Bioidentical Hormone Therapy in India: A Patient's Guide

In short: Bioidentical hormones have exactly the same molecular structure as the hormones your own body makes, such as oestradiol, progesterone and testosterone. A doctor decides on them, and sets the dose, where they are individually indicated. Assessment combines symptoms, history and examination, with tests selected when indicated. At SOMA, bioidentical hormones are one part of a physician-led hormonal plan that starts with testing, not treatment, and is reviewed against repeat blood tests.

What does "bioidentical" mean?

A hormone is a chemical messenger. One organ releases it into the blood, and it carries an instruction to cells elsewhere.

"Bioidentical" means the molecule is the same shape as the one your body makes. Your cells read it in the same way. Common examples are:

• Oestradiol, the main oestrogen made by the ovaries before menopause.

• Progesterone, made mainly after ovulation, which balances oestrogen's effect on the lining of the uterus (womb).

• Testosterone, made mainly by the testes in men and in smaller amounts in women.

"Bioidentical" describes molecular structure, not regulatory approval. It also does not tell you whether a dose is right for you. That is your doctor's decision.

What do these hormones do in the body?

Sex hormones act on far more than reproduction. Oestrogen, progesterone and testosterone have receptors (docking sites) in the brain, skin, muscle, blood vessels and many other tissues.

They also work alongside other signalling systems. Thyroid hormone sets the pace of energy use. Cortisol, the main stress hormone, rises and falls through the day. Insulin moves sugar from the blood into cells. When one of these drifts, the others often shift too. This is why the SOMA approach looks at the whole network, not one number. Our article on hormonal changes after 35 explains how these systems link up in daily life.

What are perimenopause and andropause?

Menopause is a normal life stage. It is confirmed after 12 months without a period, with no other cause. In India, the average age at menopause is about 46.

Perimenopause is the run-up to it. The menopausal transition lasts a median four years; perimenopause also includes the first year after the final period. Ovarian hormone levels rise and fall unevenly during this time. Many women notice hot flushes, night sweats, lighter sleep and mood changes as their oestrogen levels swing.

Andropause is a term often used for the gradual fall in testosterone some men have with age. Unlike menopause, it is gradual, and it varies a lot from man to man.

How does hormone testing work?

Assessment combines symptoms, history and examination, with tests selected when indicated.

For women around menopause, the Indian Menopause Society advises that menopause is diagnosed from age and cycle history, not from a blood test. Hormone levels swing so much in perimenopause that one result can mislead. Tests may still be chosen for a different reason: to rule out other causes of the same feelings, such as low vitamin D, anaemia (a low red blood cell count) or thyroid problems.

For men, the Endocrine Society advises measuring testosterone in the morning, after fasting, using a reliable laboratory method. A low result should be confirmed with a second morning test before anything is decided, and it should match the symptoms.

SOMA's own practice goes further. At SOMA, every hormonal plan begins with a diagnostic consultation and full hormone panels. These cover thyroid, cortisol, insulin and sex hormones, so the doctor can see which systems are drifting and why. Read more about how SOMA approaches hormones and metabolism.

Are approved and custom-compounded hormones the same?

Not necessarily. Bioidentical describes molecular structure, not regulatory approval. A bioidentical hormone can come as an approved medicine, or as a custom-compounded preparation mixed for one person. Guidelines in India list oestradiol and micronised progesterone among the standard options for menopause.

It is fair to ask your doctor about the exact product you are given: its Indian approval or licensing status, its manufacturer, its quality checks, and whether it is compounded.

How do the route and the combination affect safety?

Four points matter most.

Oestrogen and the uterus lining. Oestrogen makes the lining of the uterus grow. Given alone through the whole body, it raises the risk of abnormal thickening and cancer of that lining. Systemic oestrogen (taken by tablet, patch or gel so it reaches the whole body) usually requires a progestogen, meaning progesterone or a related hormone, when the uterus is present. Low-dose vaginal oestrogen usually does not.

Skin is different from a tablet. Oestrogen swallowed as a tablet passes through the liver first, which raises some clotting factors. A large UK study compared 80,396 women who had a blood clot with 391,494 women who had not. Among them, oral HRT (hormone tablets) was associated with higher clot odds than non-use (adjusted odds ratio 1.58). Transdermal HRT (patches and gels on the skin) showed no statistically significant increase; this does not establish zero risk. The Indian Menopause Society prefers the skin route for women with a higher clot risk, such as those who smoke or have migraine with aura.

Timing matters too. Age and time since menopause affect prescribing risks. Later initiation carries greater absolute risks, including stroke and blood clots.

Monitoring differs by hormone. Menopausal hormone therapy is usually reviewed clinically; testosterone treatment requires blood monitoring. For men on testosterone, that means checks of testosterone and red blood cell levels. Prostate monitoring depends on age, risk and an informed discussion with the doctor.

Who needs extra assessment before hormone therapy?

