“Bioidentical”: the word needs translation.
The hormones we prescribe every day are chemically identical to the ones your ovaries made. The products marketed as “bioidentical” are often something else entirely. The difference matters.
The fact most marketing leaves out
FDA-approved estradiol and micronized progesterone are already bioidentical — chemically identical to the hormones the ovary produces. They have been tested for safety, purity, and consistent dosing, and they are what we prescribe routinely. If "bioidentical" is what you want, you do not need a compounding pharmacy to get it.
What "bioidentical hormone therapy" is often sold as
What is frequently marketed under that name — custom-compounded blends of estradiol, estrone, estriol, DHEA, testosterone, and progesterone, delivered as pellets, troches, or creams — is a different category entirely. These products are not FDA-regulated, lack rigorous safety and pharmacokinetic data, and cannot guarantee consistent dosing. Pellets in particular have been associated with supraphysiologic hormone levels and adverse effects — and once implanted, the dose cannot be adjusted or removed.
Where compounding has a real place
We recommend compounded preparations only when an FDA-approved option cannot meet a documented clinical need — such as a true allergy to an inactive ingredient. That is the honest boundary: compounding is a tool for exceptions, not a premium product tier.
