Hormones That Qualify as “Bioidentical”

matisse-gerbe1173112658So what exactly are the hormones that are considered “bioidentical”?  Well, there really aren’t that many that we need to discuss.

The important hormones can be broken into two groups, the steroid hormones and the non-steroid hormones.  When people hear the word “steroid” they often think of athletes using drugs to get pumped up.  This type of “steroid” is more accurately called an “anabolic steroid”.  Anabolic means “building up”, so these are hormones that build up muscle, usually testosterone or a synthetic version of testosterone.  We use testosterone in bioidentical hormone replacement therapy (BHRT), but only as a way to balance hormones and treat symptoms, not to allow us to hit home runs.

Basically, steroid hormones are any hormone that is based on the chemical structure of the cholesterol molecule.  This brings up an important side note – cholesterol is absolutely necessary for the healthy functioning of the body.  And although the body has the ability to manufacture cholesterol, we still need to get some from our diet.  A zero cholesterol diet is a sure fire way to achieve hormonal imbalance.  We can talk about cholesterol at future posts, but I just wanted to put that in there.

Before I talk about specific hormones, I want to review what it means for a hormone to be bioidentical.  If you haven’t done so, please see my earlier post entitled Key Principles of Bioidentical Hormone Replacement (BHRT).  The basic explanation is that bioidentical hormones are chemically and structurally exactly the same as human hormones.  And when I say exactly, I mean exactly.  There cannot be even one little slight difference.  If there is an extra hydrogen atom on the molecule then it is not bioidentical.  In a future post, I will use progesterone as an example as to why it is so important that the hormones are identical.

steroidogenic-cascadeThe picture to the left shows the steroidogenic cascade.  This is basically a chart of how the body takes cholesterol (upper-left hand part of the chart) and changes it into the various hormones it needs.  Although there are lots of hormones on this list, we only supplement with a few.  The most important are the estrogens, progesterone, testosterone, DHEA, and cortisol.

1.  Estrogens – there are only 3 bioidentical estrogens, estrone (E1), estradiol (e2) and estriol (E3).  Estradiol is the most commonly used and the strongest of the three estrogens.  For the sake of keeping this post a reasonable length, I will discuss these indivudial hormones more extensively in future posts.

2.  Progestin – there is only one progestin that the body uses and that is progesterone.  Progesterone is an extremely important hormone and is often overlooked.

3.  Testosterone – this is thought of as a hormone for men although women need it too, just not as much of it.

4.  DHEA – this hormone is a precursor to testosterone and although current evidence suggests that the body doesn’t use DHEA directly, sometimes it is given to women who have low energy, muscle wasting, and low libido.  Personally, I have had better luck giving testosterone instead of DHEA to women who have those symptoms, but other practitioners do use it.

5.  Cortisol – aka “the stress hormone”.  Cortisol is released from the adrenal glands in response to stress.  Abnormal cortisol secretion and its resulting health problems is commonly known as “adrenal fatigue”.

Of the non-steroid hormones, the ones worth mentioning are the thyroid hormones, namely levothyroxine (T4) and liothyronine (T3).  These are peptide hormones, meaning that their chemical structure is basically a long chain of amino acids as compared to the steroid hormones which are modified cholesterol molecules.  As a side note, steroid hormones have very good penetration through the skin.  That is why estrogens, progesterone, etc. can be given as creams.  Peptide hormone have very poor skin penetration which is why we give thyroid supplementation as an oral medication.

T3 is the active thyroid molecule, meaning that it is the form that exerts its effects on the body’s cells.  However, the body produces T4 in the thyroid gland and converts it to T3 in the blood vessels.  The most commonly prescribed thyroid supplementation is oral T4 or levothyroxine  (Synthroid, Levoxyl, etc.).  For most people, this is adequate to treat their symptoms of low thyroid.  A small percentage need T3 supplementation to effectively treat their symptoms.  This can be given orally by a prescription off-the shelf medication (Cytomel), in combination with T4 (Armour Thyroid, Thyrolar), or can be made by a compounding pharmacy.

