral form, has a boxed warning that it can raise blood pressure, which raises the risk of heart attack and stroke. Your blood pressure should be checked before you start and while you are taking it. Take each dose with food.

Oral troche (compounded)Kyzatrex, the oral form, has a boxed warning that it can raise blood pressure, which raises the risk of heart attack and stroke. Your blood pressure should be checked before you start and while you are taking it. Take each dose with food.

Oral troche (compounded)Let the troche dissolve in your mouth rather than swallowing it whole, and take it as directed. It may cause mild mouth or throat irritation.

Call your provider if

you have chest pain, shortness of breath, weakness or numbness on one side of the body, slurred speech, or sudden swelling, pain, warmth, or redness in a leg, or a painful erection lasting more than 4 hours, or yellowing of the skin or eyes.

Enclomiphene

A compounded enclomiphene citrate capsule used off-label in men for low testosterone. It is not FDA-approved, and its safety and effectiveness in men are not established.

Do not use if: you are not a man being treated under physician supervision, you have liver disease or a history of liver problems, or you have a personal or family history of blood clots in the legs, lungs, eyes, or elsewhere.
Important risks: visual changes such as blurred vision, flashes, spots, or sensitivity to light, which can rarely become lasting, and a rare risk of blood clots.
Common side effects: headache, mood changes, and nausea.

Call your provider if

you have any change in your vision, severe or lasting headache, swelling, pain, warmth, or redness in a leg, sudden chest pain, trouble breathing, or new or worsening mood changes.

HCG (human chorionic gonadotropin)

A compounded form of human chorionic gonadotropin (hCG), a hormone used to support testicular function, given as an injection. It is prepared by a compounding pharmacy and is not FDA approved.

Do not use if: you have prostate cancer or another cancer or tumor that depends on male hormones, you have ever had an allergic reaction to hCG, or you are a boy showing early (precocious) puberty.
Important risks: hCG can cause your body to hold onto fluid, so it should be used with caution if you have heart disease, kidney disease, epilepsy, migraine, or asthma, tell your provider if you have any of these. Breast tissue growth or tenderness (gynecomastia) can occur. Blood clots in an artery have been reported. Serious allergic reactions, including life threatening reactions, are possible.
Common side effects: headache, irritability, restlessness, mood changes or feeling down, tiredness, fluid buildup or swelling, breast tenderness or enlargement, and pain at the injection site.

By form

InjectionDo not share needles, syringes, or vials with anyone, even if the needle is changed, because this can pass on serious infections. Redness, swelling, or pain at the injection site can occur. Use a new injection site each time as directed and follow safe disposal of used needles.

Call your provider if

you have signs of a blood clot such as sudden chest pain, trouble breathing, leg pain or swelling, weakness on one side of your body, or trouble speaking, or signs of a serious allergic reaction such as rash, hives, swelling of the face, lips, or throat, or trouble breathing, get emergency care right away. Also call if you have new or worsening swelling, mood changes, or breast tenderness.

Anastrozole

A compounded aromatase inhibitor used off-label in men to lower estrogen, available as a capsule. It is prepared by a compounding pharmacy, is not FDA approved in this form, and its safety and effectiveness for this use have not been established.

Do not use if: you have had an allergic reaction to anastrozole or any ingredient in this product, or you are a woman who is pregnant or could become pregnant.
Important risks: lowering estrogen over time can weaken bones and raise the chance of fractures, so your provider may check bone health; it can raise cholesterol; joint and bone pain are common; mood changes including depression can occur; and in people with existing heart disease there may be a higher risk of heart-related events.
Common side effects: hot flashes, joint pain, bone pain or back pain, headache, nausea, weakness or low energy, and trouble sleeping.

By form

CapsuleTaken by mouth; tell your provider about all other medicines and supplements you take.

Call your provider if

you have signs of a serious allergic reaction (rash, hives, swelling of the face, lips, or throat, or trouble breathing), new or worsening depression or mood changes, chest pain or pressure, shortness of breath, a fracture or bone that breaks easily, or yellowing of the skin or eyes.

Finasteride

A finasteride capsule for hair loss in men, prepared by a 503A compounding pharmacy. It is not FDA approved.

