HRT by state, and where the law actually changes something

The deadline that matters more than any state law

Testosterone is a Schedule III controlled substance. Under the Ryan Haight Act a clinician normally needs at least one in-person medical evaluation before prescribing one by telemedicine. The exception that the entire online TRT category runs on is a temporary federal flexibility, and the DEA and HHS have now extended it four times. The fourth extension was published on December 31, 2025 and carries it through December 31, 2026.

Read what that means for the 5 providers on our men's TRT wing. If the flexibility lapses without a fifth extension or a permanent rule, starting testosterone through a screen stops being possible in its current form nationwide, in every state at once. Estrogen and progesterone are not controlled substances, so the women's wing is unaffected by this particular deadline.

Source: Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications, Federal Register, published December 31, 2025. We read the document itself.

The 5 states where insurance law has changed

These are enacted laws, not bills in committee. Each applies to state-regulated plans, which means a large self-funded employer plan governed by federal ERISA rules is generally outside their reach. Ask your HR department which kind you have before assuming a mandate covers you.

A further 3 states have passed menopause laws that do not touch insurance coverage. California: Clinicians can earn professional licensing credit for menopause education. It aims at the supply of doctors who know the subject, and it changes nothing about what your plan pays for. Maine: The state Department of Health and Human Services must make menopause information materials available to the public. No coverage obligation attaches to it. Rhode Island: S0361 (2025) extends workplace protection to employees on the basis of menopause. It sits in employment law, so it leaves insurance untouched, and it is the only one of its kind we found at state level.

The 7 jurisdictions where compounded hormones cannot be dispensed

Alloy publishes that its compounded formulas are unavailable in Alabama, Arkansas, California, District of Columbia, Louisiana, Mississippi, Nevada. This is the single most consequential state-level fact in hormone care, because 11 of the 16 providers we track sell compounded or partly compounded hormone therapy. Live in one of those 7 and your real choice narrows to FDA-approved products.

We read this list off Alloy's own published availability statement. We did not read it out of state pharmacy codes, so treat it as one provider's operating reality and not as a legal ruling on every compounder. The underlying reason is state pharmacy regulation of compounded products and of out-of-state pharmacies shipping in, and it varies enough that we are not going to summarise seven statutes we have not read. What compounded actually means, and why it is not FDA-approved.

What each provider will actually tell you about where it operates

Nobody in this category publishes a machine-readable state list. Most publish a count. Of the 16 providers we track, 3 make a state-coverage claim we confirmed ourselves, 9 make one we recorded without confirming, and 4 have no state-coverage entry at all. Below is every one of them, verbatim, with its verification label intact.

One entry deserves singling out. Midi Health's homepage claims all 50 states while its own locations directory carries pages for 16, and nothing on the site reconciles the two. We wrote that up separately. Elektra Health is the opposite case and the more useful one: it states plainly that clinical care is limited, which most of this category will not do.

Every state, and what we found in it

All 51 US jurisdictions. A blank coverage column means we found no enacted menopause coverage mandate in the national legislative roundups we checked as of August 15, 2026. It does not mean we audited that state's insurance code line by line, and we are not going to imply that we did.

What we could not establish

We set out to carry 7 state-varying dimensions and we could source two of them properly: enacted coverage law and compounded-HRT restriction. Here is what fell over and why, because a gap you can see is worth more than a number you cannot check.

This is also why there is no page here for each individual state. We built the data first and it answered the question: with 43 of 51jurisdictions carrying nothing state-specific and telehealth pricing set nationally, a page called "HRT in Wyoming" would contain the word Wyoming and then the same paragraphs as every other state. Sites in this category publish those pages anyway. We would rather send you to the numbers that are real.

What to do with this

Since price is national, the decision is about the provider rather than the postcode. Three routes into it:

• The full rankings for all 13women's-wing providers, score-sorted, with the Transparency Grade beside each one.
• Cheapest verified HRT if the monthly number is what is deciding it. Note that the per-visit and average-only providers are not comparable to a monthly subscription, and that table says which is which.
• The match quiz if you want it narrowed for you. No email required to see the result.
• The men's TRT wing for the 5 testosterone providers, which is where the December 31, 2026 federal deadline lands.