The word “balance” has special meaning for compounding pharmacist Zoe Stefandis, founder and owner of Chapel Hill Compounding. “Ill health is fundamentally a matter of imbalance,” she observes. “Physical ailments can create imbalances—large and small—in all parts of our lives. And as a pharmacist, my focus is naturally on the process of restoring balance through the use of medications.

“It’s a complex process,” she acknowledges, “which is why the idea of balance is so important. As a pharmacist, I learned years ago that medications don’t make us healthier. Perhaps, yes, if you have strep throat, an antibiotic will cure the problem; or, for a broken bone, pain medications or anti-inflammatories will support the healing process. But a balanced approach to healing encompasses more than that.

“Medications are tools for restoring health. But it’s complicated: some medications address the source of disease; others address symptoms of the disease. And medications themselves can be a source of imbalance. The challenge is to use medications to support the body’s natural healing processes without causing additional imbalances.”

Pharmaceutical Challenges to Healing

“Perhaps the best example of health problems—imbalances—caused by medication,” says Ms. Stefanadis, “is what’s known as ‘polypharmacy.’ And this is a serious problem.

“Polypharmacy simply means multiple medications,” she explains. “But it occurs in a variety of ways. It may result from a gradual piling up of prescription medications, which often occurs when dealing with complex and chronic conditions. A medication is prescribed to treat the source of one ailment, another is prescribed to treat the symptoms—such as pain or depression. Another prescription may be needed to address the side effects of one of the medications—side effects that might be caused by problematic ingredients (allergic reaction) or might be because the medicine is delivered systemically, affecting the whole body instead of the local issue.

“It’s important to remember,” notes Ms. Stefanadis, “that medicines aren’t neutral; they are intended to affect our health imbalances, and often have unintended impact as well—so finding ‘balance’ can be difficult.”

Multiple prescriptions, she adds, “are not the only problem. A major issue is the complexity of our health care system, which tends to be specialized, so we typically see multiple doctors, each treating the patient separately. In fact, I don’t know of a single person who actually has a health history with just one physician. And when you add to that mix the fact that people frequently self-treat with over-the-counter medications, polypharmacy can become a very serious health issue.”

Compounding: A Powerful Tool
for Balanced Health Care

In such a complex system, the compounding pharmacist plays a special and powerful role. “The essence of a compounding pharmacist’s job,” explains Ms. Stefanadis, “is to solve problems and that’s a challenge I love. In my work, restoring balance is about simplifying health care, reducing negative side effects, and—frankly—making life easier for the patient.

“It begins with understanding that one size does not fit all. So everything we do is to find the right solution for the individual patient,” she explains. “It could be an issue of dosage, where we compound a specific dose not commercially available. It could be a problem of compliance—perhaps the patient has trouble swallowing or the medication is prescribed for four times a day. We can create medications to be delivered differently or less often.

“Many patients have allergies or sensitivities to the ingredients in medications. The alpha-gal allergy is a good example—where the patient is allergic to mammalian meat products. In those cases, we can offer vegetable capsules and eliminate fillers containing magnesium stearate.

“Compounding offers many other ways to simplify the medication process—and to restore balance without creating more imbalances,” she notes. “For example, we will often compound medications to treat problems locally, rather than delivering the medication systemically. So instead of a pain medication being taken orally and absorbed through the GI tract, it can be applied transdermally to the local source of pain. Not only is the medication more effective, but there is no negative impact on the digestive system.”

It Starts with Communication

“Restoring health in a balanced way,” observes Ms. Stefanadis, “really means a healing process that is individualized; ‘balance’ is something different for each of us. And finding the right path to that balanced place starts with communication and understanding.

“That is what has always drawn me to compounding,” she says. “When I worked in a traditional pharmacy, I was just basically counting out medication pills for the prescription been ordered. But, in this work, you get to know people. I think that’s the key for compounding pharmacists—we truly establish a relationship with our patients and with their providers as well. That ‘triangle’—patient, physician, pharmacist—is so important. It can really simplify life and maximize outcomes for the patient. It’s all about communication.

Restoring Hormonal Balance

“I would argue that any conversation about ‘balance’ should include hormone balance—which is a high priority at Chapel Hill Compounding,” says Ms. Stefanadis. “Hormones help control every organ system and bodily function—including growth, metabolism, reproduction, even mood. And hormone imbalances—at any age—can seriously impair our health. This is of special concern for the elderly,” she adds, “because as we age, we produce fewer hormones and the number of hormone receptors on cell surfaces decreases.”

The ideal way to address hormone imbalances, says Ms. Stefanadis, is bioidentical hormone replacement therapy—BHRT. “The only way to supplement what the body has stopped producing, or is producing in lesser quantity, is to put back exactly the same natural hormones, including estrogen, progesterone, DHEA and testosterone.

“It’s a simple solution to the many health problems people experience as a result of hormone imbalances,” she says. “But it’s not a simple process. The key to effective BHRT is to determine the precise levels of various hormones required. And sometimes it’s a matter of balance rather than absolute levels. With estrogen dominance, for example, there may be too little estrogen produced relative to progesterone and that can not only produce unpleasant symptoms but can also inhibit conversion of thyroid hormones to their active form, causing fatigue, hair loss, and other issues that might be associated with ‘aging.’ But aging itself is not the issue!”

The restoration process typically starts when an individual comes to Chapel Hill Compounding complaining of mood, sleep, or energy problems—or simply not “feeling well.” “The first step is testing to measure hormone activity at the cellular level,” says Ms. Stefanadis.

“And, testing is not only to establish a baseline, but needs to be repeated as we determine the right levels needed. We call our process ‘low and slow,’” she explains. “Because we want to make sure that we achieve not only the right levels, but the right balance of hormones for each individual.

“BHRT is not an overnight fix, and I usually find 12 weeks is a target time to begin seeing positive results. That initial process can lead to on-going collaboration, sometimes spanning years.”