CHTP Exam Content Outline

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Certified Hormone Therapy Pharmacist (CHTP)

Official Examination Content Outline

This document provides the official content outline for the Certified Hormone Therapy Pharmacist (CHTP) examination. The exam certifies that a pharmacist possesses advanced clinical knowledge and specialized skills in the assessment, design, and management of hormone therapies for a diverse patient population, including menopause, andropause, contraception, and gender-affirming care.

Examination Specifications

Name of Credential Certified Hormone Therapy Pharmacist (CHTP)
Certification-Issuing Body The Council on Pharmacy Standards (CPS)
Designation Awarded CHTP
Target Population Pharmacists with a clinical focus in women's health, men's health, and compounded therapies.
Examination Length 120 multiple-choice items
Administration Time 3.0 hours

Examination Content Outline

The CHTP examination is weighted according to the five domains listed below, which cover the comprehensive management of hormone therapies, from foundational science and patient assessment to long-term monitoring and interprofessional collaboration.

Domain 1: Foundational Principles & Patient Assessment 20%
Domain 2: Female Hormone Therapies 20%
Domain 3: Male & Gender-Affirming Hormone Therapies 20%
Domain 4: Therapy Management, Monitoring & Compounding 25%
Domain 5: Regulatory, Ethics & Interprofessional Collaboration 15%

Domain 1: Foundational Principles & Patient Assessment (20%)

Task 1: Conduct a comprehensive patient assessment for hormone therapy.
  • Synthesize a patient's medical, surgical, and family history to identify risks and contraindications.
  • Assess patient-reported symptoms using validated scoring tools (e.g., Menopause Rating Scale, ADAM questionnaire).
  • Interpret baseline laboratory and diagnostic data (e.g., hormone panels, metabolic labs, bone density).
  • Apply principles of cultural competence to address health disparities and the unique needs of diverse populations.
  • Establish patient-centered therapeutic goals through a shared decision-making process.
Task 2: Apply principles of endocrinology and hormone pharmacology.
  • Analyze the steroidogenesis pathway and the interplay between precursor and active hormones.
  • Differentiate the mechanisms of action, pharmacokinetics, and pharmacodynamics of various hormones.
  • Evaluate the benefits and risks of different hormone delivery systems (e.g., oral, transdermal, injectable).
  • Apply principles of pharmacogenomics (e.g., CYP3A4, UGT polymorphisms) to predict hormone metabolism and response.
  • Differentiate between FDA-approved products and compounded bioidentical hormone preparations (BHRT).

Domain 2: Female Hormone Therapies (20%)

Task 1: Design and manage evidence-based menopausal hormone therapy (MHT) regimens.
  • Select appropriate estrogen and progestogen products based on patient-specific factors and risk stratification.
  • Evaluate the evidence for conventional versus bioidentical hormone regimens in special populations (e.g., perimenopause, premature ovarian insufficiency).
  • Manage MHT in patients with complex comorbidities, such as breast cancer survivors with BRCA risk factors.
  • Recommend appropriate non-hormonal alternatives (e.g., SSRIs, gabapentin, ospemifene) for patients with contraindications.
  • Develop a patient-specific strategy for the appropriate duration, tapering, and discontinuation of MHT.
Task 2: Manage hormonal therapies for gynecological conditions.
  • Develop therapeutic plans for patients with Polycystic Ovary Syndrome (PCOS) or endometriosis.
  • Select and manage hormonal contraceptives for both birth control and non-contraceptive benefits.
  • Screen for contraindications to hormonal contraception using established criteria (e.g., USMEC).
  • Manage common side effects of hormonal contraceptives and therapies for gynecological conditions.
  • Differentiate therapy for vasomotor symptoms versus genitourinary syndrome of menopause (GSM).

