BHRT in Houston, with the workup it deserves.
Yes, we offer Bioidentical Hormone Replacement Therapy. We default to FDA-approved bioidenticals — and use compounded preparations when there's a specific clinical reason. Both are bioidentical. Both are BHRT.
Yes, we offer BHRT. Here’s what kind, and how we think about it.
Bioidentical Hormone Replacement Therapy (BHRT) means hormone replacement using molecules that are chemically identical to what your body produces naturally — estradiol, progesterone, testosterone. This is the standard of care for hormone replacement in 2026. The estradiol in an FDA-approved transdermal patch, the estradiol in a compounded BHRT cream, and the estradiol your ovaries produced in your twenties are all the same molecule.
At The Tide, we prescribe bioidentical hormones — that’s been our default since the clinic opened. Most of what we prescribe is FDA-approved bioidentical (transdermal estradiol patches, oral micronized progesterone, FDA-approved testosterone for men). For specific clinical situations, we use compounded BHRT preparations from licensed compounding pharmacies. Both are bioidentical. Both are BHRT.
The conversation worth having isn’t “FDA-approved or BHRT” — that’s a false choice. The conversation is “which form of bioidentical hormone replacement fits your specific situation.” That’s what consultation is for. For our broader approach to women’s HRT and men’s TRT — both of which use bioidentical hormones — see those pages.
FDA-approved bioidenticals and compounded BHRT, in practice.
Both are bioidentical hormone replacement. The differences are in regulation, dosing precision, and clinical evidence — and there are good reasons we use one or the other depending on the situation.
FDA-approved bioidenticals
Estradiol patches and gels (Vivelle-Dot, Climara, Estrogel, Divigel), oral micronized progesterone (Prometrium), FDA-approved testosterone cypionate and enanthate for men. Manufactured under FDA oversight with batch-by-batch testing. Precise dosing. Decades of clinical RCT evidence. Most insurance covers them. This is the default for the majority of our patients.
What this means: Predictable dose · Insurance covered · Strong evidence baseCompounded BHRT
Compounded creams, troches, capsules, and pellets prepared by licensed compounding pharmacies. Allows customization not available in FDA-approved products. We use compounded preparations selectively — when there’s a specific clinical reason that the FDA-approved option doesn’t fit the patient’s situation.
What this means: Customizable · Used selectively · Out-of-pocketThe clinical reasons
When a patient has a documented allergy to inactive ingredients in FDA-approved products. When low-dose testosterone is needed for women (no FDA-approved product exists at female-physiologic doses). When the FDA-approved product isn’t available in a form the specific patient can tolerate. When custom combinations or dosing fit the clinical picture better than off-the-shelf options. These are real reasons.
Evidence: Patient-specific clinical justificationThe bioidenticals we prescribe, by category.
Here’s the actual prescribing picture. FDA-approved by default; compounded where a specific clinical reason calls for it. Same bioidentical molecules either way.
The molecule is bioidentical. The delivery is matched to the patient.
FDA-approved usually works best because dosing is precise and insurance covers it. Compounded is the right answer when there’s a specific reason FDA-approved doesn’t fit. We explain the choice during consultation either way.
- Estradiol — FDA-approved transdermal patches (Vivelle-Dot, Climara) or gel (Divigel, Estrogel) by default; compounded cream when patches aren’t tolerated
- Progesterone — FDA-approved oral micronized (Prometrium) at bedtime for women with a uterus
- Testosterone (men) — FDA-approved cypionate or enanthate by injection
- Testosterone (women) — compounded at female-physiologic doses; no FDA-approved option exists at these doses
From consultation to first prescription, in real medicine.
Prescribing BHRT — whether FDA-approved or compounded — follows the same workup process. The decision about which preparation comes after we understand your specific situation.
Initial consultation
In person at our Houston clinic. We discuss your symptoms, medical history, prior hormone therapy (including compounded BHRT or pellets), current medications, and goals. We walk through the FDA-approved vs. compounded landscape honestly and start to identify which fits.
Comprehensive lab work
A full hormone panel at LabCorp or Quest — estradiol, FSH, LH, testosterone (total and free), SHBG, thyroid (TSH, free T3, free T4), DHEA-S, cortisol, A1c, lipids, vitamin D, and inflammatory markers. The panel that drives dose selection.
Protocol design
Your physician designs your specific protocol — FDA-approved bioidenticals where they fit (the majority of patients), compounded preparations where there’s a specific clinical reason. We explain the choice and the reasoning so you understand both the what and the why.
First prescription
FDA-approved products filled at retail pharmacy. Compounded preparations (when used) filled at a licensed compounding pharmacy with documented quality controls. Application instructions, starting dose, and clear expectations: most patients notice symptom relief within 4–8 weeks.
Monitor & adjust
First comprehensive reassessment at 12 weeks: repeat hormone panel, symptom review, dose adjustment if needed. Then every 6 months, and annually long-term. Dose adjustments happen in days, not months. Annual reassessment includes the benefit-risk picture and whether continuation, taper, or discontinuation is right for the next year.
Ready to talk through your options?
