Bio-Identical Hormone Therapy

Bio-identical — used properly — describes molecular structure, not a manufacturing method. Oestradiol, progesterone and testosterone prescribed as regulated pharmaceutical preparations are already structurally identical to the hormones your body produces. That is what we use. The term has been muddied by clinics selling custom-compounded blends under the same word, so it is worth being precise: we prescribe licensed products with real safety data and consistent dosing, not bespoke mixtures made up in a compounding pharmacy.

What replacement is actually for is the symptom burden that comes with a genuine decline — disrupted sleep, night sweats, mood volatility, joint pain, brain fog, loss of libido, falling muscle mass. It is not an anti-ageing intervention and it will not return your physiology to what it was at thirty. Framed honestly, it is symptom control and risk management during a transition, and for most patients who need it, that is a substantial thing.

Route matters. Transdermal oestradiol as a patch or gel avoids first-pass liver metabolism and carries a lower clotting risk than oral preparations, which is why it is usually our default. Micronised progesterone is prescribed alongside oestrogen for anyone with a uterus, without exception, because unopposed oestrogen raises endometrial cancer risk. Testosterone, where indicated, is dosed to physiological rather than athletic levels.

We start at the lowest dose likely to help and re-test at eight to twelve weeks before changing anything. Symptom relief typically begins within two to six weeks for vasomotor symptoms and takes longer for mood, cognition and body composition. Some patients feel substantially better; a minority feel little difference and we stop rather than escalate indefinitely.