Bioidentical vs Synthetic HRT: What’s the Difference? | Hormone Therapy Explained | Vitality Unfiltered

Vitality Unfiltered Podcast

Host: David J. Bauder, PA-C
 Co-Host: Stephanie Lattimore
 Guest: Christopher Reeves

In this episode of Vitality Unfiltered, we explore one of the most common—and often misunderstood—topics in hormone therapy: the difference between bioidentical and synthetic hormones.

Patients today are exposed to a wide range of information, much of it conflicting, leading to confusion and uncertainty about what these terms actually mean. Much of this confusion stems from outdated studies, marketing language, and generalized conclusions that do not reflect how modern hormone therapy is practiced today.

David J. Bauder, PA-C, founder of Weight Loss & Vitality, along with co-host Stephanie Lattimore and guest Christopher Reeves, break down the science behind hormone structure and function.

The discussion focuses on how molecular structure determines how hormones interact with receptors, how they are metabolized, and how they ultimately affect the body. While bioidentical hormones are designed to match the body’s natural hormones, synthetic hormones differ structurally—and those differences can influence physiologic response.

The episode also provides important context around early hormone research, much of which utilized synthetic formulations and contributed to widespread concern about hormone therapy. Modern approaches have evolved significantly, emphasizing individualized dosing, advanced diagnostics, and ongoing monitoring.

A central message of this episode is that hormone therapy should not be viewed in black-and-white terms. Instead, decisions should be guided by an understanding of physiology, patient-specific factors, and thoughtful medical oversight.

In This Episode We Discuss

• The definition of bioidentical versus synthetic hormones
 • Why molecular structure influences receptor binding and signaling
 • How small structural differences affect physiologic outcomes
 • The role of early hormone studies in shaping current perceptions
 • How hormone metabolism creates different downstream effects
 • The impact of route of administration and individual variability
 • Why modern hormone therapy emphasizes precision and personalization
 • How to interpret risk, benefit, and conflicting information
 • The importance of avoiding oversimplified “good vs bad” thinking
 • What responsible, medically guided hormone therapy looks like today

Key Takeaway

Hormone therapy is not defined by labels—it is defined by structure, physiology, and individualized care. Understanding how hormones behave in the body allows for more informed, balanced decisions and better long-term outcomes.

Contact Weight Loss & Vitality

📞 Call: 571-550-9000
 🌐 Visit: https://weightlossandvitality.com

About Vitality Unfiltered

Vitality Unfiltered is a medical podcast exploring the science of hormones, longevity, metabolism, weight loss, aesthetics, and precision medicine.

Each episode provides clinical insight from healthcare professionals who treat these conditions every day.

Our goal is simple: to help people better understand the biology of their health so they can make informed decisions about wellness, prevention, and long-term vitality.

⚠️ Disclaimer
This podcast is for educational purposes only and does not constitute medical advice. Listening to this episode does not establish a provider-patient relationship. Always consult your qualified healthcare professional regarding medical concerns, diagnosis, or treatment.

Transcript

SPEAKER_02 0:00

Vitality. Vitality Unfiltered. Unfiltered. With David Bowder.

SPEAKER_00 0:10

Welcome back to another episode of Vitality Unfiltered. I'm David Bowder, your host. Joining me today from Weight Loss and Vitality is Dr. Christopher Reeves, Medical Director, and nurse practitioner Stephanie Lattimore from the Washington, D.C. Clinic. Today's conversation is going to be centered around synthetic and biodenical hormones. Biodentical hormone, the f the word biodentical, it's everywhere. People automatically think that biodentical hormone is safe, synthetic is not. Or there's a lot of misinformation out there. A lot of this is being projected on social media. So we want to really kind of take it to a real high level here and talk it so the audience can understand that, yes, there's a lot of thought out there that biodentical hormone is a safer alternative. However, there are still risks associated with all of this, and that's what we're going to work on today in this conversation. So, Ms. Stephanie, real high level here. What is the difference between biodentical and synthetics?

