Bioidentical Hormone Therapy: What Practitioners Should Know

Hormone balance plays a critical role in nearly every physiological system—from metabolism and mood to bone health, cardiovascular function, and cognitive performance. As awareness around hormonal health grows, Hormone Replacement Therapy (HRT) continues to evolve, with increasing interest in bioidentical hormone therapy (BHT).

But what does this mean in practice, and why is it becoming such a prominent topic in modern healthcare?

Let’s take a closer look.

Hormone Replacement Therapy refers to the clinical use of hormones to address deficiencies or imbalances that may occur due to ageing, medical conditions, or physiological changes. It is most commonly associated with:

• Menopause and perimenopause
• Andropause (age-related hormonal changes in men)
• Thyroid disorders
• Adrenal or pituitary dysfunction

The goal of HRT is to restore hormonal levels to a range that supports physiological function and symptom management, under appropriate clinical supervision.

Here’s the key distinction:
Bioidentical hormones are compounds that are chemically identical in structure to hormones naturally produced by the human body.

Commonly discussed bioidentical hormones include:

• Oestrogen (such as estradiol)
• Progesterone
• Testosterone
• Thyroid hormones

Because of their molecular similarity, bioidentical hormones are often described as being more closely aligned with endogenous hormone activity. However, it’s important to note that “bioidentical” refers to structure—not necessarily to safety, efficacy, or superiority.

Several healthcare trends are driving increased discussion around bioidentical hormone therapy:

1. Personalised Medicine

Modern healthcare is moving away from one-size-fits-all solutions. Bioidentical HRT is often discussed within the context of individualised dosing, where hormone levels, symptoms, age, and response to therapy are considered together.

2. Expanded Delivery Options

Hormone therapy today is no longer limited to oral dosage forms. Practitioners may consider various routes of administration, including:

• Topical applications
• Capsules
• Sublingual or buccal delivery
• Injectable formats (where clinically appropriate)

These options allow flexibility in tailoring therapy based on patient needs and tolerability.

3. Focus on Hormonal Balance, Not Just Symptoms

Rather than treating isolated symptoms, many practitioners now approach hormone therapy by assessing overall endocrine balance, aiming to support long-term wellbeing alongside symptom relief.

This is where nuance matters.

While bioidentical hormones are structurally identical to endogenous hormones, they are still pharmacologically active substances and must be treated with the same clinical caution as any hormone therapy.
Key considerations include:

• Comprehensive patient assessment
• Baseline and follow-up hormone testing
• Individualised dosing strategies
• Ongoing monitoring for efficacy and safety
• Clear patient education around expectations and risks

No hormone therapy—bioidentical or otherwise—is without potential risks, and therapy should always be guided by current clinical evidence and regulatory frameworks.

It’s important to clarify a common misconception:

Bioidentical hormone therapy is not inherently “natural” or risk-free, nor is conventional HRT inherently inferior.
The distinction lies primarily in:

• Molecular structure
• Formulation approach
• Delivery and dosing flexibility

Both approaches require careful patient selection, clinical oversight, and informed consent.

In the broader healthcare landscape, compounding plays a role in supporting:

• Alternative dosage forms
• Individualised strengths
• Combination therapies (where appropriate)
• Allergen-conscious or excipient-specific formulations

This allows healthcare practitioners to address specific patient needs when standard commercially available options may not be suitable—while remaining within regulatory and professional guidelines.

Looking ahead, hormone replacement therapy is expected to continue evolving alongside trends in:

• Precision medicine
• Improved diagnostic tools
• Greater patient education
• Integration with longevity and preventative health strategies

Research into hormone optimisation, endocrine ageing, and personalised therapy models is likely to shape how HRT is discussed and prescribed in the years to come.

Hormone Replacement Therapy with bioidentical hormones represents a growing area of interest, not as a universal solution, but as one possible approach within a broader, evidence-informed framework of care.

For healthcare practitioners, the focus remains the same:

• Patient safety
• Individualised clinical judgement
• Regulatory compliance
• Ongoing monitoring and education

As the conversation around hormonal health matures, balanced, informed discussions will remain essential to delivering responsible and effective care.