Frequently asked questions
about bio-identical hormone therapy
Safety and risks
Is bio-identical hormone therapy safe?
For many women, bio-identical hormone therapy can be safe and effective, provided it is well supervised and tailored to personal risk factors. Age, medical history, timing of initiation, and the method of administration play an important role.
Does hormone therapy increase the risk of thrombosis?
Transdermal forms such as gels and patches seem to carry a lower risk of thrombosis than oral oestrogen tablets.
Does hormone therapy increase the risk of breast cancer?
The relationship between hormone therapy and breast cancer is complex and is related to multiple factors such as type of hormones, duration of use, and personal risk factors.
When is hormone therapy not suitable?
In certain forms of breast cancer, (active) thrombosis or pulmonary embolism, unexplained vaginal bleeding, or severe liver diseases, extra caution is needed.
Treatment and dosage
Is blood testing always necessary?
According to Dutch and British guidelines, extensive blood tests before starting hormone therapy are not standardly necessary for every woman. The diagnosis of menopause or perimenopause is usually made clinically, based on age, changes in the menstrual cycle, and symptoms.
In some situations, additional blood tests can be valuable, for example, to gain more insight into: hormonal balance, thyroid function, glucose metabolism, cholesterol, vitamin and iron status, and other factors that may influence symptoms.
In the case of existing liver disease, use of medication that affects the liver, or oral oestrogen tablets, it may also be important to monitor liver function.
Not every woman needs extensive blood tests as standard. This is individually tailored to symptoms, medical history, and personal risk factors.
How does a process proceed?
A process usually consists of intake, analysis of lifestyle and symptoms, possible blood tests, and a personal treatment plan. After starting hormone therapy, a follow-up consultation takes place after 4 weeks and after 3 months to see how things are going and to possibly adjust the dosage.
Is hormone therapy the same for everyone?
No. Hormone therapy should be customised. Every woman has a different hormonal situation, life stage, resilience, and medical background.
How is hormone therapy dosed?
Dosage of estradiol gel (oestrogen gel)
Estradiol gel is absorbed through the skin and is usually applied daily. The correct dosage varies per person and is tailored to symptoms, life stage, and response to treatment.
Common starting dosages are: 1 pump per day or 2 pumps per day
Depending on effect and symptoms, the dosage can be adjusted later.
Important to know: The absorption through the skin varies per person. As a result, some women need more or less gel to achieve the same effect.
More gel does not automatically mean better results. The goal is to find a dosage where symptoms improve with as few side effects as possible.
Dosage of progesterone capsules
Micronized progesterone (such as Utrogestan) is often added to oestrogen therapy in women with a uterus. Progesterone helps protect the uterine lining and supports hormonal balance. The correct dosage depends on: the amount of oestrogen, peri- or postmenopause, the bleeding pattern, and sensitivity to progesterone
Continuous treatment (for postmenopausal women)
Daily progesterone: usually 100 mg per day with the advice to take it in the evening
This regimen is often used after menopause (postmenopause) with the aim of eventually becoming free of bleeding.
Cyclical regimen
Progesterone for part of the month: usually 200 mg per day for 12–14 days per month
This regimen is more commonly used during perimenopause or in women who still menstruate. A monthly bleed may occur.
Why take it in the evening?
Progesterone can cause drowsiness or a relaxed feeling. Therefore, it is usually taken before sleeping.
Vaginal application: Sometimes progesterone is used vaginally, for example in cases of side effects from oral intake, persistent bleeding, or to improve absorption
Why give progesterone to women without a uterus?
In women without a uterus, progesterone is usually not necessary for the protection of the uterine lining. Some women still use it due to possible positive effects on sleep, relaxation, mood, or hormonal balance. The choice for this is always tailored individually.
Basic information
What is bio-identical hormone therapy?
Bio-identical hormones are hormones that are structurally identical to the hormones produced by the body itself, such as oestrogen, progesterone, and testosterone. They are used to supplement hormonal deficiencies or imbalances, for example around the menopause.
What are bio-identical hormones made from?
Bio-identical hormones are made from plant-based raw materials, often derived from soy or wild yam. In the laboratory, these substances are carefully converted into hormones with exactly the same molecular structure as the hormones produced by the body itself, such as estradiol and progesterone. This makes them bio-identical: identical to the body's own hormones.
What is the difference between bio-identical and synthetic hormones?
Bio-identical hormones have the same molecular structure as the body's own hormones. Some older synthetic hormones deviate from this. This can affect their efficacy, side effects, and metabolic effects.
