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Bioidentical HRT

Transdermal cream / patch · Oral / vaginal progesterone · (optional) testosterone cream or pelletAvailable in all 50 states

Marketing purposes only. Actual medications, if prescribed, are dispensed by a licensed pharmacy.

women's health · hormone replacement

Bioidentical HRTBioidentical HRT

Bioidentical HRT uses estradiol, progesterone, and (where appropriate) testosterone that are structurally identical to the hormones your body produces. The combination is tailored to your stage, perimenopause, menopause, or post-menopause, and to your labs, symptoms, and risk profile.

Targets vasomotor symptoms (hot flashes, night sweats)

Supports bone density and cardiovascular health when initiated in early menopause

Sleep, mood, and cognitive symptom relief in many women

Transdermal estradiol avoids the first-pass liver effects of oral estrogens

No commitment · HSA/FSA eligibleNo commitment · HSA/FSA eligible

How it works

Mechanism of action

BHRT replaces hormones that decline in perimenopause and menopause using molecules structurally identical to endogenous estradiol, progesterone, and testosterone. Transdermal estradiol bypasses first-pass hepatic metabolism and is associated with a lower VTE risk than oral estrogens in observational and meta-analytic data.

Micronized progesterone provides endometrial protection in women with an intact uterus and has independent effects on sleep and mood. Low-dose testosterone is considered for libido, energy, and lean-mass support when indicated by labs and symptoms.

The baseline panel.

Every Marek client receives this baseline panel before a provider review. Your provider may add additional biomarkers based on your health history, symptoms, and goals, pulling from 1,000+ available markers. See more biomarkers →

Hormone Profile

12 markers

Sex hormones

  • Total TestosteroneLC/MS
  • Free TestosteroneEquilibrium Dialysis
  • Estradiol, Sensitive / UltrasensitiveLC/MS
  • Sex Hormone Binding Globulin (SHBG)
  • ProgesteroneLC/MSFemale panel
  • Prolactin
  • Luteinizing Hormone (LH)
  • Follicle-Stimulating Hormone (FSH)
  • hCG, Total, QuantitativeFemale panel, pre-menopause

Adrenals & neurosteroids

  • Cortisol
  • DHEA-S

Growth hormone / IGF-1

  • Insulin-Like Growth Factor I (IGF-1)

Thyroid Status

3 markers

Thyroid hormones

  • Thyroid Stimulating Hormone (TSH)
  • Free T4
  • Free T3

Heart Health

9 markers

Cardiovascular health

  • Total Cholesterol
  • HDL Cholesterol
  • LDL Cholesterol
  • LDL:HDL Ratio
  • VLDL Cholesterol
  • Triglycerides
  • Apolipoprotein-B (ApoB)
  • C-Reactive Protein, High Sensitivity (hsCRP)
  • Lipoprotein(a) (Lp(a))

Metabolism

3 markers

Insulin sensitivity

  • Blood Glucose
  • Fasting Insulin
  • HbA1c

Organ Function

26 markers

Liver & pancreas

  • AST
  • ALT
  • Bilirubin, Total
  • γ-Glutamyl Transferase (GGT)

Kidney function

  • BUN
  • Creatinine w/ eGFR

Comprehensive Metabolic Panel (CMP)

  • Glucose
  • Blood Urea Nitrogen (BUN)
  • Creatinine
  • eGFR
  • BUN/Creatinine Ratio
  • Sodium
  • Potassium
  • Chloride
  • Carbon Dioxide, Total
  • Calcium
  • Protein, Total
  • Albumin
  • Globulin, Total
  • Albumin/Globulin (A/G) Ratio
  • Alkaline Phosphatase (ALP)
  • AST
  • ALT

Prostate health

  • Prostate-Specific Antigen (PSA)Male panel
  • Free PSAMale panel
  • % Free PSAMale panel

Nutrient Status

31 markers

Vitamins & minerals

  • Vitamin D, 25-OHD (25-Hydroxy)
  • Magnesium, RBC

Iron status

  • Iron
  • Iron Saturation
  • TIBC
  • UIBC
  • Ferritin

Complete Blood Count (CBC)

