First, as to the question of whether compounding pharmacies are using the same substance as the ethical pharmacy industry, it is easy to search the Internet for “difference between synthetic and natural hormones” and find hundreds of web pages that explain the difference.
Here is how https://www.bodylogicmd.com/faq/what-are-synthetic-hormones describes it:
“The difference between bioidentical hormones and synthetic hormones is dual fold. Unlike bioidentical hormones, synthetic hormones may be patented by pharmaceutical companies; therefore dosage varies only by milligrams dictated by your doctor, while the molecular structure of the prescribed hormone is the same for every single person on that drug. Additionally, synthetic hormones are not created structurally the same as human endogenous hormones, which often leads uncomfortable side effects. While synthetic hormones can mimic the effects of endogenous hormones on certain biological pathways, they rarely offer the same effectiveness at a deeper, molecular level.
Bioidentical hormones mimic the affinity of human endogenous hormones; therefore they are effective on more biological pathways, at all levels. Because bioidentical hormones are an exact structural replica of endogenous hormones side effects are rarely observed, and in the event you do experience side effects, talk with your doctor – the dosage may simply need to be adjusted. The added benefit of bioidentical hormones is that each dose is tailored specifically for your needs, not simply what doses the pharmaceutical company offers (as is the case with synthetic hormones.)”
Similarly, http://www.healthline.com/health-blogs/hold-that-pause/hormones-whats-the-difference describes it this way:
“Because natural substances which are found in nature, such as the progesterone derived from Mexican yams, cannot be patented, the pharmaceutical industry chemically altered the molecules of Marker’s progesterone to create synthetic variations which could be patented.
The patent allowed the pharmaceutical industry to own and market the product. Since then, the campaign to sell synthetic progesterone to physicians and their patients has been fierce and unrelenting.
But the difference between the molecularly altered progesterone and that which is not, is significant. Biochemically, your body recognizes the chemical structure of bioidentical hormones as identical to the hormones your ovaries produce. However, it does not recognize synthetic hormones as identically the same. This difference is why, according to many healthcare professionals, that synthetic hormones produce so many unhealthy side effects. But, that does not suggest that bioidentical hormones are above reproach. The research and studies conducted on them thus far is still relatively new, and they continue to remain a topic of much debate in the medical community. But, the early research on bioidentical hormones is very promising and could very likely usher in an entire new era of healthier hormone therapy for women; and that, ladies, is always good news.”
Legally speaking, the natural hormone cannot be exactly the same as the synthetic alternative (and Lilly’s synthetic version is different from AbVie’s synthetic version), because the pharmaceutical industry cannot patent a naturally occurring substance.
Frequently, I will ask pharmacists if natural Vitamin E (d-alpha-tocopherol) is the same as synthetic Vitamin E (dl-alpha-tocopherol). Pharmacists invariably say the synthetic version is just an isomer of the natural version, and so they are the exact same thing. Yet the body immediately recognizes the difference between the isomer and the natural substance, just as you can recognize the difference between your left and right hand. In humans, natural Vitamin E is a potent antioxidant, while synthetic Vitamin E is little more than junk. There are literally over 100 scientific papers now documenting the huge health outcomes distinction between natural vs. synthetic Vitamin E (again easy to see from a search of the Internet). Virtually every clinical trial or study that has claimed Vitamin E is harmful or ineffective has used synthetic Vitamin. E, while virtually all clinical studies and trials of natural Vitamin E have shown it to be highly effective — as it has been for thousands of years in humans.
Without further ado, here is my revised paragraph that emphasizes warranting a product for its intended use vs. actual use:
“Some enterprising consumers might reason that they could chop the troches into quarters, rather than just in half, and thereby obtain a 360-day supply from a 90-day prescription. The testosterone troches can only be assigned a maximum beyond use date of 180 days so they cannot be warranted for use after that time. However, I have tested testosterone troches after 270 days and found they still have full potency.”
The second sentence comes from Dr. Allen, and the third sentence adds a new piece of information that might lead some compounding pharmacies to revisit the expiration dates on troches. Testosterone does not degrade in troches anywhere near the degradation rate in compounded testosterone lotions and gels.