Bioidentical hormone replacement therapy

Bioidentical hormone replacement therapy (BHRT), also known as bioidentical hormone therapy or natural hormone therapy, is a term referring to the use of hormones that are identical on a molecular level with endogenous hormones in hormone replacement therapy. It may also be combined with blood and saliva testing of hormone levels, and the use of pharmacy compounding to obtain hormones in an effort to reach a targeted level of hormones in the body. A number of claims by some proponents of bioidentical hormone replacement therapy have not been definitively established through scientific testing. Specific hormones used in BHRT include estrone, estradiol, progesterone (which are available both in FDA-approved manufactured products and as pharmacy-compounded products), testosterone, dehydroepiandrosterone (both testosterone and dehydroepiandrosterone have some stringent limits placed on their availability and approval in Canada and the United States), and estriol (which is available in Europe but is not approved in Canada and the United States).

Custom-compounded BHRT is a practice almost wholly restricted to the United States. BHRT is a form of alternative medicine, and has been promoted as a panacea for many diseases in addition to being a means of relieving the symptoms of menopause and/or reducing the risk of osteoporosis (historically, the goals of hormone replacement therapy in allopathic medicine). There is little evidence to support many of these claims; the hormones are expected to have the same risks and benefits of comparable approved drugs for which there is an evidence base and extensive research and regulation. The exception is progesterone, which may have an improved safety profile than artificial progestogens, though direct comparisons with progestins have not been made. Risks associated with the process of compounding bioidentical hormones are not clearly understood. In addition, the accuracy and efficacy of saliva testing has not been definitively proven, and the long-term effects of using blood testing to reach target levels of hormones have not been researched.

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