A specialist prescribed him testosterone injections from a compounding pharmacy, a type of pharmacy that produces made-to-order versions of drugs that aren\u2019t commercially available, for select patients who need them. After his first injection, Noorian said he gained 15 pounds of muscle \u201cpractically overnight.\u201d He was flooded with energy and ambition.\u00a0<\/p>\n
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\u201cI was like \u2018Wow, what is this stuff?\u2019\u201d Noorian would later say on the “Dr. Gabrielle Lyon Show.”<\/a><\/p>\n This story is part of the series \u201cA Dose of Disruption: How America\u2019s desire for GLP-1s and testosterone fueled the growth of Empower Pharmacy and roiled the drug industry.\u201d<\/p>\n Read more<\/a><\/p>\n That moment changed Noorian\u2019s professional life, too. He opened his own compounding pharmacy \u2014 Empower Pharmacy \u2014 in 2009 to expand access to testosterone therapy and help others feel the same benefits.\u00a0<\/p>\n Within 10 years, Noorian significantly grew the pharmacy\u2019s size. Empower went from operating in a repurposed doctor\u2019s office to two multimillion-dollar facilities totaling about 100,000 square feet. The company brought in more than $300 million in revenue in 2024, a massive leap from its $3.5 million in sales in 2014, according to internal sales records and financial statements attached to court filings.\u00a0\u00a0\u00a0<\/p>\n Article continues below this ad<\/p>\n Empower\u2019s rise has turned Houston into a battleground over the future of the niche compounding pharmacy industry, as some of these little-known but growing businesses take on Big Pharma<\/a>\u00a0for their right to produce more accessible \u2014 and riskier \u2014 versions of drugs that millions of Americans now consume.<\/p>\n EXPLORE THE DATA: Testosterone use in Texas is skyrocketing, and more than 40% comes from compound pharmacies<\/a><\/p>\n Some compounding pharmacies, like Empower, have turned into gold mines with the explosive demand for GLP-1 weight loss drugs and their ability to sell them at lower costs. Podcast personalities, online clinics and MAHA-aligned social media influencers have further propelled the industry\u2019s reach by touting testosterone and longevity drugs that the pharmacies specialize in making.<\/p>\n Empower\u2019s path to becoming one of the country\u2019s largest compounding pharmacies has stretched the boundaries of this increasingly profitable corner of medicine. It has drawn the ire of Eli Lilly<\/a>, one of the world\u2019s largest drugmakers, who sued Empower in Houston federal court over its GLP-1 production. And it has brought additional scrutiny from regulators<\/a> with little power to control the scale at which Empower operates.\u00a0<\/p>\n Empower Pharmacy CEO Shaun Noorian addresses the crowd at a company celebration for a new FDA-registered outsourcing facility in Houston in 2016.<\/p>\n Elizabeth Conley\/The Houston Chronicle<\/p>\n And Noorian isn\u2019t done.\u00a0<\/p>\n Article continues below this ad<\/p>\n \u201cWe only serve several million patients across this country,\u201d\u00a0Noorian said on a recent podcast.<\/a> \u201cThere are hundreds of millions more that need this medicine. And billions more across the world that need it as well.\u201d\u00a0<\/p>\n Compounding pharmacies like Empower produce their own versions of brand-name GLP-1 drugs, like Zepbound and Wegovy, by changing the dosage strength and adding vitamins \u2014 changes they say are deemed necessary by a physician. An influx of prescriptions for these \u201cpersonalized\u201d versions has allowed them to dispense the drug nationally, under laws that exempt the pharmacies from costly requirements to test their drugs in humans.\u00a0<\/p>\n ‘A UNIQUE CASE’: Empower Pharmacy\u2019s CEO helped a doctor pay rent. Is it a conflict of interest?<\/a><\/p>\n So while pharmacies like Empower produce drugs at a scale that experts say resembles those of traditional manufacturers, they don\u2019t have to play by the same rules.\u00a0<\/p>\n In its lawsuit, Eli Lilly says Empower is illegally mass producing its patented GLP-1s, but Empower has described the suit as an attempt to stifle competition.\u00a0<\/p>\n Article continues below this ad<\/p>\n Noorian, now 43, talks publicly about compounding as a \u201crevolution,\u201d<\/a> a way to not only serve individual patients but to openly challenge Big Pharma and create a \u201cnew pharmaceutical supply chain.\u201d<\/a><\/p>\n Such is Noorian\u2019s vision for a pharmacy that is already one of the largest in the country.