Do not use if: you are a woman who is or may become pregnant, or you have had an allergic reaction to finasteride. Women who are or may become pregnant must also not handle crushed or broken capsules, because finasteride can harm a developing male baby.
Important risks: Decreased sex drive, erectile dysfunction, and ejaculation problems can occur and, in some men, have continued after the medication is stopped. Reduced fertility or poor semen quality has also been reported, and in some men this improved or returned to normal after stopping. Mood changes including depression have been reported. Breast changes such as tenderness, enlargement, or lumps can occur, with rare reports of male breast cancer. Finasteride lowers PSA (a blood test used to screen for prostate cancer), so tell any provider you are taking it before a PSA test. In a study using a higher dose than the dose used for hair loss, finasteride was linked to a possible increased risk of a more serious form of prostate cancer.
Common side effects: Sexual side effects are the most frequently reported, including reduced semen volume. In studies these occurred in roughly 1 to 2 out of 100 men and resolved both in men who stopped the medication and in most men who continued taking it.

Call your provider if

you notice any breast lumps, breast pain, or nipple discharge, or if you have new or worsening depression or mood changes. Also seek care for signs of a serious allergic reaction, such as swelling of the lips, tongue, throat, or face, or trouble breathing.

Follicle Fuel

A compounded once-daily oral dissolving tablet for hair loss in men, combining finasteride 1 mg, minoxidil 2.5 mg, biotin, and vitamins D3 and K2. As a 503A compounded preparation it is not FDA approved and does not carry FDA-approved labeling.

Do not use if: you are a woman, especially if you are or may become pregnant (it is not for use in women, and women who are or may become pregnant must not handle crushed or broken tablets, because finasteride can harm a developing male baby), you are a man who is trying to conceive (finasteride can reduce fertility), you have liver problems, you take another anti-androgen medicine, or you have had an allergic reaction to any ingredient.
Important risks: From finasteride: decreased sex drive, erectile dysfunction, and ejaculation problems can occur and, in some men, have continued after the medication is stopped; mood changes including depression have been reported; breast changes such as tenderness, enlargement, or lumps can occur, with rare reports of male breast cancer; finasteride also lowers PSA (a prostate-cancer screening test), so tell any provider you take it before a PSA test. From minoxidil: temporary increased hair shedding when starting, lightheadedness, and fluid retention can occur; rarely a faster heart rate or low blood pressure.
Common side effects: temporary increased shedding when starting (minoxidil), and the finasteride sexual side effects above, which in studies occurred in roughly 1 to 2 out of 100 men. Biotin, D3, and K2 are generally well tolerated and may cause mild stomach upset. Note that biotin can interfere with some lab tests (including certain thyroid and heart/troponin tests), so tell your provider you take it.

Call your provider if

you notice any breast lumps, breast pain, or nipple discharge, new or worsening depression or mood changes, lightheadedness or fainting, rapid weight gain or swelling of the ankles or feet, or signs of a serious allergic reaction such as swelling of the lips, tongue, throat, or face, or trouble breathing.

Lush Lox

A compounded once-daily oral dissolving tablet for hair growth, combining minoxidil 2.5 mg with biotin and vitamins D3 and K2. It contains no finasteride or other hormone-blocking ingredient. A 503A compounded preparation; it is not FDA approved.

Do not use if: you have had an allergic reaction to any ingredient, you have uncontrolled heart disease or low blood pressure without provider oversight, or you are pregnant or breastfeeding unless your provider approves it.
Important risks: From minoxidil taken by mouth: lightheadedness, fluid retention or swelling, and, rarely, a faster heart rate or low blood pressure. Increased hair shedding is common in the first weeks as new growth begins.
Common side effects: temporary increased shedding when starting, lightheadedness, or mild fluid retention from minoxidil. Biotin, D3, and K2 are generally well tolerated and may cause mild stomach upset. Note that biotin can interfere with some lab tests, so tell your provider you take it.

Call your provider if

you have lightheadedness or fainting, rapid weight gain or swelling of the ankles or feet, a fast or irregular heartbeat, chest discomfort, or signs of a serious allergic reaction.

ReGrow Fuel

A compounded once-daily oral dissolving tablet for hair growth, combining minoxidil 2.5 mg with the copper peptide GHK-Cu, apigenin, and fisetin. It is a non-hormonal (DHT-free) formula. A 503A compounded preparation; it is not FDA approved.

