Synthetic vs. Bioidentical Hormone Therapy

What’s the difference between synthetic vs. bioidentical hormone replacement therapy?

Let’s talk about it. 

For years, the only choice menopausal women had was prescription synthetic hormones. Fortunately, since the late 80s, bioidentical hormones have been available. 

The Difference Between Synthetic vs. Bioidentical Hormone Replacement Therapy

Synthetic hormone replacement therapy are chemically created in a lab, and have a hormonal effect in the body. For instance, medroxyprogesterone is a synthetic progestin that is derived from a testosterone molecule with fewer carbons than natural progesterone. It does protect the uterus against estrogen’s building effects so that you’re less likely to get endometrial cancer. But it does not protect the rest of your body, like your breast tissues. Progestins are not progesterone.

Bioidentical hormones look exactly like what your ovaries would make, so your cells don’t know the difference. Bioidentical hormones still have to be synthesized somewhat, which means that you can’t eat a yam and get progesterone, or eat soybeans and get estrogen. The precursor molecules of those hormones in these plants can be divided in the lab into estrogen and progesterone, as well as testosterone, pregnenolone, and DHEA.

HRT and BHRT are chemically different.

Synthetics are patentable, man-made chemicals. Bioidenticals are not necessarily patentable, although there are a few bioidenticals in pharmaceuticals that have patented delivery systems. You have choices. 

The types of bioidentical hormone replacement therapy include estrogens – estradiol, estrone, and estriol. Sometimes they’re combined, and sometimes they’re taken separately. 

Progesterone is best micronized, meaning a smaller molecule, so that it’s absorbed better. Chemically derived testosterone is methylated, which is very toxic to your liver. Bioidentical testosterone is non-methylated.

In perimenopause, I refer to hormone replacement therapy as supplemental, meaning we’re just giving you enough of those hormones to help with your symptoms, but not so much that we’re replacing all of your needs, because you may be able to still make it. We usually start with progesterone. 

By menopause, you need to consider full hormone replacement therapy – both progesterone and estrogen. 

If needed for osteoporosis or sarcopenia, testosterone can be added. 

Finding the most effective bioidentical hormones can be challenging. 

Gen-Pro™

In the early 90s, I began working with a compounding pharmacist to improve upon the existing transdermal delivery of progesterone. At the time, I was focusing on progesterone as hormone replacement therapy, but also for infertility treatments, to prevent miscarriage, as well as to regulate menstrual cycles. At the time progesterone injections were the gold standard, and they’re very painful. Then, compounders developed progesterone suppositories, great absorption, but are incredibly messy and can cause uterine cramping as well as some urogenital symptoms like urinary retention.

So, transdermal delivery seemed to be the best option, but not all transdermal bases are created equally.

After years of sharing my clinical experiences with the compounded pharmacist, we came up with an amazing liposomal-based transdermal with a very high absorption, higher than anything any other compounders had created, and higher than anything over the counter. Progesterone is such a large molecule, so it’s very difficult to deliver transdermally. Most creams deposit progesterone into the subcutaneous tissue, which makes it difficult to reach the bloodstream and become systemically absorbed.

Our progesterone formula had very high absorption rates. In fact, I was able to utilize this transdermal cream to replace injectable progesterone as well as progesterone suppositories for my pregnant women trying to prevent miscarriage.

In the fall of 2023, we were finally able to manufacture our highly effective progesterone transdermal cream. Gen-Pro™, the same formula I prescribed for my patients, is now available over the counter. 

Gen-Pro™ is the foundation for bioidentical hormone replacement therapy.

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