Bioidentical Testosterone: What You Need to Know

Medically reviewed by — Research analysis by Alex Eriksson

Bioidentical hormone replacement therapy is gaining attention thanks to the all-natural movement in today’s popular culture. There are a variety of claims being marketed by various manufacturers. And, because of the hype from their promotions, it would be no surprise if you start to wonder if your regimen for hormone replacement is using bioidentical testosterone.

To set this straight, here are a few things you need to know about these products.

What Are Bioidentical Hormones?

Your testosterone and hormones are made up of different chemicals. These chemicals are arranged in such a way that the structure of one type of hormone is unique. This arrangement is what is known as the substance’s chemical structure.

The chemical structure of a hormone is the way your receptors determine what hormone it is receiving at a given moment. In some cases, hormone receptors will only respond if they receive the chemical structure of the hormone they are meant to receive.

In addition, when you say a substance is bioidentical, it means it has the same chemical structure as a given hormone. Because of this, a bioidentical hormone can trigger the same receptors as the hormone produced by your glands.

According to the rules established by the FDA, products marketed as bioidentical hormones should be already in a form identical to the hormones they are trying to replicate. If you’re taking bioidentical testosterone, it should already have the same chemical formula and structure as the testosterone produced by your body before you even use it.

Is It the Same as Your Natural Hormones?

Yes, it acts the same way as your natural hormones. However, bioidentical hormones are not the same as natural hormones.

This is contrary to what advocates and marketers of bioidentical hormones often say. They claim bioidentical is the same as natural. They even use the words “natural” and “bioidentical” as if they mean the same thing.

But, for a substance to be considered natural, it should be produced naturally by your body, a plant, or an animal. And, although they can be made up of natural components, bioidentical hormones are made in laboratories using a variety of chemical processes.

This makes any bioidentical and pharmaceutical hormone as synthetic. The only natural hormones available to you are those produced by your glands.

Some would say synthetic hormones are bad. However, the term “synthetic” only means that the substance is a product of chemical synthesis. This is simply the execution of chemical reactions on a selection of chemical compounds (natural or man-made) to obtain a final product.

Is It Different From Conventional Testosterone?

Conventional testosterone drugs do not have the same chemical structure as bioidentical testosterone products. This difference is due to intentional modifications applied by the pharmaceutical manufacturer.

These modifications exist so that your body can use them. Examples of these modifications can be seen in injectable testosterone modifications and oral testosterone modifications.

In injectable testosterone, manufacturers added ester groups so that the testosterone would be slowly released. As for oral testosterone, modifications are added to enable absorption by the liver.

Because of these modifications, bioidentical testosterone products claim that they are better than conventional testosterone drugs. However, this difference does not have any significance as, once it enters your bloodstream, conventional testosterone would have the same chemical structure as the bioidentical substance. If this is not the case for conventional hormone replacements, these drugs would not pass clinical tests and would not be considered drugs by the FDA.

Bioidentical hormones, as per initial trials, generally work the same way as those administered in traditional or conventional hormone therapy.

By using pregnenolone cream or pregnenolone supplements, the levels of the compound in the body increases, and this brings about various benefits such as fatigue relief, and delay of the aging process.

Do They Work?

Bioidentical hormones are made with the same purpose as pharmaceutical hormone replacements. This is to provide the hormones that would be normally produced by a healthy individual.

Mood-related menopausal symptoms improved on individuals who have undergone bioidentical hormone replacement therapy.

Unfortunately, there are no studies yet on the efficacy of bioidentical testosterone. Plus, there’s still a significant lack of study to say it can consistently work for all individuals.

To illustrate, a substance must undergo four phases of clinical trials for its claims to be approved by the FDA. Currently, only two clinical trials have been done for bioidentical hormones. And, the participants only amount to 21 and 69 individuals.

From the number of participants, this is just the first phase of clinical trials. The remaining phases would require from several hundred to several thousands of participants. And, with each phase taking up at least a year, it could still be a long time before these claims can be proven.

Is It Safer?

