As compounders, we know that hormones get a lot of attention — but the base plays a critical role in the potential success of the therapy. During PCCA’s recent webinar, “Choosing the Right HRT Base for Patient Success,” Sara Hover, RPh, FAARM, along with seasoned compounders Jim Hrncir, RPh, and Madison Peach-Keen, PharmD, shared hard-earned insights on how base selection can elevate your HRT practice.

If you missed it, here’s a breakdown of the key takeaways — with the compounding pharmacist in mind.

Don’t Underestimate the Base

We all know APIs matter — but the delivery system can greatly contribute to clinical outcomes, adherence and patient satisfaction. The base you choose isn’t just a carrier; it influences absorption, stability, patient experience and the beyond-use date (BUD) that can be assigned to the preparation.

As Sara explained: “It’s not just that a base is anhydrous or hydrous — it’s about how it delivers the medication for the patient, how it supports the pharmacist’s workflow and how it meets the prescriber’s goals for the patient.”

From the Trenches: Jim Hrncir on What Works

A longtime HRT educator and compounder, Jim highlighted a success story with a complex vulvodynia case that responded only after he compounded estradiol, testosterone and naltrexone in PCCA’s Ellage® Anhydrous Vaginal. The patient was already on vaginal BHRT with little relief — but within one week of switching bases and formulation strategy, her pain dramatically improved.

His go-to favorite bases?

• Atrevis Hydrogel®: A game-changer for male transdermal testosterone, especially for patients losing efficacy on standard creams.
• VersaBase® Cream and Lipoderm®: Reliable options with predictable results.
• Ellage Anhydrous Vaginal: For patients with sensitivities.
• MucoLox™: Mucosal delivery for patients requiring better retention.

Jim’s advice: “Don’t push your belief system. Work within the practitioner’s [existing framework]. If they trust serum testing, meet them there — but equip them with the right tools and science.”

For the Newer Pharmacies: Lessons from Madison Peach-Keen

Six months into launching her own compounding pharmacy, Madison emphasized differentiation through education and uncompromising quality. Her BHRT strategy centers on:

• Sourcing all hormones and bases from PCCA
• Regularly educating providers with concise, clinically relevant updates
• Leading with Anhydrous VersaBase® HRT for BUDs, texture and patient preference

Madison also swears by MucoLox + VersaBase® Gel as a combo for vaginal applications when enhanced mucosal contact time is needed, and favors Ellage Anhydrous Vaginal for its potential to minimize leakage.

Anhydrous vs. Hydrous: Know When to Use What

Anhydrous bases provide greater BUD limits for nonsterile compounded preparations in USP 795. Longer BUDs for both hydrous and anhydrous nonsterile preparations are also available through PCCA’s FormulaPlus™ program. The decision about what base is most appropriate for each patient relies on the triad of patient care and communication between the prescriber, the pharmacist and the patient.

Key anhydrous points:

• Anhydrous VersaBase HRT: Excellent glide, non-greasy feel and strong patient acceptance
• Ellage Anhydrous Vaginal: Designed with mucoadhesive and self-emulsifying properties — engineered for high retention and hormone release
• BUD advantage: Studies support 180-day dating for bracketed ranges. Anhydrous preparations have greater BUD limits in USP 795 and PCCA studies support 180-day dating for bracketed ranges of several formulations.

Backed by Data: What the Studies Show

Sara shared multiple in-house studies comparing hormone release and absorption using PCCA bases vs. alternatives. The verdict? Up to 4x greater absorption with PCCA’s VersaBase Cream for progesterone, and 2.7x more testosterone delivery with Atrevis compared to a competitor base.

These studies aren’t just internal wins — they’re talking points to show why you choose the bases that you use for your patients.

Bottom Line: It’s About Options and Outcomes

Your base can be the differentiator in your market. Offer patients and providers more than one texture or form, and you open doors for possibly improved adherence and outcomes.

Here’s what to keep in mind:

• Build protocols around your best-performing bases.
• Stay on top of base-specific absorption data.
• Leverage BUD testing to streamline workflow and reduce waste.
• Teach providers how and why base selection matters.
• And when in doubt, let patients try the feel of the base — texture and feel can be critical.

Want to explore more? PCCA’s HRT Virtual Symposium is coming up July 24-25 — all online, jam-packed and worth your time.