When it comes to hormones, most people just want to feel like themselves again. Hot flashes, brain fog, weight gain, loss of lean muscle, trouble sleeping, low energy, low libido and mood swings can make you feel like a stranger in your own body. If you’ve been wondering whether bioidentical hormone replacement therapy (BHRT) could help, this guide will walk you through the basics in plain language.
As a functional medicine practitioner, my job isn’t just to suggest a prescription and send you on your way. It’s to step back, look at the whole picture of your health, and ask: What’s your body already doing? What’s getting in the way? What’s the most effective next step for whole body restoration?
First, let’s clear up the biggest question: Is BHRT safe?
This question is floating around out there from people just like you. There’s confusing and contradicting information out there. Here’s what you might be wondering: “I heard hormones cause cancer. Should I be scared?”
Here’s the truth:
- Early studies that made big headlines used older, synthetic forms of hormones that are not the same as bioidentical ones. Those older versions did carry some extra risks.
- Bioidentical hormones are chemically the same as the ones your body naturally makes (estrogen, progesterone, and testosterone). Research shows that, for most healthy women under 60 or within about 10 years of menopause, BHRT is safe when prescribed carefully and monitored regularly.
- Safety depends on the right type of hormone, the right dose, the right delivery method, and starting at the right time.
So, the blanket statement “hormone replacement therapy is dangerous” isn’t accurate. It’s more about whether they’re being used wisely and whether your unique risks are being considered.
How BHRT is different from “regular” HRT
Traditional hormone therapy often used synthetic or animal-derived hormones (like conjugated equine estrogen or progestins). These don’t look exactly like the hormones your body makes, which partly explains why they had more side effects in older studies.
BHRT (bioidentical hormone replacement therapy), on the other hand, uses hormones that are molecularly identical to the ones your ovaries once produced—mainly estradiol (estrogen) testosterone and progesterone. That’s why many men and women feel more balanced on BHRT compared to older synthetic versions.
Is BHRT for Men too?
Hormone balance isn’t just a women’s issue. Men can benefit from bioidentical hormone support too. Testosterone naturally declines with age, and low levels can contribute to fatigue, low libido, difficulty building muscle, brain fog, and even mood changes. BHRT for men usually involves bioidentical testosterone delivered via gels, injections, or pellets, carefully dosed and monitored. Just like with women, the functional medicine approach looks at the whole picture: Are hormones being made? Are they being used effectively? Are they being cleared properly? Lifestyle factors—sleep, stress, nutrition, and movement—also play a major role. When done safely and individually tailored, men can experience improvements in energy, strength, mood, and overall quality of life.
“What about side effects?”
Like anything, BHRT can have side effects. The most common ones early on for women are things like breast tenderness, bloating, or mild spotting if you still have a uterus. For many women, these fade as the body adjusts. For men, mild acne or mood shifts may be noticeable until the body adjusts.
One of the nice things about working with bioidentical options is that we can choose forms that are usually gentler on the body. For example:
- Estrogen and testosterone through a skin patch or gel tends to carry lower risks than pills.
- Natural progesterone (micronized progesterone) can even help with sleep when taken at night.
The key is adjusting until you find the “sweet spot” which is enough hormone to feel better, not so much that it causes problems.
“When will I notice a difference?”
Most women start to feel some relief from hot flashes and night sweats within 2–4 weeks. Sleep and mood often improve around the same time. Some benefits, like bone and heart protection, take longer and are more about long-term health than immediate changes.
Think of it like this: BHRT isn’t an instant switch, but more of a gradual reset. You’ll likely notice changes layer by layer over a couple of months.
Do I have to take hormones?
Not at all. BHRT is one tool in the toolbox, but not the only one. Some women do very well with non-hormonal options such as:
- Lifestyle changes: consistent sleep, exercise, and nutrition choices that support hormone balance.
- Stress management: your stress system and hormone system are deeply connected. Practices like CBT, deep breathing, or counseling often ease symptoms.
- Supplements and medications: there are non-hormonal prescriptions and some natural supports that can reduce hot flashes, improve sleep, and protect bone health. Schedule a consult with me to discuss your options.
If you’re not ready for hormones, there are absolutely other ways to support your body.
How functional medicine looks at hormones differently
Instead of jumping straight to a prescription, we step back and ask:
- Are you still making hormones?
