Important Safety Information.

Compounded medications

Compounded medications are not FDA-approved. The FDA does not evaluate compounded medications for safety, effectiveness, or quality. They are prepared for an individual patient by one of our 3 licensed 503A compounding pharmacies (named with their contact details at the bottom of every page), and a compounded medication is not the same as a brand-name one. Medication is prescribed only if a licensed clinician determines it is appropriate.

Compounded semaglutide and compounded tirzepatide

Compounded semaglutide and compounded tirzepatide are GLP-1 medications that may be used to support weight management goals, and they aren't for everyone. Do not take them if you have a personal or family history of medullary thyroid cancer or MEN 2, or if you are pregnant, breastfeeding, or planning to become pregnant. Nausea is common early. The same applies to the oral troche and drop forms.

Serious risks include:

• Possible thyroid C-cell tumors. Tell your clinician about a lump or swelling in your neck, trouble swallowing, or hoarseness.
• Pancreatitis. Severe stomach pain that won't go away, with or without vomiting, needs care right away.
• Gallbladder problems, including gallstones.
• Low blood sugar, especially with other diabetes medicines such as insulin or a sulfonylurea.
• Kidney problems from dehydration if you have vomiting or diarrhea. Drink fluids and tell your clinician.

Metformin can cause stomach upset and, rarely, lactic acidosis; tell your clinician about kidney or liver problems and heavy drinking. Ondansetron can affect heart rhythm in some people. Your clinician will also go through eating disorder history and the rest with you. Tell your clinician about everything you take, including Suboxone, methadone, naltrexone, Vivitrol or anything else, and don't stop or change any medication on your own.

Testosterone and related medications

Testosterone in every form (injection, cream, troche and the oral capsule) is a Schedule III controlled substance. It is available only after a video visit with a licensed provider, and your first labs are drawn in person. It is not for men with prostate or breast cancer, and it is not for women who are or may become pregnant. Testosterone can raise red blood cell counts and blood pressure, worsen sleep apnea, lower sperm count, and cause acne, mood changes and fluid retention. A testosterone cream can transfer to a partner or child through skin contact; wash your hands and cover the area.

Clomiphene and enclomiphene are not controlled substances. They can cause visual changes, headaches, mood changes and hot flashes; stop and contact your clinician if your vision changes. Anastrozole can cause joint pain, hot flashes and bone loss over time. HCG (Pregnyl) and gonadorelin are injections your clinician monitors with labs. HCG is a controlled substance under some state laws. Tell your clinician about everything you take, including recovery medications.

Finasteride, dutasteride and minoxidil

Finasteride and dutasteride may help slow hair loss in men with male pattern hair loss, and they can cause sexual side effects and mood changes, including depression and, rarely, thoughts of self-harm. Tell your clinician about any history of depression or anxiety. If your mood changes after starting, stop and contact your clinician. In crisis, call or text 988. Women who are or may become pregnant should not handle crushed or broken tablets or opened capsules.

Topical minoxidil is applied to the scalp and can cause itching, dryness or irritation, and unwanted hair growth where it touches the skin. Oral minoxidil can lower blood pressure, cause a fast heartbeat, fluid retention and hair growth elsewhere. Stop and contact your clinician if you have chest pain, a fast heartbeat, dizziness or fainting, or sudden swelling of your hands or feet. Spironolactone, used for thinning hair in women, can raise potassium and lower blood pressure, and is not for use during pregnancy. None of these are for use while breastfeeding without your clinician's say-so.

Sildenafil, tadalafil, vardenafil, PT-141 and oxytocin

• Never take sildenafil, tadalafil or vardenafil, in a tablet or a troche, with nitrates or poppers. Together they can drop your blood pressure to a dangerous level.
• They can lower blood pressure, especially with alcohol or some blood pressure and prostate medicines. Tell your clinician everything you take.
• An erection lasting more than 4 hours needs emergency care. Call 911.
• Sudden vision loss in one or both eyes, or sudden hearing loss: stop and get care right away.
• Chest pain, dizziness or nausea during sex: stop and call 911.
• PT-141 is a compounded peptide that can cause nausea, flushing and a temporary rise in blood pressure; it is not for people with uncontrolled high blood pressure or heart disease.
• Compounded oxytocin can cause headache, nausea and changes in blood pressure. Neither PT-141 nor oxytocin is FDA-approved in these forms.

Peptides, NAD+, glutathione and B12

Every product on the peptides page is compounded for an individual prescription and is not FDA-approved. Injections can cause redness, pain or swelling where they go in, and NAD+ injections commonly cause flushing, nausea or cramping during and after the dose. Sermorelin can cause headache, flushing, joint pain, fluid retention and changes in blood sugar, and are not for anyone with an active cancer. Glutathione and B12 injections can cause allergic reactions in rare cases. Nothing here treats addiction, withdrawal or cravings. Tell your clinician about everything you take.

Birth control, infection treatments and thyroid

Combined birth control pills raise the risk of blood clots, especially in women who smoke and are over 35, or who have migraines with aura or a history of clots; tell your clinician. Emergency contraception works best the sooner it is taken and is not for routine use. Nitrofurantoin, metronidazole and fluconazole are short courses for a specific infection: don't drink alcohol with metronidazole, and tell your clinician about any liver problems. Thyroid medication (levothyroxine and liothyronine) treats a thyroid that tests low. Too much causes a racing heart, anxiety, sleeplessness and bone loss, so your clinician checks your levels. It is not a weight medication.

Hormone therapy

Estrogen with or without a progestin carries a risk of blood clots, stroke, and, with longer use, breast cancer; estrogen alone raises the risk of uterine cancer in women who still have a uterus, which is why progesterone or a progestin is added. It is not for anyone with a history of breast cancer, blood clots, stroke, or unexplained vaginal bleeding. Tell your clinician if you smoke. Vaginal estradiol is low-dose and local, with far less of this risk. Compounded hormone creams, troches and drops, sometimes called bioidentical, are not FDA-approved, and a formula that contains testosterone is a Schedule III controlled substance that requires a video visit with a licensed provider.

What we never prescribe

No opioids, no benzodiazepines, no stimulants. No research chemicals or drugs still in clinical trials. No weight medications that contain naltrexone, because they can cause withdrawal in anyone taking opioid medication. Testosterone is the one controlled substance we offer, and only after a video visit with a licensed provider.