Bioidentical Hormones vs Conventional HRT: What the Evidence Says
The bioidentical vs conventional debate is mostly a marketing debate. Here is what actually differs — and what does not.
What bioidentical actually means
A bioidentical hormone has the exact molecular structure of the one your body makes — for example, 17-β-estradiol and micronized progesterone. This is a chemistry statement, not a source statement: bioidenticals can be plant-derived and lab-synthesized, and they can be dispensed by regulated pharmaceutical companies.
The controversial category is compounded bioidentical hormone therapy (cBHT) — custom preparations made by a pharmacist. cBHT has been marketed as safer or more natural, but the North American Menopause Society and Endocrine Society position statements find no evidence that compounded products are safer or more effective than regulated bioidenticals, and note real risks around dose variability and quality control.
What actually affects safety and efficacy
Route matters more than branding. Transdermal estradiol (patch, gel) avoids first-pass liver metabolism and carries a lower thrombosis risk than oral estrogen. Micronized progesterone taken orally at bedtime is well tolerated and does not raise breast cancer risk when combined with estradiol in the same way older synthetic progestins did.
Individualization matters more than compounding. A regulated transdermal estradiol patch with oral micronized progesterone can be dose-adjusted, monitored with proper laboratory work, and gives every patient a truly personalized plan.
Discuss your options
Ready to discuss hormone therapy? Book an initial hormone therapy consultation or a perimenopause / menopause appointment, or contact us via our booking page.
Frequently asked questions
Do you prescribe compounded hormones?+
Only when a regulated option is unavailable or not tolerated. Regulated bioidenticals cover the needs of most patients.
Are saliva hormone tests useful for dose adjustment?+
Not for clinical decision-making — blood remains the standard in Canadian and international practice.