SPEAKER_03 1:00

When it comes to hormone therapy, we have your bioidential hormones and your synthetic hormones. And there's pros and cons to both. Synthetic is going to be similar to what we naturally have in our body. Bioidentical is going to be a literal biologically identical match to the hormones in our body. So you can think of this as structure and shape will bind to those receptors just identically versus synthetic. They're not going to bind quite as identically, but they may still be able to get the job done. So they differ on a molecular level. And like I said, there's pros and cons to both. When it comes down to it, though, we're trying to get the best match to the hormones that our body naturally produces.

SPEAKER_00 1:42

Yes, and exactly, exactly. It could bind, it can bind exactly the same, but after that hormone breaks down, it might not look the same as when a bioidentical hormone breaks down. So is that correct? Like molecular structure correctly. Right.

SPEAKER_01 1:56

So like you know, the biodentical, as Stephanie said, is a c as close of a match to the naturally occurring form as possible. Synthetics are kind of like the pharmaceutical industry's one size fits all, kind of primarily driven by being able to mass produce these and kind of cover a population. When I was in medical school, one of my mentors said to me, he was like, Chris, whenever you whenever a new drug comes out on the market, never prescribe it within the first two, three years of it being on the market, because that's when you're going to see all the side effects. Trevor Burrus, Jr.: Because what's happened is they've done a small study with a small subset of people and they see some side effects that may come out. But when you you know when you apply that to millions of people, you're gonna tease out those more rare, those one in one thousand, one in ten thousand kind of side effects are gonna come out. And that's kind of a similar way to look at kind of like the synthetics. They were mass-produced, and so when you so you see some of these side effects. A lot of that happens when you talk about the breakdown, like you're talking about, of these um compounds. The metabolites or the breakdown products of those uh those um hormones can sometimes be different than what the body would normally uh produce when it's broken down. And those metabolites may cause some side effects and some problems. And so that's kind of the kind of a just a deeper level of looking at kind of the difference between biodenttical and synthetic.

SPEAKER_00 3:17

Aaron Ross Powell When you told the when you mentioned the story about don't be the first ones to prescribe a new medication, I immediately thought of uh celdane, the antihistamine that got taken off, uh finfin. Yes. That was another and um I think key tech. That was a macrolide that caused a lot of heart problems associated with that. And gosh, did we use the heck out of that a lot for like upper respiratory infections and things like that. And that came on the market with just like boom, and then like just like that, it was gone.

SPEAKER_01 3:45

VIOX.

SPEAKER_00 3:46

That's another one. Yeah, VIOX is a that was a big one, actually. Viox. Good point on that. You know, when this synthetic biodentical hormone controversy really started in the women's initiative study. We've mentioned this on other s on other episodes. And what what we pulled out on that, you know, and what the conversation is, is that women's health initiative study that was done, they treated all the women the same, they used synthetics, they didn't use biodenticals, and then they pulled the study. I mean, you have a lot of insight in that women's health initiative. I mean, what what are your thoughts on that?

SPEAKER_01 4:16

Trevor Burrus, Jr.: Well, uh again, there's so many things that were done like on that and that scared a generation of doctors from hormone replacement therapy for a whole generation. I mean, I was in part of that training uh lull where everybody was avoiding it because the information in terms of how the study was done, when they re-looked at the data, they saw that everybody was lumped into the same category, with you know, perimenopausal women in their 40s all the way up to their 60s and 70s. And they saw that an increase in um in cancers and cardiovascular risk, but they did not separate these groups of of women to see that if you were within 10 years of your onset of your menopausal symptoms, hormone replacement was actually protective as compared to detrimental. And as we know, as we age, incidents of heart disease, cancer, these kind of things occur independent of hormone status just with age. Uh. And so those data is kind of um that study kind of muddied the waters a little bit uh in terms of interpreting this. In addition to what we mentioned before, the use of synthetics as compared to biodentical uh gave a another different risk profile.

SPEAKER_00 5:26

Aaron Ross Powell It really, really shaped the narrative on women's hormones. That that I mean, how it how it really it really got into the media hype and it just it ran with it and it just shut down an entire tree- I mean, it's just crazy how it just really grabbed.

SPEAKER_01 5:40

The whole generation of women are suffering unnecessarily from a from a cardioproductive standpoint for longevity and vitality and wellness, but also in terms of symptomatic, you know, in terms of moods and hot sweats and sleep disturbances and irritability, loss of libido, which can affect marriage and happiness. So it's so many things that are affected by such an a way to be managed that can be managed.

