The Menopause Hormone Options No One Explained to You
Peter Koshland, PharmD
Founder, Koshland Pharm
Adjunct Clinical Professor of Pharmacy, UCSF
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When it comes to menopause hormone therapy, most women are offered a short list of standard prescriptions — and that’s it. But if you’ve ever felt like those options don’t work for you, there’s a reason: hormone therapy isn’t one-size-fits-all.
That’s where compounding pharmacies come in. These specialized labs create customized medications tailored to the exact dose, delivery method, and ingredients a patient needs. Yet most women — and many doctors — don’t even realize these options exist.
To pull back the curtain, I sat down with Dr. Peter Koshland, a UCSF-trained pharmacist and founder of Koshland Pharm, the only PCAB-accredited compounding pharmacy in San Francisco. Peter has spent two decades helping women find safe, smart ways to use hormone therapy during perimenopause and menopause.
In this episode, we talk about:
• What compounding pharmacies do and how they’re regulated
• Safety and quality control — from sterile labs to third-party potency testing
• The role of progesterone: why it’s underutilized, who should avoid oral versions, and how vaginal options can make a huge difference
• Why testosterone for women should never be cut from a men’s gel packet — and the safer alternatives that exist
• The problem with estradiol mists and why dosing and delivery matter as much as the hormone itself
• The potential of low-dose naltrexone for women with autoimmune conditions like Hashimoto’s
The big takeaway? You probably have more hormone options than you’ve been told. Whether it’s progesterone, estradiol, testosterone, or beyond — the right dose and delivery method can change everything from your sleep to your mood to your long-term bone health.
💌 If this episode gave you new insight, please share it with a friend. Too many women are navigating menopause with limited information, and together we can spread the word about the options that exist.
Chapters:
02:27 Why Peter Is "The Hormone Guy"
06:50 What is a Compounding Pharmacy?
08:55 Who is Best Served by Compounding Pharmacies?
10:23 A Compounded Drug That Helps Hypothyroidism
13:32 Why Don't All Doctors Prescribe Compounded Hormones?
16:26 Compounded Hormones: Safety and Regulation
20:55 Compounded Hormones for Menopause Hormone Therapy
33:26 Why Blood Tests Can Be Misleading
37:13 Peter's Preferred Delivery Methods for Menopause Hormones
41:55 Trends in Menopause Hormone Therapy
45:39 The Importance of Compounding in Hormone Therapy
47:04 Key Takeaways
About Peter Koshland:
Peter Koshland, PharmD, is a graduate of Georgetown University (Chemistry BS) and the University of California at San Francisco School of Pharmacy (PharmD). He has served as an Adjunct Clinical Professor of Pharmacy at UCSF since 2010.
Peter opened his compounding pharmacy, Koshland Pharm, in 2009 in San Francisco. He and his staff work with doctors and patients on individualized compounded therapies that make a difference in the quality of patients’ day-to-day lives. Koshland Pharm is the only compounding pharmacy in San Francisco accredited by the Pharmacy Compounding Accreditation Board because of its commitment to quality.
In addition to leading Koshland Pharm, Peter trains and consults with doctors across the state of California in the areas of hormone replacement, thyroid disorders, and compounding applications for dermatology, urology, pain management, and psychiatry.
Connect with Peter:
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Disclaimer:
Belong Wellness and its members, managers, employees, contractors, and other agents or representatives are not licensed medical care providers and do not provide medical services or advice, including without limitation diagnosing, examining, preventing, treating, or curing any medical conditions. The information shared in this podcast is meant to be educational, not prescriptive. Please consult your medical doctor before making any changes to your diet or lifestyle. Further, the opinions of guests on this show do not necessarily reflect the opinions of Jessica or anyone affiliated with Belong Wellness.