There is just a lot to talk about and I don’t want to make anyone’s eyes glaze over.  I you have any specific questions, please post them as a comment to this blog posting and I will do my best to answer them.

Thank you and live well!


21 Responses to “Hormones That Qualify as “Bioidentical””

  1. 1 charlottesal March 13, 2009 at 7:44 am

    This is a bit sciency for but that’s ok. It still gives us the idea. BioIdentical is plant based right?

    I am on a bioidentical cream and I love that my liver doesn’t have to process one more thing. My compounder also has me on a multi, high quality C and an adrenal revive supplement.

    Thank God for you compounding pharmacist who take us women seriously and who are willing to spend more than minutes with us. I’m living in quality health because of my compounding pharmacist.

  2. 4 Kimmy April 10, 2009 at 6:36 am

    Ok so I am a little confused..my husband who is 51 and in really good health is taking a combo of hormones for replacement. But what is zandralone (I think thats how you spell it??)And now for me, I just turned 39 I have 4 healthy children and keep myself in great health but i have begun to notice some sluggishness and a little more fatigue than usual. I am also starting to have a little bit of a thicker waistline eventhough I exercise 5 days a week! I finally had some blood work done, something i’ve never checked besides the usual stuff during pregnancy, which every pregnancy was very healthy, and in my results i had elevated liver enzymes?? What would be a good supplement for this or should I start a compounding hormonal replacement? Thank you for your time!

    • 5 thecompounder April 11, 2009 at 11:26 am

      It’s difficult to make a precise reccommendation to you without knowing more of your history and lab results. It sounds like you have a healthy lifestyle, which is important to keep up. I would recommend getting a saliva test for your hormone levels if you are concerned about hormone imbalances. Getting at lease an estradiol and progesterone test can be helpful. Measuring testosterone may be useful, but at your age, a low testosterone is less likely. If you need to find a place to get your saliva test kit, check out ZRT Labs website at https://online.zrtlab.com/zrtonline/findprovider.aspx. I hope that helps.

  3. 6 JP Saleeby, MD October 4, 2009 at 4:37 pm

    Good points here. I test and manage many patients with natural bio-identical hormones (thyroid, estrogen/progesterone, testosterone cream (in a PLO base) compounded at reliable compounding pharmacies such as yours.

    With Andropause such a big problem for older men, a little test cream can improve cognition, reverse depression, add muscle, take away fat, increase libido and stamina (and gals like those effects).

    With the Armour unavailable I have been changing people over to bio-identicals with great success. For more information on my practice and services visit: http://www.CarolinaMobileMD.com

    JP Saleeby, MD

    (800) 965-8482

  4. 7 P.A.W. December 22, 2009 at 3:00 pm

    I recently had my uterus and ovaries removed and now find myself lethargic, increasing hot-flashes, and depression. It’s been 6 weeks since the surgery – has sufficient time passed for my OB-GYN to test my hormone levels and what kind of bio-identical hormones can be considered for me?

    • 8 thecompounder December 23, 2009 at 5:00 pm

      Hysterectomies and Oophorectomies can have a tremendous impact on hormone production in the body. The ovaries are the primary source of estrogen and progesterone in the body and a secondary source of testosterone. You should definitely test for estradiol, progesterone, and testosterone and will most likely need to supplement with the first two and possibly the third.

      Don’t let your doctor tell you that you don’t need progesterone just because you don’t have a uterus. This is a falacious statement that I still hear doctors espouse. It is totally false. Progesterone is involved in almost every organ system in the body, from vascular to bone to breast to brain health. Your health and well-being will be greatly enhanced by obtaining the appropriate amount of bio-identical progesterone.
      Good luck and take care.

  5. 9 Terri June 25, 2010 at 12:59 pm

    I had my left ovary removed in May. Since then my blood tests
    showed results in the post-menapausal range. My doctor gave me
    a combo cream from compounding pharmacy of 2mg Estrogen, 150 mg
    progesterone and 2mg testosterone. He wanted me to do 2 pumps
    equal to 1ml. It was too much for me so I now just do 1 pump.
    I’m suppose to do this for 24 days on and 4 days off. Is this
    combo ok? Does it cause insulin resistance, breast cancer or
    weight gain or anything else bad? I suppose he gave me the
    combo to be taken each day together because I had Endometriosis.
    It’s just that I keep reading that you are suppose to take low
    dose estrogen each day and then progesterone day 12-26. I hope
    this combo is ok?? Does anyone know. Thank you so much!!