  • White Blood Count (WBC)
  • Red Blood Count (RBC)
  • Hemoglobin (Hgb)
  • Hematocrit (HCT)
  • MCV
  • MCH
  • MCHC
  • Red Cell Distribution Width (RDW)
  • Platelets
  • Neutrophils
  • Neutrophils (Absolute)
  • Lymphocytes
  • Lymphocytes (Absolute)
  • Neutrophil/Lymphocyte Ratio
  • Monocytes
  • Monocytes (Absolute)
  • Eosinophils
  • Eosinophils (Absolute)
  • Basophils
  • Basophils (Absolute)
  • Immature Cells
  • Immature Granulocytes
  • Immature Granulocytes (Absolute)
  • NRBC, w/ Reflex for Immature Cells

Clinical evidence

The research behind Bioidentical HRT.

NAMS 2022 Hormone Therapy Position Statement

Menopause (2022)

Updated North American Menopause Society guidelines support hormone therapy for symptomatic women under age 60 or within 10 years of menopause onset, with favorable benefit/risk for healthy candidates.

Read study →

Transdermal vs. oral estrogen and VTE risk: meta-analysis

BMJ (2019)

Large meta-analysis showed transdermal estradiol was not associated with the increased VTE risk seen with oral estrogen preparations, informing modern delivery-route choice.

Read study →

Safety profile

Monitoring & safety information.

Commonly reported side effects

  • Breast tenderness (typically transient)
  • Breakthrough bleeding during initiation
  • Bloating / fluid retention (dose-related)
  • Mood fluctuation during titration

Less common but serious risks

  • Venous thromboembolism (lower with transdermal estradiol)
  • Breast cancer risk, modestly elevated with combined HRT after ~5 years; route, formulation, and individual risk matter
  • Endometrial hyperplasia if estrogen is unopposed by progesterone in women with an intact uterus

Generally not appropriate for

  • History of breast cancer or other hormone-sensitive cancer
  • Active or recent VTE / pulmonary embolism
  • Active liver disease
  • Undiagnosed vaginal bleeding
  • Pregnancy

Typical monitoring

  • Estradiol, progesterone, testosterone, DHEA-S
  • Sensitive lipid panel (ApoB, Lp(a), particle counts)
  • Mammogram and gynecologic care per standard guidelines
  • Symptom and bleeding-pattern review

FAQ

Quick answers.

Eligibility, hormone combination, route, and dose are determined by a partnered licensed medical provider based on your complete labs, symptoms, menopausal stage, and personal/family risk profile. A prescription is not guaranteed.
Bioidentical HRT uses hormones, most commonly estradiol, progesterone, and sometimes testosterone, that are structurally identical to the ones your body produces. The combination, dose, and delivery route are individualized.
Pellet therapy is one delivery route, implanted under the skin, releasing hormones over months. Marek's approach typically uses transdermal creams or patches plus oral or vaginal progesterone, which allow finer dose adjustment and faster correction if labs or symptoms change.
The WHI data that drove early concern used oral conjugated estrogens plus a synthetic progestin. Modern meta-analyses suggest transdermal estradiol with micronized progesterone has a different risk profile, and the absolute risk increase from combined HRT after ~5 years is modest. Your provider individualizes the discussion based on your full history.
The most common short-term effects are breast tenderness, breakthrough bleeding, and mild fluid retention during titration. Serious risks include VTE (lower with transdermal estradiol) and a modest increase in breast-cancer risk with long-term combined therapy. Your provider tailors the protocol to your individual risk profile.
View all FAQs
See all FAQs

Eligibility, hormone combination, route, and dose are determined by a partnered licensed medical provider based on your complete labs, symptoms, menopausal stage, and personal/family risk profile. A prescription is not guaranteed.

Treatments are dependent on licensed clinical prescription. Client costs vary based on individual labs and panel in treatments and services.