Vaginal hormone therapy
When can vaginal oestrogen therapy be advised?
In case of complaints such as vaginal dryness, irritation, vaginal itching, pain during intercourse or recurrent bladder infections, burning sensation when urinating or urgency complaints.
Local vaginal oestrogens work mainly locally and usually contain a low dosage of hormone. Therefore, absorption in the body is limited.
Vaginal oestrogens can be used independently or combined with systemic hormone therapy such as a gel or patch.
At low dosages, extra progesterone is usually not necessary, even for women with a uterus.
The treatment often consists of:
• a start-up phase with daily use for about two weeks
• then maintenance treatment, usually several times a week
Many women notice improvement in dryness, irritation, and comfort within a few weeks. For bladder or urinary tract complaints, recovery may take more time.
Side effects
What are the possible side effects of bio-identical hormone therapy?
Possible side effects include tender breasts, water retention, bloating, headaches/migraines, nausea, weight fluctuations, mood changes, and breakthrough bleeding (oestrogen) and drowsiness, dizziness, and a fuzzy feeling (with progesterone).
Bleeding during hormone therapy
In the first months of hormone therapy, temporary spotting or breakthrough bleeding may occur. This is relatively common as the body adjusts to hormonal changes. This can particularly happen after starting or adjusting the dosage.
Light bleeding or brown discharge is usually harmless and often decreases within 3–6 months.
The chance of bleeding is related to, among other things: the phase of the menopause, the dosage of oestrogen and progesterone, the type of hormone therapy, and any changes in treatment.
Progesterone plays an important role in protecting and stabilising the uterine lining. Therefore, it is important to use the medication as prescribed.
When should I get in touch?
Contact us in case of heavy and/or persistent bleeding or new bleeding after you have not had any for a long time. Sometimes additional investigation may be necessary, for example, an ultrasound of the uterine lining.
Testosterone Supplementation
Is testosterone only for men?
Testosterone is often seen as a “male” hormone, but women also produce testosterone. It plays an important role in energy, motivation, muscle building, recovery, mood, and libido.
During the menopause, not only do oestrogen and progesterone levels decrease, but testosterone levels can also gradually decline. Some women notice changes in endurance, recovery, or sexual health as a result.
Symptoms that may be associated with a testosterone deficiency include:
• reduced libido
• less energy or motivation
• loss of muscle strength
• reduced recovery
• reduced vitality
• concentration problems
Testosterone supplementation in women is usually only considered when: other hormonal factors have been assessed, lifestyle, sleep, and stress have been taken into account, and the symptoms persist despite optimisation of oestrogen and progesterone therapy.
The treatment is always individually tailored and usually starts with a low dosage, often in the form of a gel or cream. Much lower dosages are used for women than for men.
During treatment, attention is paid to: effect on symptoms, testosterone levels, and any side effects.
Possible side effects include:
• acne or oily skin
• increased hair growth
• hair loss
• mood changes
In the Netherlands, there is currently no officially registered testosterone preparation for women. Therefore, testosterone is usually prescribed to women in low dosages using testosterone gel. This is done carefully and under medical supervision.
Contraindication for testosterone supplementation in women
For women, there are less clear international guidelines, but testosterone is usually not given in cases of:
• pregnancy or breastfeeding
• active hormone-sensitive malignancies
• severe liver diseases
• clear androgenisation complaints without a good explanation
Careful supervision remains important for women due to possible side effects such as acne, hair loss, or increased hair growth.
Testosterone supplementation in men
Testosterone plays an important role in men for muscle mass, energy, recovery, mood, libido, bone health, and cognitive functioning.
As men age, testosterone levels can gradually decrease. Additionally, factors such as chronic stress, overweight, poor sleep, metabolic dysregulation, or chronic illness can affect hormone balance.
Not every low testosterone level needs to be treated. The combination of symptoms and repeatedly low blood values is important in making a diagnosis.
Symptoms that may be associated with testosterone deficiency include:
• fatigue
• reduced libido
• erection problems
• loss of muscle mass or strength
• slower recovery
• depressed mood
• reduced motivation or concentration
Before testosterone supplementation is started, the following is considered:
• lifestyle and sleep
• weight and metabolic health
• medication use
• stress load
• blood tests (there must be at least 2 instances of a low morning testosterone level)
Testosterone can be administered via gel or injections. The dosage is tailored to age, symptoms, blood values, and response to treatment.
