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What does it actually take to deliver personalized medicine, and why are compounding pharmacies essential to that future? In this episode, I sit down with Luis Delgado, PharmD, owner of Village Pharmacy and Compounding in Miami and one of the most thoughtful pharmacists I know. Luis shares his journey from anaphylaxis as a middle schooler to building a hybrid compounding pharmacy from the ground up, and offers a clear, accessible look at how compounding works, where the regulatory landscape stands, and why precision dosing has become so important in modern hormone therapy.
Whether you are a patient navigating testosterone or hormone replacement therapy, a provider considering working with a compounding pharmacy, or simply curious about how medicine is becoming more individualized, this conversation offers both practical guidance and grounded perspective.
​​​​​Key Takeaways
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00:10 Guest Introduction: Luis Delgado
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01:05 Introduction to Compounding Pharmacy and Personal Connections
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02:10 Luis’ Journey to Pharmacy and Entrepreneurship
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07:19 Transitioning from Employment to Entrepreneurship
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12:18 The Growth of Village Pharmacy and Its Impact
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13:52 Understanding Compounding Pharmacies and Their Importance
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19:28 The Role of Testosterone Therapy in Personalized Medicine
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25:00 Understanding Drug Absorption Variability
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27:06 The Importance of Integrity in Healthcare
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27:53 Differentiating Pharmacy Types
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29:43 The Art of Hormone Replacement Therapy
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31:28 Challenges in Compounding Pharmacy Utilization
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33:14 Regulatory Landscape of Compounding Pharmacies
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35:21 Safety and Regulation in Compounding Medications
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38:19 Addressing Misconceptions About Compounding Pharmacies
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40:11 The Future of Individualized Medicine
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45:13 Empowerment Through Knowledge and Mindset
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Guest Bio
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Luis Delgado, PharmD, is the owner of Village Pharmacy and Compounding in Miami, Florida. A graduate of the University of Florida College of Pharmacy, Luis built his hybrid compounding pharmacy from the ground up alongside his wife Lizzie, growing it from a single shopping center storefront into a 25-employee practice specializing in personalized medicine, hormone replacement therapy, and patient-specific compounding. His clinical focus is on delivering individualized care that meets patients where they are, particularly in areas where traditional pharmaceutical options fall short.
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Visit their website at villagepharmacymiami.com
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Full Transcript​​
Meet Luis Delgado, PharmD
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I am so excited for today's guest. Not only is he one of the smartest people I know, but he is also my uncle. Luis Delgado is a doctor of pharmacy and the owner of Village Pharmacy and Compounding in Miami, Florida. Today we are going to talk about compounding pharmacies, testosterone therapy, and all the things we usually nerd out about.
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For context, our family is large and unusually well-resourced when it comes to healthcare. I am one of many nieces and nephews, and Luis has been a clinical resource for me my entire life. I recognize how rare that is, and one of the reasons I wanted to bring him on is to extend that same kind of access to people who don't have a pharmacist they can call.
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From Anaphylaxis to Choosing Pharmacy
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Most people in healthcare gravitate toward medicine. Luis chose pharmacy because of a personal experience. In middle school, he fell into an ant pile during a basketball game, had a severe anaphylactic reaction, and was given epinephrine by fire rescue. The relief was almost instantaneous. That moment shaped his sense of what medications can do.
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He went on to apply to medical schools after pharmacy school, but stayed with pharmacy and has never regretted it. His passion for the work is evident in every conversation we have.
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Getting Into UF and the Work Ethic That Opened the Door
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Luis met his wife Lizzie when they were both 15. She was going to the University of Florida, and he decided he was going too. UF is highly competitive, but it also had one of the top five pharmacy schools in the country at the time, so the long-term path lined up.
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He arrived with over 50 dual-enrollment credits and finished his pharmacy prerequisites in two years. Pharmacy school allows applicants to enter before completing a bachelor's degree if prerequisites are done, so he applied early. He acknowledges openly that he is not the sharpest person in the room, but he is one of the hardest-working. His approach was simple: show up every day, study after class, and walk down to the pharmacy school regularly to introduce himself.
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Whether it was his grades or sheer persistence, it worked. He got in.
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The lesson he carries from that experience, and the one he shares with high school students today: you don't have to be the smartest, but you do have to be willing to outwork everyone else.
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Leaving the Hospital for Entrepreneurship
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After graduating, Luis worked at a federally qualified health center as Associate Director of Pharmacy, treating low-income patients with a focus on psychiatry. The job was stable, the hours were good, the salary was fair, and weekends were free. By most measures, it was a comfortable career.
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But he wanted more. His parents had built their own business, and even though they didn't want that life for him, it was the path that felt natural. So in 2014, he started Village Pharmacy.
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Building From One Car and an Odyssey
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The start was humble. Luis and Lizzie were a one-car family. He traded in his Cadillac Escalade because he couldn't afford the payment alongside the business. Lizzie became a certified pharmacy technician and worked alongside him. After work, they would camp outside the restaurant next door at the shopping center, introducing themselves to elderly diners who had medications to fill.
