You can get hormone replacement therapy (HRT) from several types of providers, including your primary care doctor, an OB-GYN, an endocrinologist, a telehealth platform, or a clinic like Planned Parenthood. The right starting point depends on whether you’re seeking HRT for menopause symptoms or gender-affirming care, your insurance situation, and how quickly you want to begin.
Your Primary Care Doctor or OB-GYN
For menopausal HRT, your primary care provider or OB-GYN can write a prescription. You don’t necessarily need a specialist. Many OB-GYNs have additional training in menopause management, and some hold certification as menopause practitioners. If your symptoms are straightforward (hot flashes, night sweats, vaginal dryness), a general provider can typically get you started without referring you elsewhere.
Most people won’t need lab work before starting menopausal HRT. Blood tests to measure hormone levels are generally only recommended if you’re between 40 and 45 and your provider wants to confirm you’re actually in the menopause transition, or if you’re under 40 and premature menopause is suspected. Otherwise, your symptoms and health history are enough for a provider to make a prescribing decision.
The North American Menopause Society considers hormone therapy the most effective treatment for hot flashes and related symptoms. For women under 60, or within 10 years of menopause onset with no contraindications, the benefits generally outweigh the risks. If you’re over 60 or more than 10 years past menopause, the risk profile shifts, and your provider will weigh that carefully.
Endocrinologists and Hormone Specialists
If your primary care provider isn’t comfortable prescribing HRT, or your situation is more complex (history of blood clots, breast cancer risk, or a condition affecting your hormones), an endocrinologist is the next step. Endocrinologists specialize in the hormonal system and handle cases that fall outside what a general provider typically manages. The trade-off is longer wait times for appointments, sometimes weeks or months depending on your area.
For gender-affirming hormone therapy, endocrinologists are one of the most common prescribers. Some family medicine doctors and internists also prescribe gender-affirming hormones, particularly in urban areas or practices that focus on LGBTQ+ health. You can search for providers through directories maintained by organizations like WPATH (the World Professional Association for Transgender Health) or through your insurance company’s provider list.
What Gender-Affirming HRT Requires
The process for starting gender-affirming hormones follows a different pathway than menopausal HRT. Under the current WPATH Standards of Care (version 8), you need a single assessment from a qualified professional. That assessment confirms your gender incongruence is marked and sustained, that you understand the effects of hormones on your body and fertility, and that any mental or physical health conditions that could affect treatment have been discussed. Psychotherapy can be helpful but is not a requirement.
For adolescents, the criteria are more involved. Providers need to confirm emotional and cognitive maturity to consent, that the experience of gender incongruence has been sustained over time, and that any mental health concerns that might affect diagnostic clarity have been addressed.
Many providers now use an informed consent model, especially for adults. Under this approach, your provider explains the risks, benefits, and expected changes, and you give informed consent to proceed. This can significantly shorten the time between your first appointment and your first prescription.
Planned Parenthood and Community Clinics
Most Planned Parenthood health centers provide gender-affirming hormone therapy, including estrogen and anti-androgen therapy, testosterone therapy, and puberty blockers. They also offer surgery referrals and transition support for social and legal steps. Not every location carries every service, so check with your nearest center before booking. Planned Parenthood often operates on a sliding fee scale, making it one of the more affordable options for people without insurance or with limited coverage.
Community health centers, sometimes called federally qualified health centers (FQHCs), are another option. These clinics receive federal funding and are required to see patients regardless of ability to pay. Many have expanded their services to include HRT for both menopause and gender-affirming care. You can search for one near you through the Health Resources and Services Administration’s website.
Telehealth Platforms
Several telehealth services now specialize in prescribing menopausal HRT online. The general process involves filling out a health questionnaire, meeting with a licensed provider via video, and having your prescription sent to a pharmacy.
- PlushCare offers same-day virtual appointments. You book online, discuss your symptoms with a doctor, and pick up your prescription at a local pharmacy.
- Evernow focuses specifically on menopause. You answer questions about your symptoms and goals, get matched with a provider (often within 24 hours), and approve a personalized care plan. Medications can be delivered to your door.
- Stella charges around $200 for an initial virtual visit, which includes access to their menopause app and ongoing support tools.
Telehealth works best for straightforward cases. If you have a complex medical history or risk factors that need closer monitoring, an in-person provider may be a better fit. These platforms also vary in whether they accept insurance, so confirm costs upfront.
Retail Pharmacies vs. Compounding Pharmacies
Once you have a prescription, you’ll fill it at either a standard retail pharmacy or a compounding pharmacy. Most people use a regular pharmacy (CVS, Walgreens, or a local independent), which stocks FDA-approved hormone formulations. These products have been tested for safety, efficacy, and dosage consistency, and they come with standardized labeling and warnings.
Compounding pharmacies mix custom hormone preparations, often marketed as “bioidentical” hormones. These formulations are not FDA-approved, meaning they haven’t undergone the same rigorous testing for purity, dose accuracy, or safety. They don’t carry standard package inserts with warnings or contraindications. Some contain hormones like estriol that aren’t available in FDA-approved products. While compounding can be useful in specific situations (like a patient who needs a dosage or delivery method not commercially available), the lack of oversight is a real concern. Prescriptions for compounded hormones have been increasing, but the safety profile remains less well understood than FDA-approved options.
Insurance Coverage and Costs
Insurance coverage for HRT varies widely depending on your plan, your state, and whether the HRT is for menopause or gender-affirming care. Most commercial insurance plans cover FDA-approved menopausal hormone therapy, though you may face copays, and some plans require prior authorization or step therapy (trying a cheaper option first).
For gender-affirming HRT, coverage depends heavily on where you live. States like California require licensed health plans to cover medically necessary gender-affirming care, including hormone therapy. If your plan denies coverage, it must provide a reason and instructions for filing a grievance. Other states have fewer protections, and some plans still exclude gender-affirming treatments. Medicaid coverage also varies by state.
Without insurance, the out-of-pocket cost of HRT ranges from roughly $20 to $250 per month depending on the type, formulation, and pharmacy. Patches and gels tend to cost more than pills. Discount programs like GoodRx can bring prices down at retail pharmacies, and manufacturer coupons are sometimes available for brand-name products. Telehealth platforms often bundle the cost of the provider visit and medication into a monthly subscription, which can simplify budgeting but may cost more overall than using your insurance.