Do not use if: you have had an allergic reaction to any ingredient, you have uncontrolled heart disease or low blood pressure without provider oversight, or you are pregnant or breastfeeding unless your provider approves it.
Important risks: From minoxidil taken by mouth: lightheadedness, fluid retention or swelling, and, rarely, a faster heart rate or low blood pressure. Increased hair shedding is common in the first weeks as new growth begins.
Common side effects: temporary increased shedding when starting, lightheadedness, or mild fluid retention from minoxidil. GHK-Cu, apigenin, and fisetin are generally well tolerated, with rare mild stomach upset or skin sensitivity.

Call your provider if

you have lightheadedness or fainting, rapid weight gain or swelling of the ankles or feet, a fast or irregular heartbeat, chest discomfort, or signs of a serious allergic reaction.

Follicle Plus

A compounded once-daily oral dissolving tablet for hair loss in men, combining dutasteride 0.5 mg, minoxidil 2.5 mg, biotin, and vitamins D3 and K2. Dutasteride blocks the hormone DHT more completely than finasteride. A 503A compounded preparation; not FDA approved for hair loss.

Do not use if: you are a woman, especially if you are or may become pregnant (women who are or may become pregnant must not handle crushed or broken tablets, because dutasteride can harm a developing male baby), you are a man who is trying to conceive, you have liver problems, or you have had an allergic reaction to any ingredient.
Important risks: From dutasteride: decreased sex drive, erectile dysfunction, and ejaculation problems can occur and, in some men, have continued after the medication is stopped; mood changes including depression have been reported; breast changes such as tenderness, enlargement, or lumps can occur, with rare reports of male breast cancer; dutasteride lowers PSA (a prostate-cancer screening test), so tell any provider you take it. Because dutasteride stays in the body for months, do not donate blood while taking it or for 6 months after stopping. From minoxidil: temporary increased shedding when starting, lightheadedness, and fluid retention.
Common side effects: temporary increased shedding when starting (minoxidil), and the dutasteride sexual side effects above. Biotin, D3, and K2 are generally well tolerated and may cause mild stomach upset. Note that biotin can interfere with some lab tests (including certain thyroid and heart/troponin tests), so tell your provider you take it.

Call your provider if

Sildenafil

A compounded prescription medicine for erectile dysfunction, made with sildenafil. Compounded products are not FDA-approved.

Do not use if: you take nitrate medicines (such as nitroglycerin or isosorbide) in any form, regularly or once in a while, you take a guanylate cyclase stimulator such as riociguat, or you have had an allergic reaction to sildenafil. Tell your provider if a heart doctor has said sexual activity is unsafe for you.
Important risks: taking it with alpha-blockers or other blood pressure medicines can lower blood pressure and cause dizziness or fainting. Rare but serious effects include a painful erection lasting more than 4 hours (priapism), sudden loss of vision in one or both eyes, and sudden decrease or loss of hearing (sometimes with ringing in the ears or dizziness). People with serious heart problems should be cautious because sexual activity adds strain on the heart.
Common side effects: headache, flushing, upset stomach or indigestion, stuffy or runny nose, dizziness, back or muscle aches, and a temporary blue or color tinge to your vision.

By form

Oral tablettaken by mouth.

Call your provider if

an erection lasts more than 4 hours (seek emergency care), or you have sudden vision or hearing changes, chest pain, fainting, or signs of an allergic reaction.

Tadalafil

A compounded prescription medicine (tadalafil) used to treat erectile dysfunction, available as a daily tablet and an as-needed tablet. Compounded medicines are not FDA approved and do not have FDA approved labeling.

Do not use if: You take any nitrate medicine (such as nitroglycerin) in any form, you take a guanylate cyclase stimulator such as riociguat, or you have had a serious allergic reaction to tadalafil.
Important risks: Lower blood pressure (more likely with alpha-blockers, other blood pressure medicines, or heavy alcohol use), which can cause dizziness or fainting; rarely a painful or prolonged erection (priapism) that can permanently damage the penis if not treated quickly; rare sudden loss of vision in one or both eyes; rare sudden decrease or loss of hearing; and a possibly unsafe strain on the heart from sexual activity if you have certain heart conditions.
Common side effects: Headache, indigestion, nasal congestion, flushing, and pain in the arms or legs, with back pain and muscle aches reported more often.

Call your provider if

You have an erection lasting more than 4 hours, sudden loss or decrease of vision, sudden loss or decrease of hearing, chest pain, fainting, or signs of a serious allergic reaction such as rash, blistering, or swelling.

