Peter Koshland, Pharm.D

Peter Koshland, Pharm.D

Peter Koshland, Pharm.D, is a graduate of the UCSF School of Pharmacy, where he is currently an Adjunct Professor of Clinical Pharmacy and a member of the Alumni Association’s Board of Directors.  He is committed to the health and well-being of his patients through close collaboration with practitioners in the application of evidence-based medicine.  In 2009, Peter opened Koshland Pharm: Custom Compounding Pharmacy, which became the first compounding pharmacy in San Francisco to be accredited by the Pharmacy Compounding Accreditation Board (PCAB).  Koshland Pharm makes customized medications and specializes in bioidentical hormone replacement therapy, veterinary medications, and pain management.

The intention of this blog is to 1) to support discussions about holistic, integrative, evidence-based approaches to health and healing, 2) to raise awareness about compounded (or customized) medications as a treatment option when a standard treatment is not working, and 3) to provide useful, evidence-based information about bioidentical hormones from a pharmacist’s perspective.

Because each individual’s treatment plan for any condition needs to be worked out with her doctor and pharmacist, Peter cannot give specific treatment recommendations through this blog.  If you are looking for a practitioner to work with in your area, you might ask a local compounding pharmacy for a referral.  To find a compounding pharmacy in your area that has been accredited by the the Pharmacy Compounding Accreditation Board (PCAB), go to PCAB’s website.  If you live in California, you can check out Koshland Pharm’s practitioner referral page.

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44 Responses to “About the Author”


  1. 1 Jeanne Kisner February 16, 2009 at 9:57 am

    Hi Peter,
    Was so saddened to hear about the closing of Elepahant Pharm. I once had a conversation with you about Bioidentical Hormones for perimenopausal symptoms. I am just beginning to explore my options in dealing with this life change and I felt that I had lost a great resource when the pharmacy closed. I have seen Dr. Sondra Altman about my issues and her solution was to put me on birth control pills. I don’t feel comfortable with this at all and have decided not to go this route. So I guess I am still searching for a Doc that will help me. Have you moved on to another Pharmacy? If so, which one? I hope you are doing well and have found a place to continue your work. Thanks, Jeanne

    • 2 thecompounder February 17, 2009 at 12:17 pm

      Thanks Jeanne,
      I’m hoping to provide much of the information in this blog that I do in my talks. The great thing about a blog is that it invites comments so I can hopefully address areas that may be of particular interest to a reader. Currently, I haven relocated to another pharmacy (a situation I hope to rectify soon), and I will let you know where I end up. Thanks for posting a comment and for your kind words.

  2. 3 Andrea March 2, 2009 at 11:28 am

    Thank you so much for commenting on my blog! I am going to post about yours right now, and I will get a link to it by the end of this week (it’s on my to do list, today is crazy, we got 5 inches of snow in Charlotte!) With best wishes, Holy Hormones!

  3. 4 Andrea March 3, 2009 at 9:08 am

    Who is that darling baby in the photograph? Such a beauty!

  4. 5 The Sister March 10, 2009 at 11:40 am

    I am the lucky girl who got to spend her life watching The Compounder (aka Peter, my brother) tinkering with his chemistry set, erector sets and other incredibly smart toys compared to my dolls and board games. I always knew Peter would be going big places in the intelligent world! He has always taken such care and has worked so hard his whole life to get to this place now. I am incredibly proud of THE COMPOUNDER. His success is assured due to his carefulness and care. I am glad i am your sister peter. You go dude!

    xoxo,
    Emelie

  5. 6 Andrea March 13, 2009 at 2:45 pm

    Peter, I have a question, how will the Pfizer/Wyeth merger possibly affect BHRT? If I am not mistaken, Wyeth is the company that has absolutely gone after the compounding pharmacies for dispensing bioidentical hormones, and on the other hand, doesn’t Pfizer make one of the ingredients that is then shipped to compounding pharmacies to be made into the creams, etc. dispensed to patients? Thanks in advance for any insight you can provide, have a wonderful weekend!

    • 7 thecompounder March 14, 2009 at 1:49 pm

      It’s no secret that Wyeth (the maker of Prempro) was no friend to the compounding pharmacist. They used their financial and politicial clout to influence the FDA to go after compounding pharmacies that were dispensing bioidentical hormones. I guess they felt a little threatened by the mountain of scientific evidence supporting bioidentical hormones over their synthetic and horse derived products. Thanks to massive grass roots efforts by women across the country, who called and wrote their congresspeople, we were able to hold Wyeth at bay for the most part.

