HRT vs. Bioidentical: Understanding the Differences Between Hormone Therapies

Hormones are the body’s master regulators, orchestrating everything from your mood and metabolism to sleep and sexual health. When hormone levels drop or become imbalanced—due to age, medical treatments, or other factors—life can feel out of sync. That’s where hormone replacement therapy (HRT) steps in, offering relief and restoring balance. But with the rise of bioidentical hormone replacement therapy (BHRT), many are left wondering: What’s the real difference, and which option is right for you?

Dr. Drew Collins, an alternative medicine specialist in Bend, Oregon, has seen a surge in interest around BHRT. With four decades of experience guiding patients through hormone therapy, Dr. Collins emphasizes the importance of understanding your options. Let’s break down the basics, benefits, and risks of traditional HRT and BHRT so you can make an informed decision about your health.

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)?

BHRT is a newer approach that utilizes plant-derived hormones, often derived from soy or yams, which are chemically identical to those your body naturally produces. The goal is simple: restore declining hormone levels and relieve symptoms—especially those related to menopause, perimenopause, and andropause.

BHRT is available in many forms, including pills, patches, creams, gels, injections, and subdermal pellets. There are two main types:

• Manufactured bioidentical hormones: Produced by pharmaceutical companies and FDA-approved for safety and efficacy.

• Compounded bioidentical hormones: Custom-mixed by specialized pharmacies to match an individual’s specific needs. While the ingredients are FDA-approved, these personalized formulations themselves are not regulated by the FDA.

Key Differences: HRT vs. Bioidentical Hormones

Feature	Traditional HRT	Bioidentical HRT (BHRT)
Source	Synthetic or animal-derived	Plant-derived (soy/yam)
Chemical Structure	Similar, but not identical	Identical to human hormones
Personalization	Standardized dosing	Custom-compounded possible
FDA Approval	Yes (for most products)	Yes (for some); compounded not FDA-approved
Forms Available	Pills, patches, cream Traditional HRT hormones may come in injections	Pills, patches, creams, gels, pellets

Benefits of Bioidentical hormone replacement therapy

BHRT is often chosen by people seeking a more “natural” approach or those who have not found relief with traditional HRT. Benefits may include:

• Relief from hot flashes, night sweats, and mood swings

• Improved memory, sleep, and libido

• Reduced fatigue and muscle loss

• Enhanced skin hydration, thickness, and elasticity

• Potentially lower risks of diabetes, tooth loss, and cataracts

Many patients report that BHRT offers more tailored symptom relief, especially when compounded to their unique needs. Some studies suggest bioidentical hormones may be better tolerated and metabolized, though more research is needed.

Risks and Bioidentical HRT Side Effects

No hormone therapy is without risks. Both HRT and BHRT can cause side effects, particularly during the early adjustment period. These may include:

• Weight gain

• Bloating

• Acne

• Mood swings

• Headaches

• Breast tenderness

Serious risks—such as blood clots, stroke, heart disease, and certain cancers—have been linked to some forms of hormone therapy. For women with a history of breast cancer, hormone therapy is generally not recommended due to the risk of recurrence.

It’s important to note that while some manufactured BHRT products are FDA-approved, custom-compounded versions are not. This means their safety, quality, and effectiveness aren’t regulated in the same way. The National Academies of Sciences, Engineering, and Medicine recommend compounded bioidentical hormones only for those who cannot use FDA-approved options due to allergies or other specific needs.

Which Is Safer: BHRT or HRT?

The answer isn’t one-size-fits-all. Some people respond better to bioidentical hormones, while others do well on traditional HRT. The best choice depends on your health history, specific symptoms, and preferences. It can take several months to see the full benefits of any hormone therapy, and ongoing monitoring with your healthcare provider is essential for safety and effectiveness.

Dr. Collins takes a comprehensive, individualized approach, combining lab testing, patient feedback, and careful monitoring to find the safest, most effective hormone therapy for each person. Many of his patients continue BHRT for years, often alongside other lifestyle and wellness adjustments.

Making an Informed Choice

If you’re considering hormone therapy, don’t go it alone. Consult a qualified provider who can explain the differences, evaluate your unique needs, and guide you through the options. With the right approach, hormone therapy can help restore balance, energy, and quality of life.

Curious about BHRT or want to know which hormone therapy is right for you? Dr. Drew Collins is available for consultations. Call (858) 333-5196 to schedule an appointment and take the first step toward feeling your best.

Your hormones are unique—your therapy should be too.

Author Bio: Dr. Drew Evan Collins, B.S., N.D., is a licensed and board-certified naturopathic physician with over 40 years of experience in holistic health. A graduate of the University of Oregon and Bastyr University, he has served thousands of patients and held faculty positions at multiple naturopathic colleges. Currently based in Bend, Oregon, he is the Owner and Director of Proactive Choice Inc.