    • 10 thecompounder July 1, 2010 at 10:11 am

      Hi Terri,

      If you’ve had a ovectomy, it is not a bad idea to do continuous progesterone (with a few days off each month). The only reason to cycle the progesterone is to mimic a menstrual cycle, but the benefits can be realized with a longer duration of therapy.

      When monitoring hormone replacement therapy it is important to look at 2 things, symptoms and hormone levels. I have a good symptom list on my website at http://www.koshlandpharm.com/documents/Comprehensive-Symptom-List.pdf. Use this list to rate your symptoms and see if they are improving or worsening with your treatment. Then, its a good idea to look at your hormone levels via a saliva test (not blood test if your are using topical hormones). If your symptoms are not improving after a month or two on the hormone regimen, it might be worth doing a follow-up saliva test sooner rather than later.

      All this information put together can help guide you as to what is the appropriate hormone regimen for you. My approach is to always give the lowest dose of hormones to relieve symptoms and adequately balance out their activities.

      I hope that helps.


  6. 11 Pat VanDeusen January 20, 2011 at 5:41 pm

    I had a nodule on my thyroid 25 years ago and had a needle biopsy.
    Was put on 110 mcg of levothyroxine. It was the same for about 20 years. For the last 4 years it has gone down to 75mcg. I am also on estradiol for menopause. I am losing more of my hair than I ever had, am more constipated and am gaining weight even though I am exercising more than ever and watching what I eat. I have my blood checked every year and they keep going lower. Could it be the combination of the two medicines that is changing my blood levels lately.

    • 12 thecompounder February 5, 2011 at 2:11 pm

      Hi Pat,

      It certainly sounds like you have symptoms of hypothyroidism. You may want to find someone who is going to look more closely at your thyroid levels. Often doctors just order a TSH level that may not tell the whole story. Looking at free T3, free T4, reverse T3, and adrenal function may give a clearer picture as to what’s going on with you thyroid function. Estrogen levels that are not optimal can also cause some of the side effects that you are mentioning, so it would be also worthwhile to wee where ou are there, too. And don’t forget about the all important progesterone.

      I hope that helps.


  7. 13 Lisa Brand December 5, 2011 at 5:48 am

    Okay, so a little confused still on my Levothyroxine. Is it Bioidentical or not?

    • 14 thecompounder December 13, 2011 at 2:41 pm

      Good question. The short answer is yes. Levothyroxine is “biologically identical” to the levothyroxine your thyroid gland makes. I think what sometimes confuses people is that levothyroxine is synthetically derived, that is it is synthesized in a laboratory, not extracted from nature.


  8. 15 Margaret Green December 28, 2011 at 9:06 am

    After 20 years on Premarin & Estratest following hysterectomy/bilateral oophorectomy I made the switch to compounded Biest (8:2) 2.5 mg/0.1 ml, C-Testosterone 2.0 mg/0.1 ml (both cream), and Prometrium 100mg tablet.

    I tolerated these dosages well until blood test at 2 months revealed:
    Estradiol = 27 pg/ml
    Estrone = 33 pg/ml (high relative to E2)
    Progesterone = 3.7 ng/ml
    MD increased Biest to 4.0 mg/0.1 ml.

    Blood test also indicated mild Hypothyroidism due to poor conversion to T4 to T3.
    TSH = 2.42 uIU/ml
    T3, Free = 2.5 pg/ml
    T4, Free = 1.32 ng/dl
    Reverse T3 = 430 pg/ml
    MD added HC-Liothyronine 25mcg SR, Multivitamin/Multimineral supplement, and 5000 IU vitamin D3

    Approximately 3 weeks on these new dosages I experienced acne breakouts, and MD said to discontinue C-Test and increase Prometrium to 200mg at bedtime. One week later I am experiencing irritability, depression, insomnia, frequent bowel movements, leg muscle cramps and fatigue.

