Thank you for the tag! Mostly, I think the patient has agency and control, and if this is a direction you want to head, it really doesn't matter if it would or would not be my choice.

In general, I'm cautious about compounding -- for me, it's too unregulated, wild, wild west, especially for a drug with these kinds of potential impacts (https://www.nature.com/articles/s41591-024-03412-w.epdf?sharing_token=4FgxVpDs3GxE5xnIx4EDrtRgN0jAjWel9jnR3ZoTv0PsuBzQ8kPgW4k_HGFyff8_RIMzBJYSWVcsLLb4QFC6rStOCl2maGnVrPCJJ5Bm_NExq4zHp3MOA1tbsiAS-bl1GlaZGhKlJLdJK9_Kh_pA2iONnq5ez6rW2Q-GF-VMD9k%3D). I think compounding pharmacies serve a very useful purpose, especially when drugs otherwise come in a form that is incompatible with the needs of a patient, but compounding for something like this makes me nervous. I have no idea how the patient determines what the compounded drug is actually made of, the train of custody/condition of those ingredients, and the ways in which it may be different from the branded product.

Having said that, I suppose I might feel differently if I had a history of trust with a particular compounding pharmacy, and a solid medical team who also trusts the pharmacy and is prepared to address whatever happens in regard to (perhaps unusual?) side effects.

My choice has been to manage the cost and availability of the drug through click-counting/microdosing using a branded multi-pen product. But again, that's just me.