Domain 3: Male & Gender-Affirming Hormone Therapies (20%)

Task 1: Design and manage testosterone therapy for cisgender males.
  • Confirm a diagnosis of hypogonadism based on clinical symptoms and appropriate laboratory findings.
  • Select an appropriate testosterone formulation and dose based on patient preference, lifestyle, and risk factors.
  • Develop a monitoring plan for efficacy (symptom improvement) and safety (hematocrit, PSA, lipids).
  • Manage potential adverse effects, such as erythrocytosis, gynecomastia, and testicular atrophy.
  • Integrate therapies to preserve fertility (e.g., hCG) for patients who desire it.
Task 2: Manage masculinizing hormone therapy for transgender and gender-diverse individuals.
  • Apply established clinical guidelines (e.g., WPATH) to design a safe and effective masculinizing hormone regimen.
  • Counsel on the expected timeline and nature of physical changes, including irreversible effects.
  • Provide comprehensive counseling on fertility preservation options prior to initiating therapy.
  • Monitor for efficacy and safety, including management of supraphysiologic hormone levels and polycythemia (e.g., hematocrit >54%).
  • Coordinate care with mental health professionals to provide holistic, gender-affirming support.
Task 3: Manage feminizing hormone therapy for transgender and gender-diverse individuals.
  • Apply established clinical guidelines (e.g., WPATH) to design a safe and effective feminizing hormone regimen.
  • Counsel on the expected timeline and nature of physical changes and associated risks.
  • Provide comprehensive counseling on fertility preservation options prior to initiating therapy.
  • Monitor for efficacy and safety, including VTE risk, potassium levels, and hormone levels.
  • Address unique considerations in pediatric and adolescent care, including the role of puberty blockers and informed consent.

Domain 4: Therapy Management, Monitoring & Compounding (25%)

Task 1: Develop and implement comprehensive patient monitoring plans.
  • Design a patient-specific monitoring plan that includes appropriate laboratory tests, imaging, and clinical follow-up.
  • Interpret follow-up laboratory data to guide evidence-based dose adjustments.
  • Recognize and mitigate common adverse effects, such as VTE, metabolic changes, and liver dysfunction.
  • Integrate long-term risk monitoring for cardiovascular health, cancer screening (breast, prostate, endometrial), and bone density.
  • Educate patients on the importance of adherence to their monitoring plan.
Task 2: Provide patient education and counseling on therapy administration and risks.
  • Instruct patients on correct administration techniques, including safe handling of topicals and self-injection.
  • Counsel patients on the signs and symptoms of serious adverse events that require immediate attention.
  • Ensure the patient provides fully informed consent by documenting a thorough risk/benefit discussion.
  • Provide strategies to improve adherence and manage minor side effects.
  • Verify patient understanding of their therapy using methods such as teach-back.
Task 3: Apply USP standards to non-sterile and sterile hormone compounding.
  • Design and prepare compounded preparations (e.g., creams, injections, pellets) according to USP <795>, <797>, and <825>.
  • Implement quality control procedures and assign appropriate beyond-use dates (BUDs).
  • Ensure compliance with handling requirements for hazardous drugs (e.g., progesterone) as outlined in USP <800>.
  • Perform all necessary calculations and select appropriate high-quality active pharmaceutical ingredients (APIs).
  • Counsel patients on the risks and benefits of compounded HT, including potential dosing variability and lack of regulatory oversight.

Domain 5: Regulatory, Ethics & Interprofessional Collaboration (15%)

Task 1: Adhere to legal and ethical standards in hormone therapy practice.
  • Ensure compliance with FDA, DEA, and state board of pharmacy regulations for prescribing and dispensing hormones.
  • Apply principles of informed consent, particularly for off-label uses and gender-affirming care.
  • Implement culturally competent and patient-centered practices to reduce stigma and address health disparities.
  • Navigate the ethical considerations of prescribing hormones in pediatric and adolescent patients.
  • Maintain comprehensive and accurate documentation to support clinical decision-making.
Task 2: Foster effective interprofessional collaboration.
  • Collaborate with prescribers (e.g., OB/GYN, endocrinologists) to design and optimize hormone therapy regimens.
  • Coordinate care with mental health professionals, nurses, and social workers to provide holistic patient support.
  • Serve as a drug information resource for the healthcare team on complex hormone therapy topics.
  • Communicate therapeutic recommendations clearly and effectively to other healthcare professionals.
  • Navigate insurance coverage, prior authorization barriers, and payer policies to ensure patient access to therapy.

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