Quick answers · Last verified August 2026
22 questions, answer first, number first. Every price, count and grade below renders from the same verified provider file the rankings use, so nothing here can drift out of step with the rest of the site. We earn a commission from some of the platforms named, which never moves a score. How we score and who pays us.
All-in HRT runs $54 to $69 a month at the 2 of 5 women's platforms that bundle the medication into one monthly price. Winona sets the floor at $54. The other 3 charge for the care or the membership and bill the prescription somewhere else, so their headline number and an all-in number are not the same kind of figure.
Full verified table: what HRT costs.
$54 a month at Winona, the cheapest all-in price on our roster, then Gala Health at $69. Those figures buy the hormones. Sesame Care, Hone Health and Wisp bill the medication separately, so a monthly HRT cost quoted from one of their headline prices has left the prescription out of it.
Sorted by verified price: cheapest HRT online.
$58 a month at Hone Health, rising to $149 at Winona. Those are the published patch prices on our roster; 5 of the 5 women's platforms dispense the form. The route costs more than the molecule: Winona prices its estradiol pill at $54 and the identical hormone through the skin at $149.
Each line above is the provider's own published product string, kept verbatim. More on the form: the estrogen patch guide.
$54 a month at Winona is the cheapest cash price we have verified for systemic estradiol, with no insurer involved at any point. 5 of the 5 women's platforms we track are cash-pay only, so no insurer takes anything off the number they publish. Vaginal estradiol is cheaper again where it fits, from $20.
Every form priced side by side: estradiol, explained and priced.
Testosterone itself starts at $28 a month, Hone Health's injections, and that figure is the trap in this question. Hone Health bills $155 a month for membership and a separate biomarker assessment before any testosterone ships. Price the whole program, and treat the vial price as one line inside it.
Program pricing across the men's wing: what TRT costs.
$99 a month all-in at MangoRx, the only program on our 2-platform men's wing that puts the consult and the medication in one monthly number. The $155 you see quoted for Hone Health is a membership rather than a TRT price, with medication billed on top. Read the coverage line before the number, because the two look identical in a table.
Sorted: cheapest online TRT.
The medication usually is. The visit usually is not. None of the 5 women's platforms we track bills insurance: all 5 are cash-pay and never submit a claim. Generic estradiol and micronized progesterone sit on most commercial formularies, which makes the drug the cheap half of this.
Per-provider reality: HRT and insurance.
Two separate claims decide it, one for the clinician visit and one for the pharmacy fill. No platform on this roster bills the first, so all 5 women's-wing visits come out of your own pocket before the pharmacy is involved at all. The pharmacy claim is the dependable half.
The cash-pay math if the answer comes back no: cost of HRT.
Part D plans typically list generic estradiol and micronized progesterone, so the drug side usually works. The visit side is where it breaks. 5 of the 5 women's platforms we track bill no insurer at all, Medicare included, so the consult is money you pay yourself however well your plan handles the pharmacy claim.
Verify current visit rules on Medicare's telehealth page before booking.
Zero of the 2 men's-wing platforms we track bill insurance. Every one is cash-pay, so TRT bought through telehealth is an out-of-pocket cost whatever your plan says. A plan may still cover testosterone prescribed in person for diagnosed hypogonadism, which is a different route at a different price.
The men's rankings and what each one includes: TRT providers scored.
Safe enough that the FDA removed the boxed warning from menopausal hormone therapy, with the labeling changes approved in February 2026. The agency's stated basis was that randomized studies show women who start within 10 years of menopause, generally before age 60, have a reduction in all-cause mortality and fractures. Real risks remain, including endometrial cancer from unopposed estrogen.
The removal, the February 12 2026 approval date and the mortality and fracture finding all come from the FDA announcement of the approved labeling changes. What was removed and what stayed: the black box warning.
Headache leads the estradiol patch label at 14.9% to 50% depending on dose, against 23.6% on placebo. Breast tenderness runs 6.5% to 17%. Weight increase peaks at 8.5% on the 0.025 mg/day arm and shows no dose-response at all. The placebo column is the part almost every side-effect list omits.
All ten reactions across all five doses, with placebo beside each: estradiol patch side effects. Rates transcribed from the Vivelle-Dot (estradiol transdermal system) label on DailyMed.
The 60 in that question is a threshold for starting. Beginning HRT before 60 or within 10 years of your last period keeps the risk-benefit balance favorable; beginning it later shifts cardiovascular and stroke risk upward, so the conversation gets more individual. Continuing therapy you started in your fifties is a separate decision from initiating it at 65.
The age-at-initiation balance is set out in The Menopause Society 2022 position statement. The timing rule in full: is HRT safe in 2026.
No fixed cutoff exists. The age you keep reading, 60, describes when the evidence supports starting, and it comes from the timing rule the FDA cited when it approved the 2026 labeling changes. How long you stay on it is settled with a clinician against your own history and symptoms rather than by a number on a chart.
The Menopause Society 2022 position statement is the consensus most prescribers work from.
No association was found in the largest study to look. A UK population-based cohort of 182,010 women with asthma aged 45 to 60, drawn from nationwide primary care records linked to hospital and mortality data over 2004 to 2020, compared 9,663 incident HRT users against 172,347 nonusers and found a weighted hazard ratio of 0.97 (95% CI 0.90 to 1.04) for asthma attacks. The confidence interval sits across 1, so this is a null result rather than a small protective effect. The authors' own conclusion: "HRT use is not associated with asthma attacks in women with established asthma aged 45-60 years." Nor did it vary by subgroup: the researchers found no modification by blood eosinophil level, body mass index, smoking history or HRT type, which matters because oestrogen-only and combined therapy are often assumed to behave differently here. Two limits worth carrying with the number. The finding covers women with ESTABLISHED asthma in that age band and says nothing about whether HRT triggers new-onset asthma. And before weighting, the two groups were not alike: nonusers had more comorbidities, higher reliever use, more asthma attacks in the year before entry and lower preventer-inhaler use, which is exactly why inverse-probability-of-treatment weighting was applied. Median age was 52, interquartile range 50 to 55.
