Hormone replacement therapies are designed to restore that balance. Both Hormone Replacement Therapy (HRT) and Bioidentical Hormone Replacement Therapy (BHRT) can provide meaningful relief for people experiencing hormone-related symptoms. While they share the same goal, the way they work, the type of hormones they use, and how they are prescribed differ in important ways.
In this guide, we'll explain how HRT and BHRT work, highlight their key differences, and review potential benefits and risks. We also outline how Onus IV Therapy + Longevity approaches hormone therapy with precision and care.
Written by:
Dr. Ben Wilks
Published: August 27, 2025
BHRT vs HRT: Hormone Replacement Options
Compare BHRT vs HRT to understand key differences in hormone replacement options, benefits, risks, and how Onus personalizes hormone replacement therapy for balance.
Hormones are powerful messengers that regulate vital functions such as energy, mood, sleep, metabolism, and sexual health. When hormone levels decline or become imbalanced—whether due to aging, lifestyle factors, or medical conditions—everyday life can feel disrupted. Fatigue, mood changes, sleep disturbances, and other symptoms often signal that the body’s natural balance has shifted.
What Is HRT?
Hormone Replacement Therapy (HRT) is the traditional, widely used approach to restoring hormone levels. It typically involves estrogen and progesterone therapy for women going through menopause, and testosterone therapy for men experiencing age-related decline.
HRT uses synthetic hormones designed to mimic, though not exactly replicate, the hormones naturally produced by the body.
Delivery methods: Pills, patches, creams, and gels are the most common options.
Who it’s for: Often prescribed for women navigating menopause, and also for men and women facing hormone decline or recovering from surgical removal of reproductive organs.
HRT’s strengths lie in its broad availability, FDA-approved options, and decades of clinical research supporting its effectiveness. It remains an important treatment option for many patients.
However, potential side effects, such as bloating, headaches, mood changes, and in some cases increased risk of blood clots or stroke, are important factors to consider in consultation with a qualified provider.
What Is BHRT?
Bioidentical Hormone Replacement Therapy (BHRT) presents a more individualized approach. Unlike synthetic hormones, bioidentical hormones are chemically identical to those naturally produced in the body. This molecular similarity allows the body to recognize and respond to them as if they were its own.
BHRT uses plant-derived, pharmaceutical-grade compounds that are structurally matched to human hormones at the molecular level.
Customization: Treatment is based on comprehensive lab testing. Dosages are adjusted to each individual’s hormone levels and health needs, making BHRT a more personalized therapy than standardized HRT protocols.
Delivery methods: BHRT may be prescribed in creams, gels, lozenges, or capsules. One of the most widely used and reliable options is pellet therapy, in which small pellets are inserted under the skin to release hormones steadily over several months.
This steady delivery is often valued by patients, as it avoids the fluctuations in hormone levels that can occur with oral or patch-based therapies. For many patients, this makes BHRT both effective and sustainable in the long term.
The Key Differences That Actually Matter
While both HRT and BHRT work toward the same goal of restoring hormonal balance, there are important distinctions that influence how each therapy is experienced.
- Molecular structure: Synthetic hormones used in HRT are designed to mimic natural hormones but are not identical. Bioidentical hormones, by contrast, are structurally the same as the hormones produced by the human body.
- Dosing: HRT generally follows standardized dosing protocols. BHRT is customized, with doses calibrated through lab testing and adjusted over time as hormone levels shift.
- Source: Synthetic hormones are created through laboratory processes, while bioidentical hormones are derived from plant sources that are modified to match human hormones at the molecular level.
- Regulation: Many HRT medications are FDA-approved and available as standardized prescriptions. BHRT may include FDA-approved options, but compounded formulations are also common, created by specialized pharmacies to meet individual needs.
Knowing these differences can help patients evaluate which therapy better aligns with their health goals, lifestyle, and comfort with regulation.
Benefits and Risks of BHRT vs HRT
HRT Benefits
Effective for menopause treatment options like reducing hot flashes, night sweats, and bone loss.
Backed by long-term studies.
Widely covered by insurance.
HRT Risks
Potential increased risk of breast cancer, stroke, and blood clots (especially with certain forms).
Side effects like bloating, mood swings, or headaches.
BHRT Benefits
Designed to feel more natural because your body “recognizes” the hormones.
Tailored through ongoing testing and adjustment.
Pellet therapy offers convenience and steady dosing.
BHRT Considerations
Limited large-scale, long-term studies compared to traditional HRT.
Requires a skilled provider for safe and accurate dosing.
Both approaches aim for hormone optimization, where you feel balanced, clear-headed, energized, and in control again.
The road you take depends on your priorities: consistency, customization, regulation, or cost. We're here to help you make the choice that's right for you!
The Onus IV Therapy + Longevity Approach
Hormones don’t respond to averages. Two people can show the same lab results on paper, yet experience very different symptoms in daily life. That’s why Onus IV avoids one-size-fits-all protocols.
Every therapy begins with a detailed evaluation, not assumptions. Full hormone panels are run before any treatment is prescribed, providing a clear picture of where your levels stand and how they interact with the rest of your body’s systems.