SPEAKER_03 6:04

And another generation is impacted by those women. They're fearful of hormone replacement therapy and they've heard the worst of the worst and they don't know how to proceed. Aaron Powell Yeah.

SPEAKER_00 6:13

We need to think of the patient population coming into our clinic, too. There's just such a huge group of women, 59 to 65 that I see, just such a large, large portion. And they're all struggling with weight, but they were all left off of hormone therapy after menopause, every one of them. And they and they you know they went through that whole phase and they remember it very well. And they also are free to, you know, they freely admit that that's when their weight became very difficult to manage. And they just were left off of that. So when you think about hormone therapy, whether it's bioidentical hormones or synthetic stuff, what do you um when you think about the metabolism and the downstream effect of how this stuff breaks down in the body and kind of where are we trying to separate these two things?

SPEAKER_03 6:55

Aaron Ross Powell So, like I had mentioned, pros and cons to bioidentical and synthetic. The bioidentical hormones are going to be read by the body as same, so structurally same to the hormones that we already have. So they're going to break down a little bit more similarly to the hormones that our body naturally produces. The synthetic hormones are going to break down and hopefully improve some of the symptoms of menopause or whatever we're using them for. But there will be the formation of metabolites or kind of byproducts because they're not structurally identical. And there can be side effects from these metabolites that are produced in the body, sometimes unintended effects, not quite exactly the symptom management that we're going for. Um so that's kind of the downside of the synthetic hormones.

SPEAKER_00 7:43

Yeah. And it seems like if it's if there is going to be any long-term Well, that's leads us to our next question, talking about what does modern hormone therapy look like, or what does the what does hormone therapy look like in women in the next 10 years. And it's going to be I just think about all of the work that goes into treating a single patient and the tests, the follow-ups, the orders, getting the dose right, getting the preparation right, whether it's going to be a patch or I mean what do you think the modern modern hormone therapy is going to look like in women?

SPEAKER_01 8:14

Aaron Ross Powell Well, I think that as we get more awareness and um understanding of that this is not a scary thing, that it can be done safely, we'll begin to get more patients coming in that are seeking help with these symptoms and things that they're that they're experiencing and they're and they're having. One of the things that kind of naturally occurs is that's why having the understanding of the biodical, because there's different types of estrogen that the body makes, and they peak and valley at different times, um, you know, without getting too technical, like we talked about, E2 is the most prominent form of of uh estrogen that you know the that the women make from their uh from their ovaries, and during menopause, those levels decline. And some of the other forms, you know, kind of throw out of balance, you know, the proportion or the balance that is kept in check. And so some of the more detrimental ones can that have the side effects and that sort of thing uh come out come out of uh out of proportion. So when we you look at the biodenical hormone replacements, we're looking at increasing the number of the quote unquote safer or more tolerated uh forms of estrogen to get that proper balance back. And I think that once these once we do this more, get more experience with this. I can't say that traditional medicine will be able to kind of do it effectively because the monitoring needs to be a little bit more closely. This is kind of a recurring theme on the show, that in traditional medicine is not necessarily set up or equipped to really properly manage these uh these women because you need to s do follow-ups within three to six uh months, not six to twelve months, uh to properly make sure that you're on on par with with things. So that's where I think uh there can be a little bit of a of a of a struggle there, uh depending upon where you're seeking the care for the uh for their hormone replacement. Aaron Ross Powell Yeah.

SPEAKER_00 9:59

I just see such a long-term like tooth-to-tail, like long-term approach on managing women is it's just such going to be it's going to be such a customized approach for each single patient. It's not just you're just prescribing a medication to control someone's cholesterol level or you know, here's a blood pressure medication, you know, take this once a day. It it's different. You know, the current guidelines that are out there exclude so many women from even getting hormone therapy.