      Now that Wyeth is going to be merged into Pfizer, it is difficult to say how the Pfizer/Wyeth merger will affect Wyeth’s efforts. Will Pfizer pursue the aggressive efforts that Wyeth initiated? My guess is no. Not so much because that Pfizer is such a kind hearted company, but more because of the political change in Washington. I expect to see positive shift towards patient’s needs and away from drug company’s needs with the current and upcoming appointments from the Obama administration.

      With that said, I haven’t totally put my guard down. In 2001, before the results of the Women’s Health Initiative, sales of Prempro topped $2 billion, so there is still a huge financial incentive to intimidate compounding pharmacies and distort the evidence about bioidentical hormones. We still need to be ready to go back to our congresspeople if the FDA or anyone threatens to take our hormones away.

  6. 8 Rob March 15, 2009 at 4:39 pm

    Just a quick question about the BHRT critics. You mentioned that they say there is no evidence to support BHRT. From what I’ve read, they acknowledge the benefits of mass produced prescription products, but not the compounded hormones. Does that sound like a fair representation, or are they actually nay saying the BHRT in general?

    • 9 thecompounder March 15, 2009 at 5:43 pm

      Thanks for the question, Rob.

      I guess it depends on who you talk to. Some are opposed to the entire notion of bioidentical hormones and prefer the equine and synthetic hormones. Others want only the mass producted products since they are manufactured with the FDAs oversight. I just discovered another blog that wrote a lengthy post criticizing both compound pharmacies and the notion of bioidentical hormones. You can check it out at http://sciencebasedpharmacy.wordpress.com/2009/03/13/bioidentical-hormone-replacement.

      In future posts, I hope to answer many of the criticisms to BHRT that this blogger and others have. It is a topic that deserves a serious, science based debate.

  7. 10 Virginia Hopkins March 19, 2009 at 2:19 pm

    Hi Peter,

    Love your blog. Thought you might be interested in this article I wrote in my newsletter — Letter to Oprah about Bioidentical Hormones: http://www.virginiahopkinstestkits.com/bioidenticalhormonebreastcancer.html

    I also have articles about the FDA/Wyeth/Estriol/Bioidenticals battle: http://www.virginiahopkinstestkits.com/estriolcongress.html

  8. 11 Lynn Fitzgerald May 28, 2009 at 10:58 am

    I am new to this and blogging. Is there a specific place where I can get a specific question answered?
    Thanks.

    • 12 thecompounder May 29, 2009 at 6:47 am

      Go ahead and post your question in the comments section and I’ll do my best to answer it. Thanks.

      • 13 Dawn May 4, 2012 at 7:49 am

        Hi Peter,
        Glad to have found your website!
        I am using bioidentical harmones for last 3 years. Started mainly due to daily headaches. I started at low dose, but currently I am taking 600mg of progesterone cream and 2 mg of biest. I know it is a high dose. I divide it up during the day. I have kept a diary of my symptoms and anything less than 550mg of progesterone, I get headaches, daily headaches. I added biest recently to help balance out the high progesterone and to prevent breakthrough bleeding resulting from a high progesterone dosing. With this combination, I feel alert and can function well. Would you recommend it is safe to continue. I am 43, my mom had menopause early. I am not able to get help from my regular doctors. Appreciate your help.
        Dawn.

  9. 14 Lynn Fitzgerald May 29, 2009 at 2:18 pm

    Hi–
    I tried to research the site before asking this question–because I doubt that I am the first to ask….but, I couldn’t find my answer.

    I just put on 6 pounds (around my belly) from an adjustment in my bio-identical hormones. My doctor doubled my estrogen and left my progesterone as it was. She indicated that my blood values BOTH were too low for her liking….but, I am wondering what “normal” looks like in a 58 year old woman, who had a hysterectomy over 15 years ago.
    I have fibromyalgia–can’t afford to have this extra weight–I’ll NEVER be able to exercise it off!!

    A second question—I am using 200mg of progesterone cream. The pharmacist that I have switched to since moving–said that that is a VERY high dose and must not be getting absorbed. If I went to compounded tablets–wouldn’t the it be even MORE difficult–since it has to by-pass the liver, first? I don’t have any problems on the 200mg (unless that is causing my new belly fat)–in other words, I don’t feel sleepy nor do I feel particularly CALM!