From there, treatment is personalized. Unlike standardized prescriptions, pellet formulations at Onus IV Therapy + Longevity are compounded to meet the specific needs and dosage of each individual. Much like tailoring a suit, precision matters - your hormones deserve a fit designed for you alone.
Personalization also continues beyond the first treatment. Hormone levels shift naturally over time due to stress, age, lifestyle, or even seasonal changes. That’s why ongoing management is a core part of the process. Our team consistently monitors your progress, adjusting as needed to keep your therapy aligned with your body’s needs.
Every stage of treatment is guided by licensed nurse practitioners with specialized training in hormone therapy and clinical safety. This means you can feel confident knowing your care is handled with medical expertise and oversight.
- Comprehensive testing – Complete hormone panels provide a clear baseline before treatment begins.
- Personalized formulations – Compounded doses are designed to match your unique requirements.
- Ongoing monitoring – Regular follow-ups track symptoms and lab results, with adjustments as needed.
- Professional oversight – All care is managed by experienced nurse practitioners trained in safety and precision.
This approach goes beyond masking symptoms. It focuses on restoring balance and supporting long-term hormone health in a way that feels natural, safe, and sustainable.
How Do You Choose Between BHRT and HRT?
Choosing between hormone therapies is not about finding a universally “better” option—it’s about finding the one that fits your body, goals, and comfort level. Several key considerations can help guide the decision.
Start With Your Symptoms
If your primary concern is relief from menopausal symptoms such as hot flashes, night sweats, or bone density loss, HRT may provide proven, effective results. If you are seeking a broader reset—support for energy, mood, sleep, or libido—BHRT may be a better fit. Its personalized dosing allows treatment to be tailored more closely to your specific needs.
Consider Regulation and Oversight
Some patients feel most comfortable knowing their prescriptions come from FDA-approved, standardized products. Others value the flexibility of compounded formulations that are created specifically for them, even though they may fall outside traditional regulatory pathways. Neither approach is wrong—it depends on your comfort level and trust in your provider.
Think About the Source
HRT relies on synthetic hormones developed through pharmaceutical processes. BHRT uses plant-derived compounds that are modified to be structurally identical to natural human hormones.
Your preference may come down to whether you value the consistency of synthetic hormones or the biological familiarity of bioidentical ones.
Match the Therapy to Your Lifestyle
Daily pills, creams, or patches may be the right choice for those who prefer routine, while pellet therapy offers steady, round-the-clock support without the need for daily reminders. For patients who value convenience, pellets can feel transformative.
The Most Important Factor: Your Provider
Ultimately, the decision is less about HRT versus BHRT and more about who guides your care. A provider who listens, tests, and adjusts treatment over time will make a greater difference than the therapy itself. With the right oversight, you will not only understand your options—you will know which one is best aligned with your health.
Bottom Line: This Isn’t a DIY Decision
Hormones are powerful. The right therapy can restore your vitality; the wrong one—or the wrong provider—can leave you spinning. HRT vs BHRT isn’t about better or worse. It’s about fit. Your body, your health history, your goals. At Onus, we specialize in guiding clients through these choices with precision testing, personalized protocols, and a patient-first philosophy that’s been our promise since 2014.
Ready to Take the Next Step?
If you’re wondering whether hormone replacement therapy could help restore your balance, the best place to begin is with a consultation. At Onus IV, we take the time to review your lab results, discuss your symptoms, and explain your options clearly so you can make an informed decision with confidence.
Find out if BHRT therapy is right for you.
Frequently asked questions about BHRT vs HRT
BHRT (Bioidentical Hormone Replacement Therapy) uses hormones that are structurally identical to the ones produced naturally by the human body, such as estrogen, progesterone, and testosterone. These hormones are derived from plant sources and designed to mimic the body's natural hormone production, leading to fewer side effects compared to synthetic alternatives. BHRT is used to restore hormonal balance, improve energy levels, and reduce symptoms associated with hormonal decline, such as fatigue and mood changes.
Many patients start noticing improvements within 2–4 weeks, though full results may take up to 3 months.
Both men and women experiencing symptoms of hormonal imbalance — such as fatigue, low libido, poor sleep, or weight gain — may benefit from BHRT.
Yes. Pellet therapy is a safe, minimally invasive procedure with little downtime when administered by experienced healthcare professionals. Because pellets release hormones consistently, many patients find it provides better results than oral or injectable forms.
Every patient receives a lab panel to identify hormone deficiencies. A nurse practitioner then reviews the lab results and customizes the pellet formulation and dosage to meet your body’s specific needs. A 5 week follow up blood panel ensures that dosage is correct and allows for adjustments to be made if deemed necessary.
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Written by:
Dr. Ben Wilks
Dr. Ben Wilks
Co-Founder, Medical Director
Wayne State Masters in Medical Science, Michigan State Med School, Baystate / Tufts Residency. Part time ER doctor, full-time adventure enthusiast. Lover of all things adrenaline. Current loves include kite surfing, cycling, skiing and kicking it with my Irish Wolfhound Grace. Spend a lot of free time exploring life's mysteries along the path less traveled.
Connect on LinkedIn: https://www.linkedin.com/in/benjamin-wilks-md-93267111a/