Custom-compounded BHT is a practice almost wholly restricted to the United States. Compounded BHT is a form of alternative medicine. It has been promoted as a panacea for many diseases and for relieving the symptoms of menopause, beyond the medical objective of reducing the risk of osteoporosis. There is little evidence to support these incremental claims; the hormones are expected to have the same risks and benefits of comparable approved drugs for which there is evidence based on extensive research and regulation. The exception is progesterone, which may have an improved safety profile than artificial progestogens, though direct comparisons with progestins have not been made. Risks associated with the less-controlled process of compounding bioidentical hormones are not clearly understood. In addition, the accuracy and efficacy of saliva testing has not been definitively proven, and the long-term effects of using blood testing to reach target levels of hormones have not been researched.