    Thanks,
    Lynn

    • 15 thecompounder June 2, 2009 at 6:05 am

      Yes, 200mg of topical progesterone is a very high dose. This is more typical of an oral dose for progesterone. The progesterone is definitely going into your body. The question is, is it reaching the target cells where it can have its effect. Progesterone (and other hormones) can get trapped in adipose (or fat) cells, so it is important to apply it to a lean part of your body. This is why the inside of the wrist is generally recommended application point. Also, I would recommend getting a saliva test if you haven’t done so already. As I mentioned in my last blog posting, blood testing does not accurately reflect hormone levels after supplementation. If your saliva levels come back high, I would recommend taking a hiatus from the progesterone cream for a short time to allow your levels to come down. I’m not sure what dose of estrogen you are on, but it would be worthwhile to look estradiol as well with the goal of finding the right dose of both estradiol and progesterone for hormonal balance.

      Good luck!

  10. 16 Lynn Fitzgerald June 2, 2009 at 6:15 am

    Thanks. Unfortunately, the OBGYN that I see does not believe in saliva testing. I have scheduled an appt with a new doc–and hopefully, he will adjust things. I LIKE the progesterone at the dose that I have…..it is the estradiol that I’m having a problem with (I think). It is only .05 patch—but, it has added about 3 inches to my mid-section….can THAT happen? It seemed to come on very quickly when I started using it–and I also gained five pounds in a relatively short amount of time.

    • 17 thecompounder June 7, 2009 at 7:09 am

      I think it’s funny that someone doesn’t “believe” in saliva testing. It makes it sound like Santa Claus or something. All you doctor has to do is look at the scientific literature, although many doctors simply don’t do that. I’m glad you are finding a new doctor who, hopefully, has a more open mind.

      Rapid weight gain is a common symptom of peri-menopause. The estrogen may be the culprit, so may the progesterone, or it may be a combination of both. Have your doctor look at the big picture with the goal of balancing the hormones and I believe your will see the best results. Good luck!

      • 18 Lynn Fitzgerald June 7, 2009 at 7:27 am

        Thanks. Problem is that I’m not IN perimenopause…I had a total/complete hysterectomy 15 years ago!

      • 19 thecompounder June 7, 2009 at 8:17 am

        Right. I apologize for implying that you were in perimenopause. I guess what I meant to say was that when the hormone output of the ovaries is disrupted either through a hysterectomy, or through menopause, sudden weight gain is possible, and that hormone balancing can help with that.

  11. 20 Laurie A. June 10, 2009 at 2:29 pm

    Hi Peter!
    I finally got a chance to sit down and read your blog. Very informative and cuts thru the “bull” quickly. You will soon need an ‘updated’ profile pic!

  12. 21 AnneB June 25, 2009 at 9:56 am

    Hello,

    Thank you for such a wonderful and informative blog.

    Do you have any suggestions for finding a provider of BHRT? I had one, but moved 900 miles away, and it is impossible to maintain therapy. I’ve called dozens of OB/GYN’s and even a componding pharmacy, but have had no success.

    Thank you!

  13. 22 smartpublications October 29, 2009 at 2:39 pm

    Hi Peter!

    What a great informative and truthful blog about bioidentical hormones. We are currently working on a book titled, “Stay Young & Sexy” discussing bioidentical hormones and anti-aging. Do you mind if we add your blog to our blog roll? Ours is http://stayyoungandsexy.wordpress.com. It’s very new but feel free to comment, post or add us to your blogroll. Have a great day!

    -Annette

  14. 24 Ljubica September 23, 2010 at 2:03 pm

    Hello Peter,
    I’m pretty sure this will sound as an odd question but I must give it a try.
    Namely, since it is absolutely impossible to obtain any kind of commercial porcine desiccated thyroid here in Serbia I decided to get some fresh porcine thyroids from local slaughterhouses and prepare my homemade desiccated thyroid. May I have your assistance in doing this? Or, should I consider the recipe as a trade secret? However I’ll appreciate your comment.
    All the best in your compounding business from
    Ljubica
    P.S. I’m a molecular biologist by background education with a considerable knowledge in medicine and biochemistry.

  15. 26 grace October 3, 2010 at 7:24 pm

    Dr. Koshland,

    Your work is amazing. Thank you for sharing your insights and clinical experience!

    (ur on my blogroll)

    -Dr.BG

  16. 27 emma bUSTAMANTE March 7, 2011 at 8:36 pm

    love this site. so much great knowledge here don’t even know how i found it. I just had my saliva test and will start my bioidentcal hormone therapy soon.

  17. 28 David Asarnow June 8, 2011 at 5:58 pm

    Are you related to Marian and Dan?