\u00a0<\/p>\n And it all started with testosterone therapy.\u00a0<\/p>\n \nThe age of \u2018optimization\u2019\u00a0\n<\/p>\n Vials of testosterone compounds from Empower Pharmacy are kept in a locker at Gameday Men\u2019s Health in Houston on Sept. 18, 2025.<\/p>\n Elizabeth Conley\/Houston Chronicle<\/p>\n Testosterone therapy has become big business for telehealth companies, clinics and compounding pharmacies that sell it as a way for men to reclaim the energy and vigor of their youth.\u00a0<\/p>\n Article continues below this ad<\/p>\n The appeal traces back decades.\u00a0<\/p>\n The drugs have taken many forms \u2014 from injections to pellets to patches \u2014 since synthetic versions of the hormone were first approved for medical use in the 1930s. The therapy is designed to restore testosterone in men diagnosed with low levels of the hormone, which keeps the bones and muscles strong, enhances sex drive and promotes feelings of overall well-being. Men with low testosterone can experience low libido, fatigue, erectile dysfunction and a range of other symptoms.<\/p>\n Testosterone\u2019s use in sports doping scandals in the 1970s and 1980s influenced public opinion around the drug. But in the 2000s, testosterone therapy found new life in the mainstream, driven by aggressive direct-to-consumer marketing, new treatment methods and shifting attitudes around men\u2019s health.\u00a0\u00a0<\/p>\n Testosterone prescription sales<\/a> skyrocketed from about $100 million in 2000 to nearly $2.7 billion in 2013.\u00a0<\/p>\n It was during this upswing that Noorian opened Empower Pharmacy, leasing space in a doctor\u2019s office before moving to a 1,500-square-foot location in northwest Houston in 2011.\u00a0<\/p>\n GLP-1 LAWSUIT:\u00a0Eli Lilly targets Houston-based Empower Pharmacy over copycat diabetes, weight loss drugs<\/a><\/p>\n Today, testosterone therapy is marketed not only for low testosterone levels but as a way for men with normal testosterone levels to \u201coptimize\u201d their health by reaching their highest possible level of mental and physical well-being. It\u2019s also a reliable money maker for clinics and pharmacies, as many men stay on the treatment for years, sometimes for life.\u00a0<\/p>\n Celebrity podcasters like Joe Rogan and Dax Shepard have been open about their testosterone use. Social media influencers like Liver King, known for his extreme fitness and diet of raw animal organs, have admitted to using testosterone therapy and other steroids.\u00a0<\/p>\n Even U.S. Health and Human Services Secretary Robert F. Kennedy Jr., the country\u2019s top health official, has acknowledged that he uses testosterone to \u201cstay swole,\u201d<\/a> as one telehealth company put it.<\/p>\n For social media users who search for hormone products, testosterone ads can become ubiquitous, with many offering cheap blood tests to check testosterone levels.\u00a0<\/p>\n In one Instagram ad, telehealth company Joi and Blokes asks: \u201cNot feeling like yourself? Check your hormone levels \u2026\u201d Another ad from the\u00a0telehealth platform Maximus assures users: \u201cIt\u2019s not you. It\u2019s your low testosterone.\u201d\u00a0<\/p>\n In Noorian\u2019s words, testosterone is part of a suite of wellness drugs that can help patients feel \u201csuperhuman.\u201d\u00a0<\/p>\n \u201cWe can make ourselves similar to high-performance athletes,\u201d he said during an interview earlier this year on The CEO Magazine podcast<\/a>. \u201cWe can be LeBron James. We can be Kobe Bryant. We can be Michael Jordan.\u201d\u00a0<\/p>\n An Empower spokesperson said Noorian\u2019s \u201csuperhuman\u201d reference was a \u201cpersonal reflection\u201d on the benefits of his treatment plan, \u201cnot a claim about testosterone therapy itself, and not a suggestion that it should be used for athletic or performance enhancement.\u201d<\/p>\n While there are widely available forms of testosterone, Noorian\u2019s\u00a0experience opened his eyes to the benefits of \u201cpersonalized\u201d versions made by compounding pharmacies.<\/p>\n Seizing the opportunity<\/p>\n The son of an entrepreneur and a nurse, Noorian grew up riding and repairing go-karts at his father\u2019s race track in Houston. He wanted to fix cars for a living, but the financial crisis that greeted him out of college in 2007 forced him to use his engineering degree elsewhere.\u00a0<\/p>\n He got a job at the oil services company Schlumberger, working in hydraulic fracturing as a field engineer.