Lee B, Anpalagan H, Wong E, Tan T, Bloom CI. Hormone replacement therapy and the risk of asthma attacks: population-based cohort study. ERJ Open Research 2026;12(4), published online 10 August 2026. doi:10.1183/23120541.01599-2025 (PMID 42577565). Read 2026-08-26. One cohort is not the whole literature, and asthma control belongs with the clinician managing it. What this study removes is the assumption that starting HRT puts a woman with settled asthma at higher risk of an attack.
HRT replaces the estradiol, and usually the progesterone, that your ovaries stop producing at menopause. Clinicians also call it menopausal hormone therapy. It comes as a pill, patch, gel, spray, cream or vaginal insert, and 5 of the 5 platforms we track dispense a patch. Anyone with a uterus taking estrogen needs progesterone alongside it to protect the endometrium.
The endometrial-protection rule is the approved indication on the Prometrium (progesterone, USP) capsules label, indicated to prevent endometrial hyperplasia in nonhysterectomized postmenopausal women receiving estrogen. Not every progestogen carries that indication: norethindrone acetate is labelled as not intended, recommended or approved for use with concomitant estrogen therapy in postmenopausal women for endometrial protection. The hormone itself, defined and then priced: estradiol.
When symptoms are bothering you, and ideally within 10 years of your last period or before age 60. That window is the timing rule, and the FDA cited it directly when it approved the February 2026 labeling changes. Waiting for periods to stop completely is not a requirement, because perimenopause symptoms are treatable while cycles are still happening.
The FDA states the timing rule and the February 2026 approval date in its announcement of the approved labeling changes. If you are still cycling: HRT in peri.
Two clocks run, and only one of them is ours to verify. Getting the prescription takes a day or two on most platforms here, because intake is asynchronous and no in-person visit is required. Symptom response is the clock nobody should promise you a number on, and dose changes are made at follow-up rather than in week one.
The intake sequence, step by step: how to get HRT online. Ask any prescriber for their review interval before you pay.
An adhesive worn on the skin that releases estradiol into the bloodstream without passing through the liver first, changed weekly or twice weekly by product. 5 of the 5 women's platforms we track dispense one, published from $58 a month. The route matters: transdermal estrogen carried lower venous thromboembolism risk than oral in the BMJ 2019 data.
Supply is the other variable right now. The patch tracker carries live per-provider availability against the ASHP shortage listing. The route comparison is Vinogradova et al, HRT and risk of venous thromboembolism, BMJ 2019.
Wisp publishes the cheapest at $20, and 5 of the 5 women's platforms we track dispense a vaginal form. Each bills it on a different unit, so the verbatim strings are below rather than a single invented per-month figure. It is dosed far below systemic therapy and treats local symptoms.
Vaginal estrogen is generally considered separately from systemic HRT in the risk discussion, and ACOG's menopause guidance calls the vaginal ring, tablet and cream "local" estrogen therapy, prescribed for vaginal symptoms. Every estradiol form compared.
No. In FDA's own words in a notice published 2026-08-18: "Unlike estrogen-containing products, there are no FDA approved indications for testosterone therapy for menopausal women." It is prescribed to women anyway, and FDA says so in the same notice: "Nevertheless, the off-label use of testosterone in women nearing or after menopause has increased over the past decade." That makes every prescription of testosterone to a menopausal woman in the United States an off-label one, whatever the clinic calls it. Elsewhere the picture differs: "Testosterone is currently approved for hypoactive sexual desire disorder (HSDD) in women in Australia, New Zealand, the UK, and South Africa." On the evidence, FDA is direct that it is thin. "Beyond HSDD, there are limited data on the treatment effect of testosterone for other clinical uses. While short-term safety data exist for physiologic doses, long-term safety data beyond 24 months are limited, particularly regarding cardiovascular and breast cancer risks." FDA is holding a public workshop on September 17, 2026, 9:00 a.m. to 4:30 p.m. Eastern Time, and taking public comments on docket FDA-2026-N-5479 until October 19, 2026, 11:59 p.m. Eastern Time. 27 comments had already been filed as of 2026-08-26.
None of our women's-wing platforms is scored on testosterone, because there is no approved indication to score them against. If a clinic offers you testosterone for menopause symptoms, the questions worth asking are which symptom it is meant to treat, what dose and what form, whether it is a compounded product, and what the monitoring plan is. FDA's own summary of what is known is worth reading before that conversation: “The role of declining ovarian testosterone levels in menopausal women and its relationship to medical conditions, such as frailty, depressive symptoms, sleep, sexual function, cognition, and musculoskeletal health, are not well understood.”
The dates, if you want a say
Source: Testosterone Use in Menopausal Women; Public Workshop; Request for Comments, 91 FR 53417, Notice of public workshop. Read 2026-08-26. We have no commercial interest in this question and no partner selling testosterone to women.
Hormone implants placed under the skin, and none of the 6 platforms on our roster offers them, so every pellet price you find belongs to a clinic we have not scored. Once a pellet is in, the dose cannot be adjusted, and stopping means waiting it out. Compounded pellets are not FDA-approved.
What the word bioidentical does and does not mean: bioidentical HRT. FDA on human drug compounding.
This is general information, not medical advice. HRT and TRT are prescription therapies and the right one for you is a decision for you and a licensed clinician. Prices were last verified August 2026 and providers change them without notice; each figure is dated on the relevant provider review. Reviewed by Iacob Pastina.
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