Bioidentical hormones are promoted as a safer alternative to traditional hormone replacements. The reasoning behind this claim is that the substance having the same structure as hormones produced by the body makes it a safer option.

However, this claim does not have any basis. In fact, research suggests that bioidentical hormone therapy has the same side effects as conventional hormone therapy.

In addition, bioidentical hormones can be a risky option for hormone replacement therapy. Pharmaceutical drugs, including hormone replacement medication, went through years of clinical study to find out its side effects and effects when taken with other substances. This is why you see a list of side effects and drug interactions when you refer to a drug’s prescription information.

In bioidentical hormones, this is not the case. There is a current lack of long-term trials to ascertain any side effects and interactions of it with other substances. Plus, if you’re taking other medications, this presents a real risk as some drug interactions can be fatal.

If future studies can prove the safety and determine any side effects and substance interactions, bioidentical hormone replacement therapy would be a viable alternative to traditional hormone replacement therapy. But, as of now, it is best not to risk it.

Take note that this does not mean that there are no negative side effects for non-bioidentical testosterone. Long-term methyltestosterone use has been proven to damage the liver. It is for this reason why oral testosterone replacement is rarely administered.

Is This Legal?

Any substance containing testosterone is considered a Schedule III controlled substance. This means that you can only purchase bioidentical testosterone if you have a prescription from a doctor.

There, any product that you see online claiming to contain testosterone does not actually have the said hormone. These products probably only contain precursors of testosterone and do not work in the same way as testosterone replacements.

Bioidentical testosterone structure

What Are the Different Options for Bioidentical Testosterone?

You can get your prescribed bioidentical testosterone from a normal pharmacy and a compounding pharmacy. Of course, whatever option you are getting will have to be approved by your physician and appropriately prescribed. Here are the various options available:

  • Transdermal: Most transdermal testosterone replacements contain the bioidentical form of the hormone. This is due to transdermal applications not needing modifications as they are absorbed into bloodstream through the skin.

    However, transdermal testosterone prescriptions usually contain ingredients to accelerate skin absorption. These ingredients can cause irritation if you have any skin sensitivities.
  • Sublingual or Buccal: Since these methods of administration have the testosterone dissolved in the mouth, it bypasses the “first pass effect” of the liver. This equates to effective and fast absorption of the hormone into the bloodstream.

    Because of its fast absorption, it will have to be administered more than once a day to maintain the appropriate hormone levels. Blood testing will also be needed to determine the right time for administration.
  • Subcutaneous pellet:  In this option, the testosterone is implanted under the skin. The implants are in the form of crystallized testosterone around the size of a rice grain. Its crystalline form enables its slow release. One implant can vary to last from a few weeks to a few months.

It Does Not Change the Precautions You Must Take

Any hormone therapy has the possibility of harming your health in the long-term. To prevent this or, at least, minimize its effect on your body, it is crucial to get regular blood tests to monitor your hormone levels and general health. This is why, whether you choose a conventional or a bioidentical testosterone replacement therapy, it is important that you continuously work with your doctor.

If you happen to be recommended to get your prescription from compounding pharmacies, make sure to choose one that has the proper technologies and facilities. This is for you to get properly and safely prepared medication.

To Conclude

When considering your options, it is important that you do not buy into the marketing claims made by bioidentical testosterone manufacturers. These claims currently have no scientific basis and, at best, lack the proper clinical trials required. In addition, since there are no studies or tests on bioidentical testosterone at the moment, you have no guarantee that you will get what you pay for these products.

Moreover, current pharmaceutical options eventually end up as bioidentical testosterone when they enter your bloodstream. And, unlike bioidentical testosterone, the claims have been clinically tested and proven by the FDA.

However, if you have any concerns regarding the safety of your current treatment, talk to your doctor about it and see if there are options available that have been clinically tested.

Alex Eriksson (Research Analysis)

Alex Eriksson is the founder of Anabolic Health, a men’s health blog dedicated to providing honest and research-backed advice for optimal male hormonal health. Anabolic Health aspires to become a trusted resource where men can come and learn how to fix their hormonal problems naturally, without pharmaceuticals.

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