Summary: Bioidentical hormones, or hormones that are identical to the ones in your body, can greatly benefit transwomen while offering greater flexibility and a safer way to transition. But, not all bioidentical hormone treatments are the same.

Bioidentical hormone therapy is an alternative way of prescribing hormones, not just for transwomen, but also biological women who have gone through menopause. Bioidentical hormones are the natural hormones the body produces, meaning the body recognizes the hormone as identical to the ones found in the body. These often include the three estrogens (estrone, estradiol, and estriol), progesterone, and androgens, such as dehydroepiandrosterone (DHEA) and testosterone.

Wooden cubes with abbreviation HRT

While it’s often thought that bioidentical means natural and safe, it actually does not mean natural or safer than conventional synthetic hormone replacement therapy. If you want more insight into natural remedies, such as herbal supplements, for hormone replacement therapy for trans women, be sure to check out my video on that topic that will cover more in this area.

There are advantages, however, to bioidentical hormones over synthetic ones. While they are often not covered by many insurance providers, and may not be as consistent due to the unregulated nature of bioidentical products, and compounded drugs, there are some clear advantages. One is that they are identical to the hormones in your body, and thus your body recognizes it and can utilize it more efficiently than a synthetic version of the hormone that is intended to mimic what is in your body. And second, some actually are safer, primarily progesterone. This hormone is primarily found in women, especially during pregnancy. The bioidentical version of progesterone has been found to have far fewer side effects than the synthetic version.

Estradiol generic estrogen Prescription Medicine Container

While most of the studies on bioidentical hormones are done on women after menopause, it can benefit transgender women as well. Both estrogen and progesterone can be prescribed in a bioidentical form to be used by transgender women, but there are several key things to keep in mind. One of the best ways of using a bioidentical hormone product is a cream. Generally pills are filtered more by the liver, and a higher dosage often needs to be given. Furthermore, creams offer a more precise way of dosing. However, there is a downside. They may not be absorbed very well, or used by the body too quickly, or even rub off if wearing clothing and sweating. Plus, the inconvenience of having to apply cream daily.

The other thing to keep in mind is the type of estrogen being prescribed. There are three types: estrone, estradiol, and estriol. The only one your body needs for health and feminization is estradiol. The other two are not ideal for transwomen or post-menopausal women because estrone can cause weight gain, and estriol is primarily used during pregnancy. Thus, it’s imperative to take estradiol, and only estradiol, for the process of feminization, hence why estradiol is prescribed to transwomen for the process of transitioning. While bioidentical and compounded products may include two or three of these estrogens, the dosage of estradiol specifically may not be specified, and thus may not be helpful.

Progesterone is also a consideration for transwomen. It can provide proper development of breast tissue, but also often comes with more moodiness during transition. It can greatly benefit transwomen who have misshapen breasts that didn’t develop past tanner III or IV and help get the breast into tanner V, which is full maturity. Generally breasts may look underdeveloped or with a cone-like shape unless progesterone is taken.

There are even some over the counter bioidentical estrogen and progesterone creams available on the market. But the issue remains, most all of them are a combination of estradiol and estrone and/or estriol, and thus the amount needed for transition is not adequate enough.

After taking bioidentical hormones, It’s not so much about where your estrogen levels sit, even if they are in range, but rather how you feel. If you are having hot flashes, suffering from mental decline and bone loss, and are at higher risk for a heart attack, then your dose, even if in range, is not high enough for you and needs to be higher. You will need to find a proper doctor that can address your concerns and work on a proper dosage for you.

Bioidentical hormone replacement therapy can greatly benefit transgender women, along with postmenopausal women who are dealing with the symptoms of estrogen deficiency. They can offer greater flexibility and tend to be somewhat safer than conventional HRT, but it’s important to get the right dosage for your body.

Let me know how this works for you. Have a great day!

Additional Info

I have been interested in bioidentical hormone replacement therapy since I heard about the surgical pellet that can be placed under the skin that lasts for about six months. I heard this was bioidentical, and then I started researching and seeing what the difference was. While most bioidentical hormones require a prescription, there are a decent amount that do not. However, I cannot recommend any of these products since they all contain multiple forms of estrogen and low estradiol. However, there does appear to be one product available on Amazon. It claims to be strictly estradiol and comes with progesterone. Maybe that would be worth a try for someone looking to transition and/or a woman going through menopause.


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