Confused About Hormone Therapy Terminology?

When a patient says that she wants “natural” hormone replacement therapy, does the term mean the same thing to you as it does to her?

Let’s explore that question further by dissecting the terminology most commonly used by patients (and even some experts) when discussing hormone restoration therapy: “natural,” “synthetic” and “bio-identical.”


The term “natural” cannot be used to describe hormones or hormone therapies, because it lacks a unified definition:

  • For many laypeople, natural means “found in nature.” In other words, the substance was not man-made in a laboratory.
  • For others, natural means that even if the end substance cannot be found in nature, the source materials used to create it can.
  • For some scientific types, natural does not refer to the source of a substance, but that it is found naturally in the system to which it is being introduced.


Synthetic is another term with a variable definition, depending on who is asked:

  • It is often used to represent any therapeutic agent produced by a drug manufacturer that does not contain exclusively bio-identical hormones.
  • Others have used the term to describe any therapeutic agent that is produced in the lab.
  • Still others feel that synthetic should apply to any substance that is foreign to the body.

Due to overwhelming confusion over these two terms, it is best to avoid using “natural” and/or “synthetic” when discussing hormone therapies or options.


Bio-identical means that the hormone has the exact same chemical structure as the endogenous hormone, and thus, it is undistinguishable from the hormone produced by the body.

Is the therapy bio-identical or non-bio-identical?

When using a substance that is foreign to the body, the therapy is non-bio-identical. Furthermore, substances that are foreign to the human body will increase risk for adverse reactions.

For years, the standard hormone replacement therapy protocol included the use of many agents, which (at least partially) contain substances that are foreign to the human body. More recently, bio-identical hormones have been available in manufactured drug choices; but if you want to achieve optimal patient outcomes, there is much more involved than simply selecting therapy agents.

Evolving Our Best Practices for Optimal Patient Outcomes

  • Aim to restore hormones to normal pre-menopausal levels in a manner that balances the different, yet highly interactive hormones.
  • Refer to bio-identical therapy as restoration therapy rather than replacement therapy. Why? We are restoring hormones to normal levels using the same exact hormone rather than replacing a patient’s hormones with substitutes.
  • Regularly measure and monitor of hormone levels along with patient symptoms. Restoration must be facilitated in a responsible manner using highly scientific methods.
  • Make adjustments on an individual basis. Consider the influences of other endocrine hormones on the outcomes of the sex steroid therapies.

There are no standard doses that can be applied across the board to woman in general, so therapy must be individualized for optimal outcomes. Too much bio-identical hormone may have as much overall health risks as lack of the hormone.


By Jim Paoletti, B.S. Pharmacy, FAARFM, FIACP | Director of Education, Power2Practice






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