  18. 30 Iguana Girl June 10, 2012 at 6:56 am

    Do you know how I can find a compounding pharmacist to review a recipe I have put together for a facial treatment/product? I want to make my own so as to avoid the parabens and other additives. I just want to sent the recipe and see if there is anything that will interact in a strange way, or if there is an ingredient that needs to be stabilized somehow.

  19. 32 Dagmar Climo, IACP August 29, 2012 at 10:37 am

    Great article, Peter. We are sharing it with your fellow International Academy of Compounding (IACP) Members. Thanks for helping to set the record straight on pharmacy compounding.

  20. 33 Mrs. G November 19, 2012 at 11:43 am

    I have been on Tri-est for 18 months and progesterone for 24 months. I’ve had my tri-est increased 4 times in 18 months and my dr told me that I am at the maximum amount of 1.25mg cream. I should note that Im also taking
    c-progesterone in a capsule (powder) at 300mg, both taken at night. My pharmacist said she can’t increase tri-est above 1.25 and I need to consider having my thyroid tested. My thyroid is within normal limits on medicine. I am on levothyroxin 50mcg. I am still having hot flashes, which occur about 4 times a night, sometimes lasting 20 minutes each time. Now I feel like my dr is going to have to put me on traditional HRT, which I do not want to do. However, I must have help with this sleep deprivation and hot flashes. I thought this more natural approach was an answer for those that don’t want traditionl HRT. WHat can I do about this? Is it really true that 1.25 is the limit for tri-est? I don’t know what to do!

  21. 34 Mindy Elease February 19, 2013 at 7:14 am

    I just started a petition in NC regarding BCBS no longer covering compounded medications…I thought this may be of interest to you with your work or maybe you could pass it along to others who it may affect:

    http://signon.org/sign/blue-cross-blue-shield?source=c.fwd.in&r_by=6853786

  22. 35 Krista Sweet June 29, 2013 at 6:06 pm

    Dear Dr. Koshland,

    Please let me begin by saying that I am a client of yours with Koshland.

    My current doctor has prescribed several hormones and well as thyroid

    replacement via your pharmacy.

    Several years ago, I was a highly functioning teacher.
    Today, I am bedridden, hoping against hope that there is a way out of the hell I am in today.

    I am hoping you can help me.

    I have been ill since 2010, after living through an elongated period of stress and an ultimate diagnoses of PTDS.

    Since then, I have been diagnosed with Hashimotos, Adrenal exhaustion, Fibromyalgia, RA, and have been through myriad tests, showing that I am allergic to most everything.
    My most recent TSH was 20. And, this was after long term thyroid treatment with compounded thyroid meds.
    My digestion is not working properly-tests have shown that I am not absorbing nutrients, or porting, and that my insulin levels remain high.
    I have tested positive as well for reactivated Epstein Barr, MGUS, and the MTHFR gene.
    Also, all, and I mean all, of my hormones are depleted.
    According to my Dr, my levels were” that of an 80 year old woman.”
    Since beginning BHRT, they have changed very little.
    I have gained a great deal of weight, and I no longer recognize myself or look in the mirror.
    My hair has turned grey, and is brittle.
    My face is bloated, now has acne and facial hair from the hormones.
    The arm on my skin is covered with Keratosis Pliaris, something I never had before all of this began.
    My feet have changed shape, and are always in pain.
    My iron levels dropped so low that they ordered IV iron. I had an allergic reaction to that, as well as B12 injections.
    I can not remember details from yesterday, and sometimes even those from the same day.
    Although I am very well educated and have a Master’s degree, I often feel like someone who has just landed in a new country, searching for words or sentences, so that I can communicate to my husband, the one person who has been willing to stand by me during this nightmare.
    Friends and family have all faded away, thinking that I am inconsiderate, selfish, lazy, etc… They have said that “I could get better if I just” …..fill in the blank.
    I am 44.
    Today, my life consists of debilitating fatigue and all over body pain, depression, pain, and hopelessness.

    My husband and I have begged many people for help.
    We are hoping you can give us some help or direction.
    We would be extremely grateful.

    Thank you,
    K. S

    • 36 thecompounder July 2, 2013 at 12:37 pm

      Hi Krista,

      I am unable to discuss your specific situation on this blog, but since you are a patient at my pharmacy, I’d be happy to discuss it over the phone. Please give me a call at the pharmacy when you get a chance.