Tadalafil and Sildenafil

A compounded prescription medication that combines two PDE5 inhibitors, tadalafil and sildenafil, for erectile dysfunction, available as a rapid-dissolve troche. It is compounded by a licensed pharmacy and is not FDA-approved, so it does not carry FDA-approved labeling.

Do not use if: you take any nitrate medicine (such as nitroglycerin or isosorbide) in any form, regularly or now and then, including recreational "poppers"; you take a soluble guanylate cyclase stimulator such as riociguat; or you have had a serious allergic reaction to tadalafil or sildenafil.
Important risks: taking it with nitrates or with a GC stimulator can cause a sudden, dangerous drop in blood pressure; alpha-blockers, blood pressure medicines, or larger amounts of alcohol can also lower your blood pressure and cause dizziness or fainting; rarely, a painful or prolonged erection lasting more than 4 hours (priapism) can occur and can permanently damage the penis if not treated quickly, with higher risk if you have sickle cell anemia, multiple myeloma, leukemia, or a deformed penis; rare cases of sudden vision loss in one or both eyes and sudden decrease or loss of hearing (sometimes with ringing in the ears and dizziness) have been reported; sexual activity may not be safe if you have certain heart conditions, so talk with your provider first.
Common side effects: headache, flushing, upset stomach or indigestion, stuffy or runny nose, back pain, muscle aches, dizziness, and changes in vision such as blurriness or a blue tinge.

By form

Rapid-dissolve trocheLet it dissolve in your mouth rather than swallowing it whole. It may cause mild mouth or throat irritation.

Call your provider if

an erection lasts more than 4 hours, you have sudden vision loss in one or both eyes, you have a sudden decrease or loss of hearing, you have chest pain, severe dizziness, or fainting, or you have signs of a serious allergic reaction such as rash, swelling, or trouble breathing.

Women's Health

Passion

A compounded oral dissolving tablet for female sexual arousal and desire, combining tadalafil 10 mg, bremelanotide 10 mg, and pregnenolone 10 mg. It is taken before intimacy and works through blood flow, brain-driven desire, and hormone support. A 503A compounded preparation; not FDA approved.

Do not use if: you take nitrate medicines (such as nitroglycerin) or another PDE5 inhibitor or melanocortin-receptor agonist, you have uncontrolled high blood pressure or significant heart disease, you have a hormone-sensitive condition or use hormone therapy without medical oversight, you are pregnant or breastfeeding, or you have had an allergic reaction to any ingredient.
Important risks: From tadalafil: blood pressure can drop, especially if combined with nitrates, which can cause fainting; rare reports of sudden vision or hearing loss. From bremelanotide: nausea, facial flushing, headache, and temporary increases in blood pressure; darkening of the skin or gums can occur with repeated use. From pregnenolone: mood changes or hormonal sensitivity in some users.
Common side effects: headache, flushing, nasal congestion, or dizziness (tadalafil); nausea, facial flushing, or headache (bremelanotide); mood changes or vivid dreams (pregnenolone). Do not use more than one tablet in 24 hours.

Call your provider if

you have chest pain, fainting or severe dizziness, a sudden change in vision or hearing, severe or persistent nausea, or signs of a serious allergic reaction such as swelling of the lips, tongue, throat, or face, or trouble breathing.

Vitality

A compounded once-daily oral dissolving tablet for female hormonal balance, energy, libido, and mood, combining low-dose enclomiphene 3 to 6 mg, DHEA 10 mg, pregnenolone 10 mg, and boron 5 mg. It is intended as a gentler, non-estrogen alternative to traditional hormone therapy. A 503A compounded preparation; not FDA approved.

Do not use if: you are pregnant, breastfeeding, or have a hormone-sensitive cancer, you have uncontrolled polycystic ovary syndrome (PCOS) or high androgen levels without medical oversight, you use hormone therapy or fertility medication without clinician monitoring, or you have had an allergic reaction to any ingredient.
Important risks: From enclomiphene (a selective estrogen receptor modulator): breast tenderness, changes to the menstrual cycle, and mood changes can occur; visual changes are an uncommon class effect. From DHEA and pregnenolone: acne, unwanted hair changes, mood changes, or vivid dreams. From boron: occasional stomach upset.
Common side effects: mild breast tenderness or menstrual-cycle changes (enclomiphene), occasional acne, mood changes, or vivid dreams (DHEA and pregnenolone), and occasional stomach upset (boron).