SPEAKER_01 10:24

Trevor Burrus, Jr.: You said about the future. I think that you made a really good point. I think that I don't want to gloss over it is the rise and the advent of genetic testing and screening. It can be absolutely monumental in terms of teasing out this gray area that is not black and white, but really laying in this gray area where you lie. So, for example, depending upon your genetic screening, you may find that you know a transdermal form is better than an oral form, or you may want this, you know, uh an E3 heavy, E2 light uh version versus an E2 versus E3. So these are things that we're gonna start to get more data, more information as we start doing more of this genetic screening and testing. And I think the future will allow for this precision medicine type approach for hormone replacement to safely administer these patients in those ones that traditionally today would be kind of excluded.

SPEAKER_00 11:12

Aaron Powell Yeah, 100%. They'd be excluded from anyone because no one's gonna take first of all, there is no processes in place to manage them. Right. It's just like it is literally black and white. No, yes. Okay, you have these five things. No, you can't have it. You got these things, you're good. Oh, you can have it, you here's a patch. I mean, this is what we got right now in medicine.

SPEAKER_03 11:27

Aaron Ross Powell And you said that um the intake is time consuming, it really is. I had a new patient last week um who came in for hormone replacement therapy. We talked for 90 minutes. I was very lucky to have that much time in my practice. She had been, and this will kind of help with the synthetic bioidentical mind frame. She had been prescribed an estrogen patch E2 synthetic from her OBGYN and 100 milligrams of progesterone. Um we checked her labs. They were decent for postmenopausal. They were not optimized by any means, and her symptomology followed the same pattern. She was feeling better post-menopause, but not quite. I think there was room to grow. There was improvement to be made. I offered her switching that estrogen, that E2 synthetic, because she did have some side effects, to an E2, E3 combination of biestrogen cream. This was something that I could tailor to her. She'd get some of those benefits of the weaker E3 with less of the side effects. So she was willing to give it a try. So I will now assess her in six to eight weeks to see if we've kind of moved the mark on her symptoms as well as in her lab work. And I increased her progesterone because she wasn't sleeping well. So that was kind of a, you know, but that's just kind of a comparison of the synthetic can only be tailored so uniquely to a patient versus the room that me we can make with bioidentical.

SPEAKER_00 12:52

When you think about when when these patients that you're seeing, how do you go about uh informing the patients of the risks associated with the with the hormones?

SPEAKER_03 13:01

Um so definitely the intake is a big piece of it, that family history. I have a list of absolute contraindications, which I take with a grain of salt, but it's really important to take that history and pair it with routine screening. Have they had a routine mammogram? Have they had a baseline pelvic ultrasound? Family history, you know, we're always gonna dig up some distant aunts and, you know, extended family members. But I'm I want to know you, your mom, your grandmother, and I always ask if they have uh daughters as well. Um, a lot of my patients have had genetic testing, so they know, oh, I had a distant with a breast cancer, we're not BRACA, we're not, you know, it's not a um hormonally driven cancer. So patients are well educated. Um, they're savvy, they come and they know what they want, what they need. Um, they make for great candidates. And there's always those screening tools I can use for women who don't know their family history as well. Every woman is gonna have the same basic lab testing and screening to increase safety and to minimize risk.

SPEAKER_00 14:04

So I wish that the bracket test would be cheaper. You know, like insurance gives insurance really gives uh gives the patients a a runaround on getting it approved through the insurance. And I think the the cash price is right at $1,400. So you get the comprehensive one. And um it should just be open. It should just be open season. I mean, I'm not kidding. This should be like a just somebody needs to come online and say this is a $150 lab test and it should just be open for everyone.

SPEAKER_03 14:29

Do you know how many women would jump on that? Oh, absolutely, 100%. I would.

SPEAKER_00 14:32

Yeah, absolutely. Absolutely. There is an online BRCA testing uh business that does it, but they don't do the comprehensive one. They kind of they just do I think just I think they're just doing BRCA one. And and it's not so terribly bad, but you still need the whole profile to be added. If you're gonna do this correctly. Like what do you normally do?

