Bioidentical Hormones vs Traditional HRT: What’s the Difference?
Hormone therapy can be a great option for individuals that are struggling with hormone imbalances that cause them troublesome symptoms. But before starting treatment, you will want to fully assess your options for hormone replacement therapy (HRT) with a healthcare provider. This involves reviewing the two types of hormone therapy: traditional HRT and bioidentical HRT.
Both traditional and bioidentical HRT can be helpful in treating hormone imbalances, but they have distinct differences that may impact your treatment and outcomes. This article will explain the key differences between the two so that you can make the right decision together with your healthcare provider.
HRT is a medical treatment that works by supplementing the body with additional hormones. Typically, HRT is utilized in instances where individuals may have low levels of certain hormones and experience troubling symptoms as a result.
Hormone replacement therapy is commonly used in the context of menopause. Menopause causes many hormonal changes that can lead to uncomfortable symptoms. These can include things like hot flashes, night sweats, or flushing. Many individuals will opt for HRT to treat symptoms of menopause because HRT mimics hormones found naturally within the body. In replenishing hormones such as estrogen and progesterone, many women experience symptoms relief.
Although menopause is one of the more common indications for HRT, there are several other conditions that HRT can support. For example, testosterone supplementation can help with low libido, and estrogen can also treat premature ovarian insufficiency (1).
When it comes to something like estrogen therapy, HRT can work in two major ways. With systemic estrogen therapy, estrogen enters the bloodstream and is transported throughout the body to different organs and tissues. Systemic estrogen therapy can include things such as pills, gels, skin patches, and sprays. Alternatively, local estrogen therapy works by releasing low doses of estrogen straight to the vaginal tissue. As such, these come in forms like creams, vaginal rings, and tablets (2).
Aside from estrogen therapy, HRT can also include progesterone or testosterone, depending on what one’s treatment goals are. There are several FDA-approved formulations and delivery methods.
There are two types of hormone replacement therapy - traditional hormone replacement therapy and bioidentical hormone therapy. While both aim to provide symptom relief for hormonal conditions, they are made slightly differently and with different types of oversight.
Bioidentical hormones differ from normal hormones because they are both processed and derived from plants. They structurally identical to the hormones found in our body and chemically similar. There are two types of bioidentical hormones: FDA-approved bioidentical hormones and compounded bioidentical hormones.
The role of FDA
When it comes to FDA-approved bioidentical hormones, there are those that are commercially available and approved by the U.S. Food and Drug Administration (FDA). These include products like estradiol, micronized progesterone, and dehydroepiandrosterone. The benefit of these is that they are subject to the strict oversight and monitoring of the FDA, exactly like traditional hormone therapy. Any FDA-approved medication must have undergone several clinical trials in humans as well as testing in animals to prove their safety and efficacy before they are able to be brought to market.
In addition, FDA-approved HRT products will also be subject to high manufacturing standards, ensuring the quality of the product. FDA-approved products also have a higher likelihood of being covered by insurance companies, oftentimes meaning less out of pocket costs for patients.
Compounded preparations
Alternatively, compounded preparations of bioidentical hormones are also available. While these have many benefits, they are are not regulated by the FDA. Compounded BHRT is available with a healthcare provider’s prescription, however, they are not dispensed at a normal pharmacy.
If you’ve never been to a compounded pharmacy before, you may not be aware of what they do. Compounding pharmacies are different from normal pharmacies in that they produce individualized treatments. This can be done in a variety of ways, but it typically means customizing dosage strengths and developing medications into individualized forms, such as adding flavor for kids and pets. The idea is that these medicines are tailored to specific needs, which can be done specifically with hormone therapy.
While the products of compounded pharmacies are not FDA-approved, they fall under the oversight of state boards of pharmacy. These drugs are compounded by a licensed pharmacist in a state-licensed pharmacy or federal facility. They can also be compounded by a physician. These products must meet the conditions set forth in section 503A of the Food, Drug, and Cosmetic Act (3).
Compounded bioidentical hormones include hormones such as estriol, estrone, estradiol, testosterone cypionate, testosterone propionate, dhea and pregnenolone. They are available in a wide array of routes of administration, including oral products, injectables, suppositories, or implants. These differ from FDA-approved formulations in that they are individualized for the specific patient as directed by the physician. Thus, many patients that prefer alternative dosage forms or those that have allergies or sensitivities may opt for compounded preparations.
It is important to note that “bioidentical” does not necessarily mean that BHRT is safer or more effective than traditional HRT. This is a common misconception, as many think that because they are derived from plants, they must be better. However, safety and efficacy claims are mixed, but BHRT can be a good option for some patients and for some indications (4).
Although it may seem like you’d want to go for the FDA-approved option for hormone therapy, many patients have and continue to choose BHRT. There are several benefits, including:
Hormone therapy, whether it is bioidentical or traditional hormone therapy, does carry some risks. These are important to be aware of when you are making the decision to start hormone therapy.
Hormone therapy can increase one’s risk of:
Additionally, HRT may be loosely associated with heart disease or gallbladder disease.
In addition to the risks, some side effects of bioidentical hormones include things like weight gain, acne, drowsiness, spotting, cramping, blurry vision, breast tenderness, bloating, headaches, and mood swings.
Side effects can be common in the initial stages of treatment when your body is not yet used to the therapy. With time, your body will likely adjust to the different hormone levels and some of these side effects may subside (4).
As with starting any medication, the first step will be a consultation with your healthcare provider. They will be able to review your health history and current condition to assess whether hormone therapy, and potentially BHRT, will be right for you. If they decide that BHRT is a good option, they’ll also be able to select a dose and route of administration that will work best for your condition.
Now that we’ve gone over both traditional and bioidentical HRT, you likely have a better understanding as to how these differ. While they both target hormone imbalances, there are some key distinctions between the two. Both can be effective in treating conditions like menopause, but each carries some unique benefits and risks that you should consider before starting therapy. Which is right for you will depend on your unique treatment goals and the recommendations from your prescriber.
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