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HRT vs. Bioidentical: Understanding the Differences Between Hormone Therapies

Updated: 4 days ago

Your body's hormones are not just messengers; they are the key regulators that keep everything running smoothly, from digestion to mood and more. When these hormones get out of whack, it can throw things off balance and significantly affect your overall well-being. This is where hrt bioidentical hormone replacement plays a crucial role.

Many people turn to hormone replacement therapy when their hormones drop or become imbalanced, whether it's to alleviate symptoms or as part of gender-affirming care. One type of hormone replacement therapy that's been getting a lot of attention lately is bioidentical hormone replacement therapy (BHRT).

What is "Traditional" Hormone Replacement Therapy?

Back in the day, about 75 years ago, Hormone Replacement Therapy (HRT) was quite different from what we know today. It mainly involved using "all-natural" hormones from human placentas or, with the FDA's nod, from the urine of pregnant mares, known as Premarin. However, things changed in the 1950s when scientists started creating synthetic hormones in labs. These synthetic hormones mimic the ones our bodies naturally produce. Today, when we talk about traditional HRT, we're mainly referring to these lab-made synthetic hormones, although Premarin is still sometimes used. These traditional HRT options have been extensively researched, ensuring they're both effective and safe for use.

What is Bioidentical hormone replacement therapy (BHRT)?

Bioidentical hormone replacement therapy (BHRT) is often used to increase hormone levels when they are low. It's commonly used to relieve symptoms of perimenopause and menopause, or andropause, and it can also help with symptoms related to cancer treatment. Additionally, BHRT may be used to address conditions like insulin resistance, adrenal and thyroid disorders, osteoporosis, and fibromyalgia.

Bioidentical hormones are man-made hormones made from plants, designed to be exactly like your body's natural hormones. They copy hormones like estrogen, progesterone, and testosterone, and you can get them as pills, patches, creams, gels, or injections.

Components of BHRT

Bioidentical hormone replacement therapy (BHRT) consists of two types: manufactured bioidentical hormones, commercially available drug companies, and compounded bioidentical hormones customized by pharmacies based on a doctor's prescription. Compounding involves altering or combining ingredients to suit individual needs. 

While the FDA has approved some manufactured bioidentical hormones, such as estriol and progesterone, it has not approved any custom-compounded bioidentical hormones. 

Bioidentical hormone replacement therapy vs HRT

what is the difference between hrt and bioidentical hormones

  1. Bioidentical hormones are chemically identical to the hormones our bodies naturally produce, and they are derived from plants, unlike traditional hormone replacement therapy (HRT) hormones, which are often molecules that have been altered or are from a non-plant source. (pregnant mare’s urine “Premarin,” for example).

  2. Traditional HRT estrogens are made from the urine of pregnant horses and are not bioidentical. Progestins are also not the same as progesterone, which is found in our bodies.

  3. Supporters of bioidentical hormones argue that they are safer because they are "natural" and have the same chemical structure as the body's natural hormones.

Benefits of BHRT

BHRT is commonly utilized by individuals experiencing a decrease in hormone levels due to perimenopause, menopause, andropause, or trauma.  Its primary goal is to elevate the levels of hormones that have declined and alleviate moderate to severe menopause or andropause  symptoms, such as:

  • Hot flashes

  • Night sweats

  • Mood changes

  • Memory problems

  • Weight gain

  • Sleep disturbances

  • Reduced interest in sex or pain during sex

  • Low libido

  • Fatigue

  • Loss of Muscle Mass

  • Depression / lack of motivation

Moreover, hormone replacement therapy may potentially lower your risk for conditions like diabetes, tooth loss, and cataracts. Some individuals also suggest that it could enhance skin thickness, hydration, and elasticity and possibly reduce the appearance of wrinkles.

Risks and Bioidentical HRT Side Effects

The FDA has not fully approved all bioidentical hormone therapy (BHRT) products. While some BHRT products are FDA-approved, compounded BHRT hormones are not currently regulated for safety or effectiveness. The compounds used by a licensed compounding pharmacist are FDA-approved, but the result is an individually prescribed medicine that is monitored by your physician with feedback from the patient and pharmacist.

The National Academies of Sciences, Engineering, and Medicine suggest that compounded bioidentical hormones should only be considered in specific cases, such as when there is an allergy to FDA-approved hormone products.

Despite claims that bioidentical hormones are safer and more effective because they mimic the body's hormones, there's limited evidence from large-scale studies to support these claims.

Certain hormone replacement therapies have been linked to increased risks of conditions like blood clots, stroke, gallbladder disease, heart disease, and breast cancer. For those with a history of breast cancer, hormone replacement therapy for menopause symptoms is generally not recommended due to the potential risk of cancer recurrence.

In consultation with the patient and specific and ongoing Lab testing, Dr.Collins goes over the Risks and Rewards, likely and unlikely outcomes, what conventional doctors would prescribe, and what would happen if no action was taken with each patient seeking BHRT.

Hormone replacement therapies can also lead to side effects, especially during the initial adjustment period. These side effects may vary depending on the type of hormone therapy and may include acne, bloating, weight gain, fatigue, and mood swings.

It's essential to consult your doctor about the risks, benefits, and potential side effects of BHRT, bioidentical vs synthetic hormone replacement, or any hormone replacement therapy, particularly considering your individual health history.

Are bioidentical hormones safer than synthetic hormones?

Depending on factors like dosage, individual health, and hormone levels, BHRT can affect each person differently. It usually takes around three months to see the full benefits of hormone therapy, though some may notice improvements sooner.

BHRT sessions typically last three to six months, with adjustments made as needed based on changes in health or hormone levels, as diagnosed. These sessions are followed by office visits and lab testing. Dr. Collins takes a comprehensive approach to care, often combining BHRT with other treatments and lifestyle adjustments for optimal results.

If you're interested in learning more about BHRT and if it's right for you, Dr. Collins is available for consultations. Contact his office at (858) 333-5196 to schedule an appointment.

About The Author: Dr. Collins

Author: Dr. Collins

Dr. Drew Collins, an alternative medicine specialist based in Portland, has noticed a rising interest in BHRT (Bioidentical Hormone Replacement Therapy). With 40 years of experience safely and effectively treating patients using this therapy, Dr. Collins strongly advocates for BHRT. He observes that many of his current patients are already familiar with the health benefits and risk profile of BHRT and have made the decision to undergo treatment. Instead of questioning the benefits and risks, most patients are curious about the difference between HRT and bioidentical hormones. Understanding these differences is crucial, as it empowers you to make informed decisions about your health. Let's explore what BHRT is and the difference between bioidentical hormones and HRT.


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