Call your provider if

you have new or unusual vaginal bleeding, a persistent breast lump or breast pain, changes in vision, severe mood changes, or signs of a serious allergic reaction.

HRT Cream (estradiol/BIEST, testosterone, with or without progesterone)

A compounded transdermal hormone therapy for women that combines estrogens (estradiol and estriol, often called BIEST) and testosterone, with or without progesterone, applied to the skin as a cream. It is prepared by a compounding pharmacy and is not FDA approved.

Boxed warning

This is a compounded product without FDA approved labeling. Using estrogen alone, without a progestogen, increases the risk of cancer of the uterine lining (endometrial cancer) in women who still have a uterus. Use the lowest effective dose for the shortest time consistent with your treatment goals.

Do not use if: you have or have ever had breast cancer or another estrogen sensitive cancer, you have unexplained vaginal bleeding, you have or have had blood clots, stroke, or heart attack, you have a blood clotting disorder, you have liver disease, or you are pregnant, think you may be pregnant, or are breastfeeding.
Important risks: In the Women's Health Initiative studies, estrogen taken with a progestin was associated with a higher risk of heart attack, stroke, blood clots, and breast cancer, with risk influenced by age and how long after menopause therapy begins. Estrogens may also raise the risk of ovarian cancer with long term use, and gallbladder problems, high blood pressure, high triglycerides, and changes in blood sugar can occur. Added testosterone can cause masculinizing changes such as unwanted hair growth, deepening of the voice, or enlargement of the clitoris, some of which may not fully reverse.
Common side effects: headache, breast tenderness, nausea, bloating, mood changes, dizziness, irregular vaginal bleeding or spotting, fluid retention, and acne or increased facial or body hair from the testosterone.

By form

Cream (transdermal)Skin reactions such as redness, itching, or irritation can occur where you apply it. The hormones in this cream, including estrogen and testosterone, can transfer to others through skin contact and may harm children and partners, so wash your hands after applying and avoid skin to skin contact at the treated area.

Call your provider if

you have chest pain, sudden shortness of breath, or coughing up blood; pain, swelling, warmth, or redness in a leg; sudden severe headache, vision changes, trouble speaking, or weakness or numbness on one side of the body; a new breast lump; yellowing of the skin or eyes; or heavy or unexpected vaginal bleeding.

Female Testosterone (cream)

A compounded low-dose testosterone medication used off-label in women, applied to the skin as a cream. It is prepared by a compounding pharmacy and is not FDA-approved for women.

Boxed warning

Children and women can be exposed to testosterone through skin contact with a treated person. This can cause serious effects, including early puberty signs in children, body or pubic hair, and enlargement of the genitals (such as the clitoris or penis), some of which may not fully go away. To protect others, wash your hands after applying, let the area dry, keep it covered with clothing, and avoid skin-to-skin contact at the treated site. Keep children away from the application area.

Do not use if: you are pregnant, trying to become pregnant, or breastfeeding (testosterone can harm an unborn or nursing baby), or you have or have had breast cancer, uterine (endometrial) cancer, or another hormone-sensitive cancer or condition, or you are allergic to testosterone or any ingredient in the cream. Talk to your clinician first if you have liver disease, and tell your clinician about any history of blood clots before you start.
Important risks: because this is compounded, its safety and effectiveness in women have not been established by the FDA and long-term safety data are limited. Higher exposure makes androgen effects more likely; scalp hair thinning is a less common one. Androgen therapy can raise your red blood cell count (thicker blood), which is why your clinician may monitor your blood. Drawing on testosterone therapy generally, much of it at higher male doses, it has been associated with blood clots, including clots in the legs and lungs (DVT/PE), and data at low female doses are limited. Testosterone can also raise blood pressure, so your clinician may check it.
Common side effects: acne, oily skin, unwanted facial or body hair, and mood changes.

By form

Cream (transdermal)may cause redness, irritation, or dryness where you apply it. Because testosterone can transfer to others through skin contact, follow the secondary-exposure steps in the boxed warning above.

Call your provider if

you notice a deepening voice, clitoral enlargement, or rapid or worsening hair growth, or you become pregnant or think you may be pregnant. Get urgent care for signs of a blood clot, such as leg pain or swelling, sudden shortness of breath, or chest pain.