Sometimes your body is still producing estrogen, progesterone, or testosterone but at lower levels. Testing can help us see whether production is low or if symptoms are caused by something else (like stress, thyroid imbalance, or nutrient deficiencies). - If you’re making them, are you actually using them?
Hormones have to “dock” into receptors (like a key in a lock) to have an effect. Inflammation, insulin resistance, stress, or toxin exposure can “jam the lock,” making it harder for your body to use what it already has. - Are you clearing them out properly?
Hormones don’t just need to be made, they also need to be broken down and excreted after use. If your liver or gut isn’t working optimally, hormones can build up or break down into forms that cause symptoms like PMS, breast tenderness, or heavy bleeding.
When we evaluate hormones through this lens, it changes the conversation from “Should I take hormones, yes or no?” to “What’s my body already doing, and where do I need support?”
“Is it expensive?”
It depends. FDA-approved bioidentical hormones (like estradiol patches or micronized progesterone capsules) are often covered by insurance and are available as generics. That keeps costs lower.
Custom-compounded versions (made at a compounding pharmacy) can be more expensive and usually aren’t covered by insurance. We only use those if you need a special dose or form that’s not available otherwise.
So, for many people, BHRT is more affordable than they expect, especially if we stick with standard bioidentical options.
“What if I’m worried about heart disease, stroke, or blood clots?”
This is another area where the type and delivery of hormones matter. Here’s the simple version:
- Estrogen through the skin (patch/gel) is generally much safer for clot risk than pills.
- Starting BHRT earlier, closer to the time you enter menopause, tends to be safer and sometimes even protective for the heart.
- Regular check-ins (blood pressure, cholesterol, blood sugar, family history) help us personalize your plan.
Putting it all together
Here’s what a functional medicine approach to hormones looks like:
- Foundations first: sleep, nutrition, exercise, stress, gut health. These are the soil your hormones grow in. We also look into the hierarchy that we discussed in our last blog and make sure to address the upstream before immediately jumping to downstream sex hormones.
- Evaluate carefully: test whether you’re making, using, and clearing hormones well. Look at thyroid, blood sugar, nutrients, and lifestyle factors. We also look into the hierarchy that we discussed in our last blog and make sure to address the upstream before immediately jumping to downstream sex hormones.
- Choose the right support: sometimes that’s BHRT; other times, it’s lifestyle or non-hormonal treatments.
- Monitor and adjust: your needs change over time, so your plan should too.
BHRT isn’t a magic bullet, but for many women, it’s a game-changer. The key is personalizing it and making sure it’s the right fit for your body, your season of life, and your health goals.
If you’re struggling with hormone-related symptoms, don’t ignore them or settle for “this is just getting older.” With the right testing, the right plan, and the right support, you really can feel like yourself again.
Summary: BHRT at a Glance
Q: Is BHRT safe, or does it cause cancer?
A: When used appropriately and monitored, bioidentical hormones are safe for most healthy women under 60 or within 10 years of menopause. Risks depend on type, dose, timing, and personal health history.
Q: How is BHRT different from regular HRT?
A: BHRT uses hormones identical to what your body naturally makes (estradiol, progesterone). Older synthetic forms used in past studies are not identical and had more side effects.
Q: Will I have side effects?
A: Some women notice mild breast tenderness, bloating, or spotting early on, but these usually fade as the body adjusts. The form and dose can be tailored to minimize side effects.
Q: When will I notice a difference?
A: Most women feel some relief (hot flashes, sleep, mood) within 2–4 weeks, with full effects in 2–3 months.
Q: Do I have to take hormones to feel better?
A: No. Lifestyle, stress management, supplements, and non-hormonal medications are also options. BHRT is one tool, not the only one.
Q: How does functional medicine approach hormones differently?
A: We ask three key questions:
- Are you still making hormones?
- If yes, is your body using them effectively?
- If yes, are you clearing them out properly?
Q: Is BHRT expensive?
A: Generic bioidentical hormones (patches, capsules) are often covered by insurance and affordable. Compounded versions cost more and usually aren’t covered, but they’re not always necessary.
Q: What about heart disease, stroke, or clots?
A: Estrogen through the skin is lower risk than pills. Starting earlier in menopause is usually safer. Regular check-ins make it more personalized and safer.
Bottom line: BHRT can be life-changing, but it’s not “one-size-fits-all.” The best plan looks at your whole body, your unique risks, and your personal goals.