\u00a0<\/p>\n One day, Noorian damaged his spine as he lifted a piece of heavy metal. The injury sent him to physical therapy, where a doctor discovered Noorian had the testosterone level \u201cof an 80-year-old man,\u201d Noorian said on a podcast.\u00a0\u00a0<\/p>\n A urologist prescribed him testosterone made by a compounding pharmacy because, Noorian said, it would be more cost effective for someone who needed the therapy for life. He also said the pharmacy could alter the drug from the name-brand versions to meet his individual needs, which he did not specify during the interview.\u00a0<\/p>\n For many large compounders that specialize in testosterone, it wasn\u2019t their ability to offer a cheaper drug that caught their interest, according to interviews with multiple pharmacy owners and executives. It was their ability to make versions of testosterone that pharmaceutical companies didn\u2019t \u2014 like testosterone made with different oils or in different concentrations \u2014 for patients who couldn\u2019t access testosterone through traditional doctor\u2019s offices and insurance companies.\u00a0<\/p>\n Compounding pharmacies now largely serve telehealth companies and cash-based clinics that are more flexible in how they prescribe testosterone.\u00a0<\/p>\n \u201cIt\u2019s hard to say that we’re really focused on price,\u201d said Matthew Montes De Oca, the chief clinical officer at Strive Pharmacy, a compounding pharmacy with locations throughout the U.S. that specializes in testosterone therapy, GLP-1s and other drugs. \u201cIt’s more so getting people access and getting them the highest quality.\u201d\u00a0<\/p>\n When Noorian first set his sights on the business, he became a licensed pharmacy technician and put his engineering mind to work.<\/p>\n \u201cI wanted to learn how these drugs were made,\u201d\u00a0he said on a podcast.<\/a>\u00a0<\/p>\n He consulted with physicians<\/a> to come up with unique variations of hormone drugs for patients, and, like other compounders, Empower began modifying the inactive ingredients and creating new forms of testosterone.\u00a0<\/p>\n While the FDA-approved testosterone injections use cottonseed oil, Empower makes testosterone injections with grapeseed oil, which the pharmacy says allows patients to more comfortably inject it under the skin. The pharmacy also offers testosterone in lower concentrations than what\u2019s commercially available and in different mixtures intended to modify how the hormone is released in the body.\u00a0<\/p>\n EXPANSION: Empower Pharmacy opens $4.7M compounding facility<\/a><\/p>\n Noorian believes in the benefits of this \u201cpersonalized\u201d treatment, so much that he partnered with a prominent urologist in 2017 to open a testosterone clinic in Houston that would offer compounded hormone therapies. The partnership would allow physicians to collaborate with compounding pharmacies to produce \u201ccustom formulas\u201d not available at traditional retail outlets, according to business plans obtained by the Chronicle.<\/p>\n The plans ultimately fell through over a property dispute, but the opportunity was there: The clinic aimed to enroll 5,000 patients in the Houston region by its third year, with $5 million in potential annual earnings.<\/p>\n Patients who are prescribed compounded testosterone aren\u2019t always aware of the specific changes the pharmacies make to the drugs, though they still report benefits.\u00a0<\/p>\n Patrick Hollingsworth, 57, of Houston, was looking for a way to maintain his energy after long hours monitoring equipment at oil refineries. His primary care doctor had suggested testosterone therapy years earlier.\u00a0<\/p>\n Patrick Hollingsworth has been a client at Gameday Men\u2019s Health and has noticed a significant change in his energy levels since starting testosterone therapy.<\/p>\n Elizabeth Conley\/The Houston Chronicle<\/p>\n Through his own research, Hollingsworth early last year found\u00a0Gameday Men\u2019s Health, a national chain of cash-based testosterone clinics with 14 locations in the Houston area. He felt comfortable at the clinic, which prescribed him weekly injections of Empower\u2019s testosterone.\u00a0<\/p>\n At first, he said he didn\u2019t know whether the drugs were any different from commercial versions, until he learned a few months later about the different carrier oil options. But the medicine worked: He found more energy to work out in the morning and keep up with his active 14-year-old.\u00a0<\/p>\n \u201cI haven’t felt like that since I was a young man,\u201d Hollingsworth said. \u201cAnd it feels great.