HRT Oral (estradiol with oral micronized progesterone)

A compounded hormone therapy for women combining estradiol with oral micronized progesterone. As a 503A compounded product it is not FDA approved and does not carry FDA approved labeling.

Boxed warning

Estrogen used by itself can raise the risk of cancer of the uterus lining in women who still have a uterus.

Do not use if: you are pregnant or think you might be, you have unexplained vaginal bleeding, you have or have had breast cancer or another estrogen sensitive cancer, you have or have had blood clots in the legs or lungs (deep vein thrombosis or pulmonary embolism), you have had a stroke or heart attack, you have liver problems or liver disease, you are allergic to peanuts (the progesterone capsule contains peanut oil), or you are allergic to estradiol or progesterone.
Important risks: Higher risk of blood clots, stroke, heart attack, breast cancer, and gallbladder problems.
Common side effects: headache, breast pain or tenderness, irregular vaginal bleeding or spotting, nausea, bloating, joint pain, and mood changes.

By form

Oral tablet + capsuleCan cause dizziness or drowsiness. Taking it at bedtime can help lessen these effects. Use caution driving or operating machinery until you know how it affects you.

Call your provider if

you have chest pain, trouble breathing, coughing up blood, sudden severe headache, vision changes, slurred speech, weakness or numbness on one side of the body, pain or swelling in one leg, a new breast lump, yellowing of the skin or eyes, or any vaginal bleeding that is heavy, unexpected, or will not stop.

HRT Patch (estradiol patch with oral progesterone)

A compounded menopausal hormone therapy with two medicines: an estradiol skin patch worn on the body, plus oral progesterone capsules taken by mouth. These are compounded preparations, not FDA-approved products.

Boxed warning

Estrogen, taken without enough progesterone, raises the risk of cancer of the uterus lining. Estrogen with progesterone has been linked to a higher risk of stroke, blood clots, heart attack, breast cancer, and, in women 65 and older, dementia. Do not use these hormones to prevent heart disease or dementia.

Do not use if: you are or may be pregnant; you have unexplained vaginal bleeding; you have or have had breast cancer or another cancer that grows with estrogen; you have or have had blood clots in the legs or lungs (DVT or PE); you have had a stroke or heart attack, or have a blood-clotting disorder; you have liver problems; you have had an allergic reaction to estrogen or progesterone; or you are allergic to peanuts (the progesterone capsules contain peanut oil).
Important risks: serious blood clots, stroke, and heart attack; higher risk of breast cancer and cancer of the uterus lining with longer use; gallbladder disease; high blood pressure; and changes in vision.
Common side effects: headache, breast tenderness or pain, bloating, abdominal pain, joint pain, low mood, dizziness, and swelling.

By form

Transdermal patch + oral capsuleApply to clean, dry skin and rotate where you place it to lower the chance of redness or irritation at the site. Avoid the waistline, where clothing can rub it off.

Oral capsuleMay cause drowsiness or dizziness, so use care driving or operating machinery, especially when taken at bedtime.

Call your provider if

you have leg pain or swelling, chest pain, sudden shortness of breath, coughing up blood, sudden severe headache, weakness or numbness on one side, trouble speaking, sudden vision changes, yellowing of the skin or eyes, a new breast lump, or any unusual vaginal bleeding.

Vaginal Estradiol

Estradiol (a form of estrogen) prescribed for vaginal symptoms such as dryness.

Boxed warning

In a woman with a uterus, estrogen taken without a progestogen can increase the risk of cancer of the uterine lining.

Do not use if: you have or have had breast cancer or another estrogen-sensitive cancer, unexplained vaginal bleeding, blood clots, a stroke, a clotting disorder, or liver problems, or you are or may be pregnant.
Important risks: Estrogen can raise the risk of gallbladder disease, high blood pressure, and high triglycerides.
Common side effects: vaginal burning, itching, or irritation, vaginal discharge or yeast infection, headache, breast tenderness, and nausea.

By form

Vaginal creamThe cream can transfer to a partner during sex and can weaken latex condoms, diaphragms, and cervical caps, so do not rely on these for contraception.

Call your provider if

you have any unusual or unexplained vaginal bleeding, a new breast lump, sudden or severe headache, chest pain or trouble breathing, swelling, pain, or warmth in a leg, sudden vision changes, or yellowing of the skin or eyes.