      Peter

  23. 37 Dominique Lardi May 19, 2016 at 5:21 pm

    Hi Peter
    I am 55 & was menopaused @ 33. I was on BIHT troches 0.5 mg triest / 200g progesterone / 20 mg DHEA / 1.5mg testosterone (since 2013 only). 8 months testoterone was raised to 1.75mg to adress my nonexistent libido but I became argumentative & agressive & very ‘mental’. I didn’t like it @ all. Stopped everything 3 months ago. I had 3 months break. I was fine @ first, but start having viginal burning & disconfort & urgencies (I never had children). I was told that I might have viginal atrophy due to lack of estrogen (used to be estrogen dominant before menopause) & so restarted the BIHT : triest 0.5 my & progesterone 1.75mg. I also used 0.025 estriol pessaries temporarily. My viginal disconfort has improved greatly but my libido hasn’t & I am extremely tired & very foggy brain/forgetful. ..
    I am thinking to go 200mg progesterone & 1mg biest in troche. What do you think ? is troche just as good as cream ? And if I would decide to start with cream instead (natural progesterone & biest) what are correct doses. P.s. my bone density is low osteopenia. My doctor isn’t sure. Also, my compound pharmacy doesn’t make estriol patch, but a ‘normal’ pharmacy sells it in patches or cream. Is it safe to use ? I was told it’s the same. .. i am in sydney & would love some advises. Thank you for your blog. Dominique

    • 38 thecompounder May 20, 2016 at 12:41 pm

      Hi,
      Thanks for writing into the blog. While Peter can’t respond to patient-specific questions in this online format, I’ve noted a general topic you’ve raised here that he could write about in a future post, which is to discuss the estriol patch (which is not compounded but commercially available) and considerations for troches/cream as a dosage form.
      The specific questions you’ve raised (such as dosage strengths and how to address specific symptoms you have) are important ones to ask both your doctor and the compounding pharmacy you work with. Thanks again for writing. All my best, Krista Shaffer, Outreach Director at Koshland Pharm

  24. 39 Kim Hatton June 4, 2016 at 10:16 am

    How do you convert Injection to Troche?
    I was taking 3.75mg Estrogen & .75mg Testosterone in Injection form. How does that translate/convey to Troche form?

    Thanks,
    K Hatton

    • 40 thecompounder June 14, 2016 at 4:12 pm

      Thanks for your question. I am planning to sit down with Peter soon to transcribe a blog post answering “common questions about hormone therapy,” and this question of conversion between different dosage forms comes up often. I will be sure to include that topic in the next post. In the meantime, have you asked this question of the compounding pharmacy you work with? They should be able to help you with the specifics of your prescription’s conversion from injection to troche form. If you need a good resource for a compounding pharmacy in your area, the Pharmacy Compounding Accreditation Board has a website where you can search for pharmacies by state that have passed their rigorous standards. Here’s the link: http://www.pcab.org/accredited-locations.html All my best, Krista Shaffer, Outreach Director at Koshland Pharm

  25. 41 Kim Hatton June 14, 2016 at 5:13 pm

    Yes, I’ve asked my compounding pharmacist, two of them actually, and one said he didn’t know how to do “that” and the other said it couldn’t be done because one is injection and the other sublingual.
    I knew that surely there must be a way to convert the two.

    Thanks for responding.

    I look forward to your post,
    Kim Hatton

  26. 42 Dustin Abrahamson January 6, 2017 at 9:21 am

    Hi Peter,

    Love your blog. I thought you might be interested in a new product that our company SpecializedRx has developed and is currently marketing to the compounding pharmacy market. It’s a child resistant 30 cavity troche mold:

    https://specializedrx.com/smartscripps-troche-mold.html

    If you have any interest in evaluating it, we would be happy to send you some samples.

    Dustin

  27. 43 Lorina Massey January 28, 2017 at 8:13 am

    Hi,
    I have a different kind of question. I am a psychiatric nurse practitioner and work with a family medicine group. I have noticed how many women will get referred to me mid 40s to mid 50s with complaints of anxiety, sleep disturbance and depression. These women often have no history of these conditions and have a good marriage, job they like, good relationships with family and friends and have no real financial problems. I have long felt that there is some relation to hormones. I occasionally get men in similar situations and think it happens to them probably as often but men are less likely to seek help (I think).

    My question is where can I get more education on this for my patients? Are there any CME conferences on this topic that I can attend? Good references or journals I can subscribe to? Can I offer testing? I already offer pharma-cogenomic testing and find that valuable for my patients. I would like to learn more about this for my patients.

    Thanks!

    Lorina


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