These are screening points for a doctor to consider, not a complete list:

• pregnancy, or a chance of pregnancy

• unexplained vaginal bleeding, which must be investigated first

• past or present breast cancer, or another hormone-sensitive cancer

• a past blood clot, stroke or heart attack

• serious liver disease

• for men: prostate or breast cancer, a raised PSA (a prostate blood test), a high red blood cell level, or untreated severe sleep apnoea (breathing pauses in sleep)

• men planning to father a child soon, because testosterone lowers the body's own sperm production

Risks differ by hormone, dose, route, timing and your own history. Report any unexpected bleeding or spotting to your doctor promptly.

How does a SOMA doctor decide if it is right for you?

Hormone therapy is never started at SOMA without documented need, and some situations rule it out. Your doctor starts with your history, your full hormone panels and your goals. The plan is proportionate to what the tests show. Nutrition and lifestyle correction form the base. Targeted support is added where needed. Bioidentical hormones are used where individually indicated, at doses your physician sets.

It does not stop at a prescription. Repeat blood tests at intervals your physician sets show how your body is responding, and doses change as your biology changes. You can read more on hormonal optimisation at SOMA and on how SOMA builds a plan around you.

How do you choose a doctor or clinic?

Look for these signs:

• an assessment of symptoms, history and examination before any prescription, with tests selected when indicated

• a clear answer on whether a product is approved or compounded

• a progestogen plan if you take systemic oestrogen and have a uterus

• a discussion of route, such as skin or tablet, based on your own risks

• a schedule of follow-up reviews, with blood tests where the hormone needs them, not a one-off prescription

SOMA centres in Mumbai and New Delhi

Hormonal optimisation, including bioidentical hormones where your doctor finds them indicated, is available at both SOMA centres:

• Mumbai: A-507, Kohinoor Square, N.C. Kelkar Marg, Shivaji Park, Dadar West, Mumbai 400028. Phone +91 98671 94033.

• New Delhi: E-354, Greater Kailash II, New Delhi 110048, serving Delhi NCR and Gurugram. Phone +91 87969 92001. More about the New Delhi centre.

The New Delhi centre is independently operated under licence from SOMA Longevity Sciences, and its own doctors lead care there. Both centres follow the same SOMA assessment and diagnostic standards. Online consultations are also available. Contact either centre.

Questions people ask

What is bioidentical hormone therapy?

It uses hormones with exactly the same molecular structure as those your body makes, such as oestradiol, progesterone and testosterone. A doctor decides whether it is individually indicated after assessing symptoms, history and examination, with tests selected when indicated, and sets the dose.

Are bioidentical hormones safer than other hormones?

The molecule alone does not decide safety. Risk depends on the hormone, dose, route, timing and your history. For example, in a large UK study, oral HRT was associated with higher clot odds, while HRT through the skin showed no statistically significant increase; that does not mean zero risk. Systemic oestrogen also usually requires a progestogen when the uterus is present.

Do I need a blood test to know I am in perimenopause?

Usually not. Indian guidelines diagnose menopause from age and cycle history, because hormone levels swing during perimenopause. Tests may still be selected to rule out other causes, such as thyroid problems, anaemia or low vitamin D.

How long does hormone therapy last?

There is no fixed length. Your doctor reviews the benefits and risks at regular intervals and adjusts or stops treatment as your needs change. Menopausal hormone therapy is usually reviewed clinically; testosterone treatment requires blood monitoring.

Where can I get bioidentical hormone therapy in Mumbai or Delhi?

SOMA offers physician-led hormonal optimisation, including bioidentical hormones where individually indicated, at its centres in Dadar West, Mumbai and Greater Kailash II, New Delhi. Every plan begins with a diagnostic consultation and full hormone panels.

Sources

1. Meeta M, Anuradha M, Ashraf AB, Aggarwal K, et al. Clinical practice guidelines for menopause: an executive summary and recommendations. Indian Menopause Society 2026. Journal of Mid-life Health 2026;17(Suppl 1):S12–S116. https://pmc.ncbi.nlm.nih.gov/articles/PMC12948155/

2. The 2022 Hormone Therapy Position Statement of The North American Menopause Society Advisory Panel. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause 2022;29(7):767–794. https://pubmed.ncbi.nlm.nih.gov/35797481/

3. Vinogradova Y, Coupland C, Hippisley-Cox J. Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases. BMJ 2019;364:k4810. https://pmc.ncbi.nlm.nih.gov/articles/PMC6326068/

4. Bhasin S, Brito JP, Cunningham GR, Hayes FJ, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology & Metabolism 2018;103(5):1715–1744. https://pubmed.ncbi.nlm.nih.gov/29562364/

5. Santoro N, Braunstein GD, Butts CL, Martin KA, McDermott M, Pinkerton JV. Compounded bioidentical hormones in endocrinology practice: an Endocrine Society scientific statement. Journal of Clinical Endocrinology & Metabolism 2016;101(4):1318–1343. https://pubmed.ncbi.nlm.nih.gov/27032319/

6. SOMA Longevity Sciences. Hormonal optimisation. https://www.somalongevitysciences.com/therapies/hormonal-optimisation