\u201d\u00a0<\/p>\n The rejuvenating effects of testosterone would allow Noorian to expand the reach of his drugs \u2014 and make millions doing it.\u00a0<\/p>\n \nGoing big\u00a0\n<\/p>\n Empower Pharmacy CEO Shaun Noorian gives a tour of the facility in Houston in 2016.<\/p>\n Elizabeth Conley\/Houston Chronicle<\/p>\n From 2013 to 2016, Empower grew exponentially, its total assets climbing from about $66,000 to nearly $3 million, according to financial statements attached to public court filings.\u00a0<\/p>\n Empower obtained licenses to ship drugs to all 50 states and embraced automation technology to churn out testosterone drugs from a 15,000-square-foot facility at 5980 W. Sam Houston Parkway North.\u00a0\u00a0<\/p>\n During the pandemic, Empower further expanded its footprint in Houston, opening a $55 million, 86,000-square-foot manufacturing plant at 7601 N. Sam Houston Parkway. In 2024, the company purchased another drug manufacturing plant in New Jersey, which it said would be capable of producing 50 million vials of compounded drugs per year.\u00a0<\/p>\n Empower generated $311 million in revenue and dispensed nearly 3 million prescriptions in the first ten months of 2024, according to an internal sales dashboard obtained by the Chronicle. Empower said it does not comment on internal financial records.<\/p>\n Most compounding pharmacies don\u2019t publish financial statements, but in sheer revenue, that puts Empower on par with a mid-size biopharmaceutical company, according to estimates from a McKinsey and Company report.\u00a0<\/p>\n Empower now claims to be the largest and most advanced compounding pharmacy in the world.<\/a><\/p>\n The largest share of Empower\u2019s revenue stemmed from GLP-1 sales, but a significant portion \u2014 about $26 million \u2014 came from Empower\u2019s hormone drugs, according to the sales dashboard.\u00a0<\/p>\n In a smattering of podcast and TV interviews, Noorian hasn\u2019t given many specifics on how he built Empower to make drugs at \u201ca scale and sophistication that very few in the compound space have even attempted,<\/a>\u201d other than his own drive to expand access.\u00a0<\/p>\n But Houston proved to be a fertile environment for growth, especially when it comes to testosterone therapy. Dr. Larry Lipshultz, one of the most prominent urologists in the field, practices here and prescribes drugs made by Empower and other compounding pharmacies.<\/p>\n RECALL: Houston’s Empower Pharmacy recalls 8,000 testosterone injections, citing quality concerns<\/a><\/p>\n One large national chain of testosterone clinics, SynergenX, started in Houston and has a large footprint in the area with 15 clinics. And the fast-growing GameDay Men\u2019s Health, which also prescribes Empower\u2019s testosterone, is aiming to expand its presence in the city to 26 clinics, said Farukh Bhagani, a Houston entrepreneur who owns five GameDay locations.<\/p>\n Gameday Men\u2019s Health co-owner Faruk Bhagani talks about the business in Houston on Sept. 18, 2025.<\/p>\n Elizabeth Conley\/Houston Chronicle<\/p>\n \u201cHouston is a pretty dense TRT (testosterone replacement therapy) market,\u201d said Bhagani. \u201cThere’s a lot of players here, and there’s a lot of urology capability here.\u201d<\/p>\n Houston also has been a hot spot for non-traditional clinics, such as medical spas and IV hydration clinics, that typically offer compounded IV therapies, weight loss drugs and hormone therapy, said Sara Shikhman, a healthcare lawyer whose firm represents hundreds of wellness clinics nationwide.<\/p>\n Texas took steps to regulate some of these facilities this year, creating a new law that requires licensed healthcare professionals to administer IV therapy. But \u201chistorically, there hasn’t been a lot of regulation of those businesses, and Texas makes it very easy for those types of businesses to open,\u201d said Shikhman.<\/p>\n Challenges to compounding<\/p>\n As the industry grows, Empower and other compounding pharmacies contend with skepticism from the medical community over the benefits and safety profile of their drugs.<\/p>\n The pharmacies do not have to test their drugs in humans before dispensing the prescription, although they are required to use raw ingredients that have been tested for impurities. Finished drugs that are deemed a high risk, such as injectables, are also required to undergo basic quality testing.\u00a0<\/p>\n![\"\"\/](\"https:\/\/files.sfchronicle.com\/static-assets\/compression-bot\/1781586000_adoseofdisruption.png\")
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