During treatment, regular checks are important, including of:
• testosterone levels
• hematocrit
• PSA
• blood pressure
• cardiovascular risk factors
Contraindications for testosterone supplementation in men
• active or untreated prostate cancer
• elevated PSA or abnormal prostate examination
• Men with breast cancer
• unmanaged severe sleep apnoea
• strongly elevated hematocrit/polycythemia
• active desire for children
• certain cardiovascular conditions
Medication that can influence testosterone production
Not only age, sleep, stress, and lifestyle can affect testosterone levels. Various medications can also influence the production, conversion, or action of testosterone.
Medications that can affect testosterone levels include:
• opioids (strong painkillers)
• long-term use of corticosteroids such as prednisone
• some antidepressants
• certain antipsychotics
• medications for prostate issues such as finasteride or dutasteride
• anabolic steroids
• some anti-epileptics
• hormone-suppressing therapies
Dosage Testosterone Hormone therapy
Testosterone gel in men
In men, testosterone gel is usually applied daily to the skin, for example on the shoulders or upper arms.
Starting dose: A commonly used starting dose is 1 pump per day
Depending on symptoms, blood values, and absorption through the skin, the dosage may be adjusted later.
After 6-12 weeks, a blood test will take place to check testosterone levels, hematocrit, and PSA. The effect of the therapy on the symptoms will also be evaluated.
What is the effect of testosterone on blood thickness?
Testosterone can stimulate the production of red blood cells. As a result, the haematocrit can rise. Haematocrit is a measure of the percentage of red blood cells in the blood. When the haematocrit becomes too high, the blood can become thicker or "more viscous". This may contribute to an increased risk of thrombosis or other cardiovascular problems. Therefore, regular checks are carried out during testosterone therapy.
An increased risk of rising haematocrit exists, among other factors, in the case of:
• higher doses of testosterone
• dryness
• sleep apnoea
• overweight
• dehydration
Lifestyle and health
Can lifestyle also make a difference?
Nutrition, sleep, exercise, stress reduction, and recovery have a significant impact on hormonal health.
When can hormone therapy be beneficial?
For which complaints can hormone therapy be used?
Hormone therapy can help with, among other things, hot flashes, sleep problems, fatigue, mood swings, joint complaints, vaginal dryness, loss of libido, reduced resilience or recovery, and weight gain around the abdomen.
From what age can hormone therapy be beneficial?
Hormone therapy usually plays a role around the perimenopause and menopause, often between the ages of 40 and 60. Some women experience hormonal complaints at a younger age.
For women with an early menopause or premature menopause, hormone therapy can be particularly important for supporting bones, cardiovascular health, and overall functioning.
Most scientific data on the benefits and safety of hormone therapy is available for women who start around the menopause or within about ten years thereafter. During this period, hormone therapy can contribute to the reduction of menopausal symptoms and support quality of life.
There is increasing evidence that hormones may influence healthy ageing, including in the areas of bone health, muscle mass, metabolic health, and cognitive functioning. The role of hormone therapy for preventive purposes in later life is still being researched and always requires an individual assessment of benefits and risks.
For women over 60, treatment is always customised. The potential benefits, symptoms, medical history, and personal risk factors must be carefully weighed.
Hormone therapy is therefore always individually tailored and regularly evaluated.
Can I use hormones if I am still menstruating?
Yes. Many women already experience symptoms in the perimenopause while menstruation is still present. It is precisely in this phase that hormonal fluctuations can cause symptoms.
How do I know if my symptoms are hormonal?
Symptoms such as fatigue, poor sleep, mood changes, or weight gain may be hormone-related, but often have multiple causes. Therefore, we look not only at hormones but also at nutrition, stress levels, sleep, recovery, exercise, and metabolic health.
Is hormone therapy the same as contraception?
No. Hormone therapy does not protect against pregnancy.
Can hormone therapy help with weight gain?
Hormones influence fat distribution, muscle mass, appetite, insulin sensitivity, and energy expenditure. Hormone therapy alone is usually not a “weight loss treatment”, but it can contribute to better recovery, sleep, energy, and metabolic balance.
Is hormone therapy the same as anti-aging?
No. The aim is not to “stay young”, but to support quality of life, functioning, recovery, and hormonal balance when there is a medical indication for it.
Can lifestyle also make a difference?
Absolutely. Nutrition, strength training, sleep, stress reduction, alcohol consumption, and recovery have a significant impact on hormonal health. Hormone therapy often works best as part of a broader approach.