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A year in, his father-in-law offered him a beat-up white Honda Odyssey with over 300,000 miles. He took it gratefully. For the next year he drove that minivan around Miami, happy and humbled. They grew slowly, eventually relocated to a better space, and have grown every year since.
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Today, Village Pharmacy has roughly 25 employees and does work he never imagined possible when he started.
What Compounding Pharmacy Actually Is
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Many people in healthcare are skeptical of compounding pharmacies. Luis traces that hesitation back to how clinicians are trained. We are educated to depend on large randomized controlled trials and the protocols built from them. Operating outside those protocols feels risky. That conservatism has its place, but it leaves a real gap: human beings are far more variable than the protocols assume.
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A traditional retail pharmacy, like CVS or Walgreens, dispenses finished products that have gone through standardized manufacturing and FDA approval. There is no laboratory on site, and there is no ability to individualize. Compounding pharmacies fill that gap. They make medications tailored to specific patients in formulations, doses, and delivery methods that aren't available off the shelf.
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This becomes essential for pediatric patients who need liquid versions of medications that don't exist commercially, for patients who can't tolerate fillers in standard products, and for hormone therapy, where precise dosing matters enormously.
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How a Family Diagnosis Shifted His View
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Luis and his wife learned that both of their children carry an inherited retinal condition under the umbrella of retinitis pigmentosa. There is no FDA-approved treatment for the specific gene involved. The condition affects too small a population for pharmaceutical companies to invest in.
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For Luis, that was the moment personalized medicine stopped being a clinical preference and became a personal conviction. If standardized medicine can't help your child, you start looking at the system differently.
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Why There's No FDA-Approved Testosterone Dose for Women
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Testosterone is one of the clearest examples of where the system fails. There is no FDA-approved testosterone product for women in the United States. There is no female-specific dose, syringe, or formulation. The reason isn't clinical, it's financial. Pharmaceutical companies are unlikely to invest in the large trials required for a new indication on a generic drug whose exclusivity protections would be short and whose competitive landscape would erode the return.
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So women who would benefit from testosterone therapy are largely served in one of two ways. Either providers prescribe AndroGel, a male formulation, and ask patients to titrate it down using a syringe (which is messy, wasteful, and prone to supraphysiologic dosing), or compounding pharmacies create patient-specific doses with the precision the work actually requires.
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How Compounding Pharmacies Dose Testosterone for Women
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A compounding pharmacy can create a testosterone cream with the exact concentration a patient needs. Some patients respond well to a 5-milligram thigh application. Others, when the medication is applied intravaginally for higher absorption, need only a 1-milligram dose to achieve the same physiologic effect. That kind of fine-tuned dosing simply isn't possible with an FDA-approved gel packet.
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For patients, the device often used is the Topi-CLICK, which looks like a small deodorant bottle and delivers a precise amount with each click. The medication is rubbed in, not swiped on, which is a detail patients sometimes miss when they first start.
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The Regulatory Landscape: 503A Versus 503B
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Compounding pharmacies fall into two categories. A 503A pharmacy, like Village Pharmacy, makes medications on a patient-specific basis. Each prescription comes from a provider for an individual patient, and the pharmacy is regulated through its state board of pharmacy.
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A 503B pharmacy makes medications at a larger scale, not patient-specific, more like a wholesaler producing bulk inventory for clinics. 503Bs are regulated by the FDA and are subject to FDA inspections.
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Both are tightly governed. Both follow USP (United States Pharmacopeia) standards. Neither is the unregulated wild west some patients have been led to believe.
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How a Reputable Compounding Pharmacy Ensures Consistency
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A trustworthy compounding pharmacy follows a documented process for every formulation. Each medication has a written protocol, almost like a recipe. The pharmacy uses computer-connected scales that require the exact weight before any step can be approved. Ingredients arrive with certificates of analysis confirming purity and potency. Many pharmacies, including Village Pharmacy, send finished products out for third-party testing.
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There are also conservative expiration guidelines under USP. A water-based oral compound with preservatives, for example, gets roughly a 30-day expiration not because it would necessarily fail beyond that, but because the standards are intentionally cautious to protect patients.
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How to Evaluate a Compounding Pharmacy
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For both patients and providers, the best way to evaluate a compounding pharmacy is to visit it. See the lab. Ask about the process. What's the workflow? How is each step verified? How are ingredients sourced and tested? How are finished products checked for consistency?
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Patients can advocate for themselves by asking their provider whether a compounded option exists for their medication. If a provider is unfamiliar with the local compounding landscape, patients can name a pharmacy they have heard about and offer to facilitate the introduction. Some providers are open. Others are not. For patients whose providers are firmly opposed, the most realistic path forward is often to seek a provider who is more current on personalized medicine.
