HRT Protocols

Bioidentical Hormone Replacement Therapy

Clinical guidelines for prescribing compounded BHRT, including patient assessment, dosing protocols, and monitoring requirements.

Introduction to BHRT

Bioidentical Hormone Replacement Therapy (BHRT) utilizes hormones that are molecularly identical to those produced endogenously by the human body. These hormones (Estradiol, Estriol, Progesterone, Testosterone, DHEA) are synthesized from plant-derived sources and compounded into patient-specific formulations.

The primary goal is to alleviate symptoms of hormonal imbalance (menopause, perimenopause, andropause) by restoring hormones to optimal physiological levels. Unlike synthetic hormones, BHRT offers a more physiological approach, allowing for personalized dosing and potentially reduced risks.

Absolute Contraindications
  • Undiagnosed abnormal vaginal bleeding
  • Known/suspected breast cancer
  • Estrogen/progesterone-sensitive neoplasia
  • Active/history of DVT or PE
  • Active/recent arterial thromboembolic disease (stroke, MI)
  • Severe active liver disease
  • Pregnancy
Patient Assessment & Candidacy
A thorough evaluation is mandatory before initiating therapy.

Clinical Evaluation

  • Symptom EvaluationVasomotor, genitourinary, psychological, sexual dysfunction, quality of life.
  • Medical HistoryCVD, thrombosis history, cancer history (breast, endometrial, prostate), liver disease.
  • Physical ExamBP, BMI, CV/Thyroid assessment. Women: Breast/Pelvic exam. Men: DRE as indicated.

Baseline Laboratory Panels

Female Panel

Estradiol (E2), Progesterone (P4), Total & Free Testosterone, DHEA-S, FSH, LH.
Progesterone best tested in mid-luteal phase for premenopausal women.

Male Panel

Total & Free Testosterone, Estradiol (E2), PSA, LH, SHBG.

General Health

CBC, CMP, Lipid Panel, HbA1c, Vitamin D, hs-CRP, Thyroid Panel (TSH, Free T4/T3, Antibodies).