A 45-minute consultation with one of our physicians. We’ll review your situation and walk through what BHRT looks like for you specifically — FDA-approved bioidenticals, compounded preparations, or some combination.
What’s true about BHRT, and what’s marketing.
The BHRT conversation has a lot of marketing in it. Some of the claims are accurate. Some are mostly true but oversold. Some aren’t supported by clinical evidence. Here’s how we sort them during consultation.
Claims that are actually true
- Bioidentical hormones have the same chemical structure as what your body produces
- Many FDA-approved hormone products are bioidentical (estradiol patches, oral micronized progesterone, testosterone cypionate)
- For women starting HRT within 10 years of menopause, the benefit-risk picture favors treatment for symptomatic relief
- Bioidentical estradiol via transdermal route has a different (more favorable) thrombosis risk profile than oral synthetic estrogen
- Compounded preparations can be the right choice for specific clinical situations
- Quality varies across compounding pharmacies — choosing a reputable one matters
Claims that aren’t supported by evidence
- “Compounded BHRT is inherently safer than FDA-approved bioidenticals” — no evidence supports this
- “FDA-approved hormones aren’t bioidentical” — many of them are exactly bioidentical
- “Saliva testing is more accurate than serum” — not supported by either Endocrine Society or Menopause Society guidance
- “Only compounded BHRT is ‘natural'” — molecule structure determines bioidenticity, not source
- “Pellets are the only way to get bioidentical hormones” — pellets are one delivery method among many
- “You need higher-than-normal hormone levels to feel optimal” — physiologic range is what your body is built for
Before you book.
Do you offer BHRT?
Yes. Bioidentical hormone replacement therapy is what we prescribe — that’s been our default since the clinic opened. We default to FDA-approved bioidenticals (estradiol patches, oral micronized progesterone, FDA-approved testosterone) for the majority of patients, and we use compounded preparations selectively where there’s a specific clinical reason. Both are bioidentical. Both are BHRT.
What’s the difference between BHRT, HRT, and TRT?
BHRT (Bioidentical Hormone Replacement Therapy) refers to hormone replacement using bioidentical molecules — which is the standard of care today. HRT (Hormone Replacement Therapy) is the broader category, encompassing both bioidentical and non-bioidentical preparations historically. TRT (Testosterone Replacement Therapy) specifically refers to testosterone replacement, typically in men. Most modern HRT and TRT uses bioidentical molecules — meaning most modern HRT and TRT IS BHRT, even when it’s not labeled that way.
Are FDA-approved bioidenticals really bioidentical, or is that just marketing?
They really are bioidentical. The estradiol in Estrace, Vivelle-Dot, Climara, Divigel, and Estrogel is chemically identical to the estradiol your ovaries produced before menopause. The progesterone in Prometrium is chemically identical to natural progesterone. The testosterone in testosterone cypionate becomes testosterone in your bloodstream within hours. The FDA approval status doesn’t change the molecule.
When does compounded BHRT make clinical sense?
Several real scenarios: (1) documented allergy to inactive ingredients in the FDA-approved product; (2) testosterone replacement for women at female-physiologic doses — no FDA-approved product currently exists at these doses, so compounded is the only option; (3) the FDA-approved product isn’t available in a form the patient can use (severe patch reactions, can’t swallow capsules); (4) specific delivery preferences when clinically justified. Outside these scenarios, FDA-approved is usually the better default.
I’ve been on compounded BHRT and felt great. Should I switch to FDA-approved?
If you’re on compounded BHRT, stable, monitored on schedule, and not having side effects, there’s not necessarily a reason to switch — especially if there’s a clinical reason you ended up on compounded in the first place. We’d verify that the dose makes sense for your labs and symptoms, and that the compounding pharmacy has solid quality controls. We don’t pressure patients to switch when things are working.
What about saliva testing for hormone monitoring?
Salivary hormone testing isn’t supported by major endocrinology or menopause societies for monitoring hormone replacement therapy. The correlation between salivary and serum hormone levels is poor, particularly with non-oral routes of administration. Serum testing remains the standard. Clinics relying on salivary testing for dosing decisions often produce inconsistent results across visits.
How much does BHRT cost?
FDA-approved bioidenticals: typically $20–$60/month for transdermal estradiol, $15–$40/month for oral micronized progesterone — both usually covered by insurance. FDA-approved testosterone for men: $30–$80/month. Compounded BHRT preparations: $40–$150/month, generally not covered by insurance. Our clinical service fees ($349 initial consultation; ongoing program fees) cover physician oversight and monitoring separately from medication costs.
Do you bill insurance for the medications?
FDA-approved bioidenticals fill at retail pharmacy using your insurance, so the medication cost flows through your insurance normally. Compounded BHRT is generally not covered by insurance and is paid out-of-pocket to the compounding pharmacy. Our clinical service fees are paid directly to us — we can provide documentation suitable for HSA/FSA submission and out-of-network reimbursement.
Start with a conversation, not a label.
A 45-minute consultation with one of our Houston physicians. We’ll walk through what BHRT actually means for your specific situation — FDA-approved bioidenticals, compounded preparations, or some combination — and decide together what fits.