Progesterone

A compounded form of micronized progesterone, a hormone, available as a capsule.

Do not use if: you are allergic to peanuts (some formulations contain peanut oil) or to any ingredient, you have or have had breast cancer, you have a current or past blood clot (such as in the legs or lungs), stroke, or heart attack, you have liver problems or liver disease, you have unexplained vaginal bleeding, or you are or may be pregnant.
Important risks: When used with estrogen, this therapy has been linked in studies to a higher risk of heart attack, stroke, blood clots, and breast cancer, and to probable dementia in women 65 and older. It is not used to prevent heart disease.
Common side effects: Dizziness, headache, abdominal pain, breast tenderness, and bloating.

By form

CapsuleCan cause drowsiness. Do not drive or operate machinery after taking it.

Call your provider if

you have chest pain, trouble breathing, sudden severe headache, vision changes, weakness or numbness on one side of the body, trouble speaking, leg pain or swelling, yellowing of the skin or eyes, unusual vaginal bleeding, or new or worsening depression.

DHEA (vaginal and oral)

A compounded hormone precursor (DHEA, also called prasterone) for women's health, available as a vaginal cream and an oral capsule; because it is compounded, it is not FDA approved.

Do not use if: you have or have had breast, uterine, ovarian, or any other hormone-sensitive cancer, you have unexplained or unusual vaginal bleeding, or you are pregnant or breastfeeding.
Important risks: your body converts DHEA into estrogen and testosterone, so it can raise these hormone levels; the oral form is less studied and is not established for safety or effectiveness.
Common side effects: acne, oily skin, unwanted hair growth, mood changes.

By form

Vaginal creammay cause local vaginal discharge, irritation, or spotting; use only as directed.

Oral capsuletake as directed.

Call your provider if

you have new or unusual vaginal bleeding, a breast lump or breast changes, new or worsening mood changes, or any symptom that worries you.

Scream Cream (topical arousal)

A compounded prescription cream applied to the genitals to support arousal. The active ingredients vary by formula (commonly sildenafil and L-arginine), and it is not an FDA-approved product.

Do not use if: you are allergic to any ingredient in your formula. Because some formulas use blood-vessel-relaxing ingredients, do not use if you take nitrate medicines (such as nitroglycerin) or a guanylate cyclase stimulator (such as riociguat) in any form, unless your provider has reviewed your full history and medicines first. Tell your provider about any heart condition, low blood pressure, or recent heart attack or stroke before using.
Important risks: How much of the medicine passes into the body from a compounded cream is not established. Its safety and effectiveness have not been confirmed in studies.
Common side effects: local burning, stinging, redness, or irritation where the cream is applied; headache, flushing, lightheadedness, or dizziness may also occur.

By form

Cream (topical, genital)Apply only where your provider directs and wash your hands after. The cream can transfer to a partner on contact, so let it absorb and consider barrier protection.

Call your provider if

you have trouble breathing, swelling of the face, lips, or tongue, severe or spreading rash, chest pain, fainting, or severe dizziness, or any reaction that does not ease after you wash the cream off. If your formula contains sildenafil, seek emergency care for an erection that is painful or lasts more than 4 hours.

Tadalafil and Oxytocin (troche)

A compounded prescription product for intimacy that combines tadalafil (a PDE5 inhibitor) and low-dose oxytocin, available as a rapid-dissolve troche placed in the mouth. It is prepared by a compounding pharmacy and is not FDA approved. The troche form of oxytocin is off-label and has not been well studied.

Boxed warning

The only FDA-approved oxytocin product is an injection used in a hospital for labor, and its strongest warnings apply to that obstetric use, not to this product. There is no FDA-approved oral or troche oxytocin, so that safety data does not apply here, and the troche use is not well studied.

Do not use if: you take any nitrate medicine (such as nitroglycerin or isosorbide) or a guanylate cyclase stimulator such as riociguat, you have had a serious allergic reaction to tadalafil or oxytocin, you are pregnant, think you may be pregnant, or are breastfeeding, or your provider has told you that sexual activity is unsafe because of your heart.
Important risks: Tadalafil can lower blood pressure. Taking it with alpha-blockers, other blood pressure medicines, or several alcoholic drinks can cause dizziness, lightheadedness, or fainting. Rarely it has been linked to sudden loss of vision in one or both eyes, sudden hearing loss, and prolonged or painful erections. Low-dose oxytocin can rarely cause allergic reactions, and its effects on blood pressure and heart rate by this route are not well characterized. Because this is a compounded product, it is not FDA approved and is not the same as any FDA-approved medicine.
Common side effects: headache, flushing, upset stomach or indigestion, stuffy nose, back pain, and muscle aches.

