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Bill Burch, RPh
Jennifer Burch, PharmD
Sejjal Patel, PharmD
Donna Ferrell, RPh
Michael Verble, PharmD
Kayla Harris, PharmD
Ziyad Jabar, PharmD

Mynam Vuong, PharmD
Jhuvon Francis, PharmD


2609 North Duke Street, #103
Durham, NC 27704
Telephone: (919) 220-5121
Fax: (919) 220-6307


6224 Fayetteville Rd, #104
Durham, NC 27713
Telephone: (919) 484-7600

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Addressing Imbalances:
Medications & Hormones

“Finding balance,” observes pharmacist, Dr. Jennifer Burch, of Central Pharmacy and Compounding Center in Durham, “is pretty much what pharmacy is all about. Medications are all designed to address an imbalance of some kind—pain, or blood pressure, or some dysfunction. Whether the medications are effective, however, is influenced by how they’re used, in what dosages, and in combination with what other factors. Balancing those factors successfully is the fundamental challenge and reward of pharmacy. And that is especially true for a compounding pharmacist, since we are often seeking a precise solution for a single individual—whose problem, metabolism, and life circumstances are unique.”.

Dr. Burch begins the process of preparing a medical suppository using the Pharmacy’s new 3-D “Printer.” This equipment, she explains, “allows a remarkable degree of precision, which is a wonderful time saver when preparing multiple doses—each needing to be at a precise weight and volume.”

Hormone Imbalances Can Throw Life Off Track

Among the many health challen-ges she deals with, Dr. Burch considers hormone balance to be one of the most complex— and rewarding—puzzles to solve.

“We all have the same hormones—just in different ratios,” she explains. “And those ratios are critically important, because, working together, our hormones play a key role in balancing our whole system. Too much estrogen, for example, or too little testosterone can throw everything out of balance.”

People typically associate hormonal imbalances with the women’s menopausal hot flashes or pre-menstrual mood changes, notes Dr. Burch, “but imbalances can affect both genders, starting at a young age. Adoles-cents’ acne and moodiness reflect hormonal changes; men with low testosterone may experience fatigue, loss of muscle mass, and low sex drive; problems with thyroid or adrenal hormones may produce fatigue, weight issues, depression, or brain fog.”

And just as hormones affect us physically, mentally, and emotionally, notes Dr. Burch, “stress—physical, mental, and emotional—has a huge impact on our hormones, particularly when it comes to women’s reproductive hormones. We live in a high stress world, and when our body kicks into overload, we lose our hormonal balance.”

Regaining Balance from Within

“Balancing hormones is critically important for long-term health,” says Dr. Burch. “Hormones affect every cell in the body; they play a role in bone density, muscle strength, digestion, memory, mood. But, at different stages in our lives, and especially as we age, hormone levels change. The body may stop producing a hormone, or produce less of it—but that doesn’t mean the hormone is no longer important.

“That is why BHRT (Bio-Identical Hormone Replacement Therapy) is so important,” she says. “To maintain your hormonal balance, you need to replenish the hormones the body has stopped producing or is producing in lesser quantity—including estrogen, progesterone, DHEA, and testosterone. And it’s important to do so with exactly the same natural hormones; that’s why we use only bio-identical hormones.”

Dr. Burch emphasizes “that there is no one ‘right’ hormonal balance for everyone: our hormone profiles are as unique as our fingerprints.” And the process for determining that individual ‘right’ balance begins with testing. She starts this process with personalized consultations and saliva testing kits to determine the free, usable hormone levels that could drive underlying imbalances.

“For hormone replacement therapy to be effective,” she emphasizes, “we need to test and test again. And everything has to be individualized. We need to know the starting point for each specific client and it is critical to monitor the process with lab tests.

“And then there is the art of this process—which is determining the actual dosage of the hormones, and the right balance between estrogen and progesterone. When we fine tune in this manner, the results are often wonderful. Women come in feeling fantastic, and their doctors are pleased.”

Balancing Benefits with Risk

Dr. Burch acknowledges that there are those who still associate estrogen supplementation with increased cancer risk, and thus advise that women should be on hormone therapy for as short an amount of time as possible. “However,” she says, “this is also a matter of balance. The risk occurs when estrogen is too high or out of balance with progesterone levels. Our goal with BHRT is to provide ‘physiologic doses’—doses that mimic what our body would have been producing—not super human doses. This keeps hormone levels in a safe zone, where they do not increase the risk of breast cancer. And estrogen is only one factor in the complicated etiology of breast cancer, with other risk factors including diet, body composition, hormone metabolism, and sleep.”

When balancing risks and benefits, says Dr. Burch, “it’s important to remember that our increased longevity makes hormonal balance even more critical. It’s one thing to live longer; it’s often another to live well. Balancing all of our different hormones is essential in protecting our quality of life.”

Polypharmacy: Medications Out of Balance

“I can’t leave a discussion about balance, without noting a problem we see all too often in our pharmacy,” says Dr. Burch. “It’s called ‘polypharmacy.’ We see folks who have been put on a medication, which had a side effect, and then were put on another medication—to treat the side effect—and then they had another side effect . . . and before you know it, they’re on 15,18, 20 medications!” shares Dr. Burch. “It’s not only expensive, but it’s a mess because you don’t really want to have to treat a side effect with an additional medication.”

In the regular course of her individual consulting work, Dr. Burch frequently untangles such complicated webs of multiple prescriptions, often recommending fewer medications as well as other resources to help clients balance their medications. These might include not only standard pharmaceutical solutions to health issues, but nutritional approaches or custom-compounded formulations based on individual needs and issues.