SPEAKER_03 15:00

Aaron Ross Powell So I'll definitely do a full panel, um, complete blood count, metabolic panel. I always like to check liver and kidney function. Um cholesterol is a big piece for women entering menopause. A lot of times their cholesterol can go up, hemoglobin A1C. These are my basic screenings. But the three primary hormones I test for all women are that estradiol, the pro the primary estrogen, progesterone, and testosterone. Can't forget about testosterone. A lot of times I'll check a sex hormone binding globulin, um, free testosterone. Um, those are the big ones that I'll check. Did I miss any? Thyroid Oh, always. Oh, yeah. The biggest one. You guys are like, is she gonna say it? Is she gonna say it? Thyroid stimulating hormone and probably the whole panel. You can't ignore the the we talked in an earlier episode about how women, especially aging women, are at a eightfold increased risk of developing a thyroid condition as well as an autoimmune condition. Um so weight gain, high uh menopause symptoms should raise alarm bells on hypothyroid.

SPEAKER_01 16:04

So that's in that's in my Do you routinely check uh cortisol levels in the Dutch test?

SPEAKER_03 16:09

Aaron Powell I do not.

SPEAKER_01 16:10

No.

SPEAKER_03 16:11

I don't. We talked about adding it to our our panel. Cortisol, as we discussed in the earlier episode, um, really needs to be tracked throughout the day. You know, a single number morning, night, it's gonna it doesn't really tell us as much as uh 24-hour would.

SPEAKER_00 16:26

Aaron Powell That that Dutch test is something else. I mean, that's there's some there's some good test. I mean, there's no doubt about it.

SPEAKER_03 16:32

Trevor Burrus, Jr.: Tell me about is that the urine test.

SPEAKER_01 16:34

It's a dried urine test that you take. And that gives you kind of like we're talking about that curve for cortisol. It tells you exactly where your peaks and your valleys are and your basal levels and that sort of thing. Uh gives you an indication of those things. And given the all that we're talking about, how cortisol affects everything and and including the symptoms we're talking about here, I think that uh maybe we should you know I I when I was preparing for that uh that lecture, I was like, well, maybe we should do more Dutch tests.

SPEAKER_00 17:00

Trevor Burrus, Jr. Yeah. Like um when when I explored it like I originally when you know the whole the whole formulation of the protocols and things like that were being established, this was talked about a little bit. And it's an expensive test. Yeah. It's not a cheap one. And uh even already when we're testing patients, you know, and and you know, we're trying to go through it by the numbers and do it do it the right way, uh it all adds up. And uh it really came down to um not as many, not very many patients wanted to pay the extra for the job.

SPEAKER_01 17:30

Trevor Burrus, Jr.: That's the problem with some of this stuff, is that in order to get the real answers and the real data that we need to really personalize and treat these patients as they need to be treated, insurance unfortunately is not gonna cover a lot of these lab tests. Trevor Burrus, Jr.: That's right.

SPEAKER_00 17:45

Aaron Ross Powell And that's actually we're gonna probably cover that. And one of our episodes we're gonna talk about is uh a laboratory testing over 35. And um and I'm sure we're gonna get into that on that on that conversation.

SPEAKER_03 17:56

Aaron Ross Powell And you just made me think of something else, Dr. Reeves. Synthetic versus bioidentical. Synthetic might be covered by insurance, able to pick up at a retail pharmacy. Bioidentical?

SPEAKER_00 18:08

Maybe not. Aaron Ross Powell Yeah, not very many. Trevor Burrus Yeah.

SPEAKER_03 18:10

So that's a pros and cons. We you know we think of all the benefits of one, but ease of access, systems, this is a big theme.

SPEAKER_00 18:17

Absolutely. Across the board for all our patients. Yeah, I think that's uh I really appreciate you guys' time today. And uh just for the listeners out there, just always understand, you know, um hormones aren't dangerous, misinformation is. And uh make sure you're doing your research, make sure you get a credible, qualified, competent clinician, provider that can help walk you through this, somebody that's gonna take their time and do an appropriate workup for you, explain the nuances of all of these different things that are involved with synthetic and biodental hormones. Synthetic hormones could certainly work very well for some certain patients out there. Biodentinal hormones from a compounding pharmacy could work perhaps better for another patient. And so with that, I want to thank you all for listening. If you enjoyed the show, make sure you click the subscribe button below. It really helps us out. And we and we'll see you next time on the next episode.

SPEAKER_02 19:06

Thanks for joining us on Vitality Unfiltered with David Bowder. Addressing norms, busting myths, and uncovering health realities for a more vibrant life today. For more expert insights and real talk, make sure to subscribe and join us next time.