The complete HRT guide: the whole roster, on one page

Four decisions, in this order. First, insurance or cash: 3 of the 16 providers we track bill commercial insurance and all of them charge per visit, while the other 13 are cash-pay subscriptions. Second, what the price includes: 5 providers charge one all-in monthly number, 2 require an annual or 12-month commitment for the advertised rate, and 6 sell care while the medication is billed separately by a pharmacy. Third, delivery route, because oral and transdermal estradiol are metabolised differently and not every provider offers every form. Fourth, lab work: 5 providers put bloodwork in front of a prescription and 7 state that they do not require it. Price settles a tie between two providers that both fit. It is a poor place to open the decision.

FDA-approved hormone products have been through a registration trial and carry a label the agency reviewed. Compounded hormones are mixed by a pharmacy for an individual prescription and are not FDA-approved, which means no registration trial, no agency-reviewed label, and no guarantee of batch-to-batch consistency. Bioidentical describes the molecule rather than the approval status: FDA-approved estradiol is bioidentical too. On this roster 4 providers sell compounded hormones only (Winona, Gala Health, Inner Balance and Telos RX), and several others sell both. Compounded is not automatically worse and it is not automatically safer, and any provider implying the second is a disclosure problem worth noticing.

It depends entirely on the provider, and the split is wider than most people expect. 5 of the 16 providers we track require or centre lab work before prescribing, led by Hone Health at 7.5/10. 7 state on their own pages that labs are not required, and 4 publish nothing either way, which is itself a disclosure gap. For menopause HRT, diagnosis is usually clinical and based on symptoms plus cycle history rather than on a hormone panel, so a no-labs model is not automatically careless. For men's TRT the reverse is true: the American Urological Association criterion is total testosterone below 300 ng/dL on two separate early-morning draws plus symptoms, so a TRT clinic that will prescribe without bloodwork is a warning sign.

The honest answer is a range with a qualifier attached to each end, because the numbers providers advertise are not describing the same product. The lowest genuinely comparable monthly price on this roster is $40/mo, all-in from Alloy, meaning a real recurring charge that includes the medication. Above that, 2 providers publish a low rate that only applies on a 12-month commitment, 6 sell the care while your pharmacy bills the drug separately, and 3 charge per visit with no subscription at all (Midi Health $150 per visit, Gennev $199 per visit, Elektra Health $149 per visit). Comparing a per-visit fee against a monthly subscription is the single most common way this category misleads people.

It is a separate axis from the 0-10 score and it is not averaged into it. The grade measures what a provider discloses before you start intake: pricing published up front, named clinicians with credentials, a written cancellation policy, corporate disclosure, and third-party reviews you can actually reach. The current distribution across 16 providers is 1 A, 6 B, 5 C, 4 D. Alloy holds the only A. An unanswered BBB F rating or a corroborated billing-surprise pattern caps a provider at D regardless of how much it publishes. A high score with a low grade means the care looks good and the disclosure does not, which is a real and common combination.

Some, yes. 2 of the 16 providers we track treat both, and they appear in both rankings with a position derived separately per wing, because a clinic that is mid-table for menopause HRT can lead the TRT list. The treatments are genuinely different: menopause HRT is usually estradiol with progesterone where a uterus is present, while men's TRT is testosterone, and enclomiphene is a third thing again that stimulates your own production rather than replacing it. We keep the wings separate for that reason, with menopause HRT on the home page and rankings, and men's TRT at /trt.