Are Bio-Identical Hormones (BHT) Legit?

Wow, this is an oddly polarizing and confusing subject for women’s health. I’ve seen educators say that bio-identical hormone replacement doesn’t exist (It does). I’ve seen posts that it’s only pellet therapy (it’s not). Or that it’s about hormones made from compounding pharmacies (again, it’s not exclusively). This misinformation is hurtful to women trying to understand hormones if they choose to go that route. Let’s get into what it is, and what it is not!

According to Mayo Clinic, Cleveland Clinic, WebMD, and Wikipedia (for better or worse) the definition of bio-identical hormones are “man made” hormones that are identical on a molecular level to your own hormones that you make in your body. For example, the bio-identical progesterone in micronized progesterone capsules should look just like the progesterone in your body.

While the FDA does not recognize the BHT as a scientific term, it is commonly used as a marketing term. Interestingly, there are several commercially available FDA-approved hormone preparations that are bio-identical.

Your estradiol patch, capsule, and gel are likely BHT if they specifically say “17β-estradiol” on the ingredients. If your progesterone pill says ‘micronized progesterone,’ that is also considered BHT.

This is very different from a synthetic estrogen or a progestin - such as in the birth control pill, progestin IUD, medroxyprogesterone (don’t let the name fool you), and conjugated equine estrogen (CEE - from horses).

Therefore to answer the title question - bio-identical hormones are legit.

Now, let’s answer some misconceptions around them.

Does BHT only mean pellet therapy? No. As already stated, there are a variety of FDA-approved patches, pills, creams, inserts, and gels that are bio-identical. Having said that, pellets (not FDA-approved) are also bio-identical.

Does BHT only mean compounded at a compounding pharmacy? No. Again, as I’ve already covered the FDA-approved options you know this is a misconception. However, compounding pharmacies DO make bio-identical hormone preparations too. For example, if you have a peanut allergy, the progesterone capsule called Prometrium has peanut oil in it. Your practitioner likely suggested a compounded option without peanut oil.

Do I need a prescription for BHT? Yes (mostly). There are some over-the-counter progesterone oils and creams available for use. However, the larger majority do require a prescription.

My doctor said that bio-identical is not a real thing, why is that? Great question. I can understand that it’s not recognized as a scientific term for pharmaceuticals. However, it is true that if the label says estradiol (which is 17β-estradiol) or progesterone (or micronized progesterone), then it’s just like the kind in your own body.

My doctor said that all hormone replacement therapy is synthetic, is that true? I have heard this too as well. The first time I heard it, they meant because the hormones are made in a lab, then it’s considered synthetic even though it looks identical to the hormone in your body. I understand this technical argument but it’s missing the nuance of separating hormone therapy that looks identical to our own, and hormone therapies that do not. I have also heard doctors who are new to understanding hormones assume all pharmaceutical prescription hormones are synthetic in that they are not bio-identical. Of course, you now know this is not true.

I have heard there are no side effects with bio-identical hormones, is this true? This is not true. Just like the hormones in your own body can cause unpleasant symptoms, so can BHT. If the does is too high or too low or if the type of preparation doesn’t jive with your body, you might get side effects.

Hopefully this helped answer some questions around the term “bio-identical” and clear up the confusion!