    My questions: did the addition of T3 amplify the action of Testosterone, and/or are the doses of Biest, Prometrium or T3 too high?

  9. 16 Valerie Petersen October 24, 2012 at 5:05 am

    Not sure if this is appropriate for this blog but not sure where to find the right answers. Started BHRT about a 2 yr ago for post menopausal symptoms. MD said “I don’t do much testing.” and he started me at a dose he felt would be appropriate for my symptoms of severe brain fog, memory loss, HOT FLASHEs that we driving me insane, mood swings, and depression. Compounded Biest, progesterone and testosterone cream applied vaginally (his suggestion). He increased dose based on lack of relief of symptoms. And increased dose again…then finally tested. Saliva testing results were OFF THE CHART literally! He said OH my god your severely estrogen dominant! ( I thought that was why I went to him to begin with:-\) Any way cut back on all dosages significantly to Biest 1.5/progesterone 30mg/TG 0.5mg 1ml daily. Retested from different lab and saliva tests are even higher?!!! All except progesterone and that 2032 pg/ml which is in possible range. Estradiol 165pg/ml, estriol 1598pg/ml, testosterone 172pg/ml! Now I am frightened of this whole mess. Have an appointment to see a different GYN. But must wait awhile to get in…ANy insight or suggestions at this point in time would be helpful.

  10. 17 Paul Gilbert August 5, 2014 at 7:14 am

    Hello sir, I hav read so much about ur products. Problem of bone density, thin and loss of hair, forgetfulness, low erection, shrinking of Testis and fatigue. Which Testorone product is good for me.

    • 18 thecompounder November 12, 2014 at 3:20 pm

      Thank you for writing in a question to this blog back in August. At our pharmacy, we have found that people often have the best outcomes when they work closely with both their doctor and pharmacist to answer this type of question. It’s important for your doctor and pharmacist to know your whole situation, which requires in-person visits and close analysis of lab results. If you would like to include a pharmacist in your health care team to discuss options for hormone replacement therapy, we recommend using the online resource of the Pharmacy Compounding Accreditation Board (www.pcab.org), which allows you to search for for compounding pharmacists by state.
      I hope this information helps. All my best,
      Krista Shaffer, Outreach Director at Koshland Pharm, http://www.koshlandpharm.com

  11. 19 Kara September 23, 2015 at 6:17 pm

    So, if a thyroid medication has levithyroxine in it is it bioidentical? Or just a generic form of synthroid? I am confused about what makes a product bioidentical ….. Is it the ingredient of the hormone or whether there is a combination of that hormone with another (t4 with a t3) or is it how it is derived?
    I was on naturethroid and now I am on westhroid pure I was told both were bioidentical, but I am feeling a little worse. I started reading and now I feel like this medication is synthetic!

    • 20 thecompounder May 20, 2016 at 12:08 pm

      Thanks for writing into the blog last September. These are great questions about thyroid medications. What makes a medication bioidentical is that it has the exact structure of the corresponding molecule made by the body. It does get confusing to sort out what the differences are among thyroid medications. I have noted this topic for a future blog post for Peter to write about, specifically including naturethroid and westhroid as a part of the discussion.
      Thanks again for writing. All my best,
      Krista Shaffer, Outreach Director at Koshland Pharm

  12. 21 Kathy April 4, 2017 at 11:16 am

    I am a 53 year old female who just reached 1 year without menses. I have been using progesterone cream bought online for over a year now. I went to a compounding pharmacy and had a consultation for BHRT. I filled out an extensive pamphlet related to history and symptoms and did extensive lab work. My final recommendations included 4 hormones. One of them was a compounded oral dose of progesterone/DHEA. My question is do you recommend to take these 2 orally or is it better topically? Everything I have read leads to topical. I am also having sticker shock on the compounding prices, which my insurance does not cover. I am also being told that there are FDA guidelines prohibiting 3 month supply on the topical BHRT is could be a cost saving.

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