Is bioidentical testosterone better than synthetic?

Bioidentical testosterone is structurally identical to the testosterone that is naturally produced by the human body. It is often prescribed to treat low testosterone levels. Synthetic testosterone refers to testosterone that is chemically manufactured and not structurally identical to human testosterone.
There are several key differences between bioidentical and synthetic testosterone:

Bioavailability
- Bioidentical testosterone is considered to have better bioavailability than synthetic versions. This means more of the hormone reaches circulation to have an effect in the body.

Side Effects
- Many patients report fewer side effects with bioidentical testosterone compared to synthetic. However, side effects are still possible with both forms.

Delivery Methods
- Bioidentical testosterone comes in more delivery methods than synthetic, including gels, pellets, patches, and injections. More options can mean better customization for the patient.

Monitoring
- It is important to monitor hormone levels for patients using both bioidentical and synthetic testosterone. However, some functional medicine doctors claim bioidentical hormones require less frequent testing and dose adjustments.

Legality
- FDA-approved synthetic testosterone is legally available in standard doses by prescription. Compounded bioidentical testosterone requires a customized prescription and is considered more legally ambiguous by some physicians.

When weighing bioidentical versus synthetic testosterone, there are several key questions patients may want to consider:

• What are my testosterone deficiency symptoms and treatment goals?


• Am I willing to have frequent bloodwork to monitor hormone levels?


• What side effects or risks concern me most?


• Will insurance cover my preferred treatment option?


• How important is FDA-approval versus customization for my goals?

There are good arguments on both sides. Some of the potential benefits more frequently cited in favor of bioidentical testosterone include:

• More natural hormone structure


• Increased bioavailability for testosterone uptake


• Fewer side effects reported for some patients


• More delivery method options like gels or pellets

However, potential benefits more frequently cited in favor of synthetic testosterone include:

• FDA approval provides standardized safety & efficacy data


• Usually lower cost with insurance coverage


• Legally unambiguous to prescribe and fulfill


• Ease of administration with injections or topicals

In the end, the "better" option depends greatly on the individual patient, their medical history, treatment goals, and preferences in consultation with their healthcare provider. There are good evidence-based arguments on both sides. An open discussion of the pros and cons can lead patients to the right personalized choice for their needs.