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Peptide "Research Companies" Are Not the Same as Compounding Pharmacies
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One of the more important distinctions for patients to understand is that online "research peptide" companies operate in a completely different regulatory space than licensed compounding pharmacies. A compounding pharmacy is governed by a board of pharmacy, regularly inspected, and subject to significant legal consequences for noncompliance. Online research companies are not.
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When patients tell me they have sourced peptides online, that is where the safety concern is real. The mechanism of oversight that protects compounded medications doesn't apply.
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Where Medicine Is Heading
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Luis is cautious about predicting the future, but he sees clear momentum toward individualized medicine. Even pharmaceutical companies are moving in this direction, particularly in oncology and gene therapy.
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His children may eventually qualify for a gene therapy trial in Germany that recruits only sixteen patients globally. It is a striking example of how personalized medicine is no longer theoretical. It is here, in narrow but expanding applications, and the regulatory and economic systems will eventually need to catch up.
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The Final Takeaway
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When I asked Luis what he wanted listeners to walk away with, he didn't reach for a clinical insight. He went back to his story.
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When you want something, don't limit yourself. If there is anything you can do to move toward it, do it. Walk down to the building every day. Trade in the car. Drive the Odyssey. Adapt to where you are. The biggest limitation most people face isn't external. It's the belief that they can't.
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That, more than any single piece of medical knowledge, is what he wanted to leave with the audience.
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FAQs
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Why is testosterone for women only available through compounding pharmacies?
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There is no FDA-approved testosterone formulation designed for women. The financial incentive to invest in the trials required to gain a new indication for an already-generic molecule is limited, and as a result, there is no commercially designed product. Compounding pharmacies fill this gap by producing precisely dosed, female-appropriate testosterone preparations.
How do I know if a compounding pharmacy is reputable?
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Key markers include FDA-approved active ingredients with certificates of analysis, written master formulas, computer-verified scales and batch records, conservative beyond-use dating, willingness to undergo third-party testing, transparent communication with prescribers, and openness to in-person visits. Asking about these directly is one of the most effective ways to assess quality.
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Can my doctor prescribe compounded medications?
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Yes. Any licensed prescriber can write a prescription for a compounded medication, just as they would for a commercial product. The prescription is sent to a compounding pharmacy, which prepares the medication to the specifications outlined in the order.
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Does insurance cover compounded medications?
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Coverage varies significantly by plan and medication. Many compounded preparations, especially in hormone therapy, are paid for out of pocket. Compounding pharmacies can typically provide cost estimates upfront.
Are compounded hormones safer or more natural than commercial hormones? Compounded hormones use the same active pharmaceutical ingredients found in commercial products. The advantage is not "naturalness", it is precision and customization. The clinical benefit comes from the ability to tailor dose, strength, and route of administration to the individual.
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How long do compounded medications last?
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Compounded medications carry beyond-use dates set conservatively within USP guidelines. For example, oral aqueous preparations with preservatives are typically dated around 30 days. These dates account for potency stability, sterility, and other safety considerations.
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What should I do if my doctor refuses to prescribe a compounded medication I'm interested in? Have an open, informed conversation about your interest, the clinical rationale, and the specific compounding pharmacy you are considering. If the relationship remains a poor fit for the level of personalization you are seeking, it is reasonable and appropriate to seek a provider whose approach aligns with your goals.
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Terms used:
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1. Anaphylaxis - a severe, rapid, and potentially fatal systemic allergic reaction requiring immediate emergency treatment with epinephrine
2. Epinephrine - a critical medication used to treat life-threatening allergic reactions, severe asthma attacks, and cardiac arrest
3. Cadillac Escalade - premium full-size luxury SUV
4. Honda Odyssey - premier family minivan featuring a 280-hp 3.5L V6 engine, 10-speed automatic transmission, and seating for up to eight
5. Happy as pig in shit - a vulgar idiom meaning someone is extremely happy, satisfied, or content, often to the point of being gleeful
6. Hybrid car - one that uses two or more distinct types of power, such as submarines that use diesel when surfaced and batteries when submerged
7. Personalized medicine - a tailored medical approach that uses a patient's genetic profile, environment, and lifestyle to guide disease prevention, diagnosis, and treatment
8. Physiological doses - the administration of a substance at levels that mimic the body’s natural production or baseline functioning, aimed at maintaining homeostasis
9. Negative formulary - a state-regulated list of specific brand-name prescription drugs that pharmacists cannot substitute with cheaper generic alternatives
10. Private equity - involves investment firms raising capital from institutional and accredited investors to acquire, overhaul, and eventually sell private or public companies for a profit
11. Semaglutide - a GLP-1 receptor agonist that improves blood sugar control and induces significant weight loss by slowing digestion and lowering appetite
12. Colluctancy - an archaic noun referring to a struggling to resist, a striving against, or a general resistance and opposition of nature
13. Gene therapy - a technique that modifies, replaces, or inactivates genes within a patient’s cells to treat or cure diseases, such as inherited disorders, cancer, and infections
14. Biohacker - an individual who uses scientific, technological, or lifestyle interventions to alter their own biology, aiming to optimize physical and mental performance, health, and longevity