By form

Rapid-dissolve trocheLet the troche dissolve fully in your mouth and do not chew or swallow it whole; it may cause mild mouth or throat irritation.

Call your provider if

you have an erection lasting more than 4 hours, sudden loss or decrease in vision or hearing, ringing in the ears, chest pain or pressure during or after sex, or fainting. Also call right away for signs of a severe allergic reaction, such as swelling of the face, lips, or throat or trouble breathing.

Minoxidil and Spironolactone (hair)

A compounded oral medication for female hair loss that combines low-dose minoxidil and spironolactone in a capsule. It is custom prepared by a compounding pharmacy and is not FDA approved.

Boxed warning

Oral minoxidil carries an FDA boxed warning: it can cause fluid building up around the heart (pericardial effusion) that can rarely become severe enough to press on the heart (tamponade), and it can cause new or worsening chest pain (angina). Spironolactone also carries an FDA boxed warning: it was tumorigenic in animal (rat) studies, so unnecessary use should be avoided and it should be used only when clearly needed under a provider's direction.

Do not use if: you are pregnant, trying to become pregnant, or breastfeeding (spironolactone can affect the development of a male fetus), you have high potassium, you have a serious kidney problem (including very low urine output) or Addison's disease, or you take potassium supplements, salt substitutes that contain potassium, or other medicines that raise potassium (such as certain blood pressure medicines); this product is for women only.
Important risks: dizziness or lightheadedness from lower blood pressure, fluid retention and swelling, and a faster heartbeat from minoxidil; high potassium in the blood from spironolactone, which can affect heart rhythm and may need blood tests.
Common side effects: increased unwanted hair on the face or body, mild puffiness, breast tenderness, menstrual changes, and headache.

By form

CapsuleTake as directed by your provider. Tell your provider about all other medicines and supplements you take, since some can raise potassium or lower blood pressure when combined with this capsule.

Call your provider if

you have chest pain, shortness of breath, a fast or pounding heartbeat, rapid weight gain or swelling, fainting, or signs of high potassium such as muscle weakness, numbness, or an irregular heartbeat.

Thyroid (T3/T4)

A compounded combination thyroid hormone (liothyronine, the T3 hormone, plus levothyroxine, the T4 hormone), available as a capsule. Compounded medications are prepared by a licensed pharmacy and are not FDA approved.

Boxed warning

Thyroid hormones must never be used, alone or with other medicines, for weight loss or to treat obesity. In people with normal thyroid function, the doses needed to affect weight can cause serious or life-threatening harm, and the danger is greater when taken with appetite suppressants.

Do not use if: you have an overactive thyroid that is not being treated, you have adrenal gland problems that have not been corrected, or you are recovering from a recent heart attack.
Important risks: The most serious risks come from getting more thyroid hormone than your body needs, which can strain the heart and, over time, weaken the bones, so your provider monitors your levels. This medicine can also affect heart disease, diabetes, and blood thinners, so tell your provider about these.
Common side effects: signs your dose may be too high include: fast or irregular heartbeat, chest discomfort, tremor, sweating, trouble sleeping, nervousness, increased appetite or weight change, and feeling overheated.

Call your provider if

you have chest pain, a fast or irregular heartbeat, or shortness of breath; seek emergency care for severe or sudden symptoms.

PT-141 (Bremelanotide)

A compounded form of bremelanotide (PT-141), a medication used for low sexual desire in women and men, given as an injection. This compounded version is prepared by a pharmacy and is not FDA approved.

Do not use if: you have uncontrolled high blood pressure, or any known heart or blood vessel disease.
Important risks: it can transiently raise blood pressure and lower heart rate after each dose; with repeated use it may darken the skin, gums, or face, which may not fully fade; nausea is common and may need anti-nausea support.
Common side effects: flushing and headache.

By form

Injectiondo not share needles, syringes, or vials; expect possible redness, swelling, or irritation where you inject.

Call your provider if

you have a severe headache, or nausea or vomiting that will not stop.