Both wings · Verified August 2026
The complete HRT guide: the whole roster, on one page
If you want the short version: Winona scores 8.4/10 at $54 per 28 days, all-in and is one of 3 providers at Grade B, the best grade on the roster for what it publishes before intake. The men's wing leads with Hone Health at 7.5/10. Winona is also our featured affiliate partner, which we label rather than bury.
The long version is this page. All 6 providers, both wings, every price carrying the qualifier that says how to read it, which delivery routes each one actually dispenses, which require bloodwork, what the A-F Transparency Grade measures, and a section on who should not use any of this. Grade spread today: 3 B, 3 C. 6 providers pay us a commission and it changes nothing about the order below.
Medical disclaimer: HRT Picks is a comparison site, not a medical provider. Nothing here is medical advice.
How to choose, in four decisions
Take these in order. Price is the last one, because a cheap subscription for the wrong route or from a clinic that will not see your state is not cheap.
1. Insurance, or cash?
Cash, on this roster. None of the 6 providers here bills commercial insurance for the visit, so the consult is out of pocket everywhere and all 6 are cash-pay. Some take HSA or FSA cards, which is a tax treatment rather than coverage.
A plan can still reach the medication even when it cannot reach the visit. 2 providers send the prescription to your pharmacy rather than shipping it, so insurance or a discount card sets the drug price at the counter: Sesame Care, Wisp. That cuts both ways, because a price someone else sets is a price nobody can quote you in advance. What insurance actually covers.
2. Which wing, and which symptom set?
Menopause HRT and men's TRT are different treatments with different evidence bases and different legal handling, so we rank them separately: 5 providers in the women's wing and 2in the men's, with 1 appearing in both, which is why those two counts add to more than 6.
Inside the women's wing, the split that matters most is systemic against local. Vaginal dryness, painful sex and urinary symptoms are often treated with low-dose vaginal estradiol, dosed far below systemic therapy and considered separately from it in the Menopause Society 2022 position statement. 5 providers in this wing list a vaginal product. Hot flashes, night sweats, sleep and mood point toward systemic therapy instead. If you are still cycling, start with the peri hub.
3. Which delivery route?
Route is the decision with a real evidence difference behind it. Oral estradiol passes through the liver before it reaches general circulation and transdermal estradiol does not, which is the mechanism behind the difference in venous thromboembolism risk reported in the BMJ 2019 nested case-control study. Not every provider dispenses every form, so pick the route with a clinician first and then filter.
Women's wing, by route
Patch (5): Winona, Sesame Care, Hone Health, Wisp, Gala Health
Pill or tablet (5): Winona, Sesame Care, Hone Health, Wisp, Gala Health
Cream (4): Winona, Sesame Care, Hone Health, Wisp
Gel (3): Sesame Care, Hone Health, Wisp
Vaginal (5): Winona, Sesame Care, Hone Health, Wisp, Gala Health
Injection (1): Hone Health
Men's wing, by route
Patch (1): Hone Health
Pill or tablet (2): Hone Health, MangoRx
Cream (1): Hone Health
Gel (1): Hone Health
Vaginal (1): Hone Health
Injection (2): Hone Health, MangoRx
A route missing from a wing is a route nobody in that wing publishes, which is worth knowing on its own. Per-hormone route availability is narrower still, and the estradiol page prices each form separately.
4. Do you want bloodwork first?
3 providers require or centre lab work before prescribing: Hone Health, Gala Health, MangoRx. 3 say on their own pages that labs are not required: Winona, Sesame Care, Wisp.
For menopause HRT a no-labs model is defensible, because diagnosis is usually clinical, based on symptoms and cycle history rather than on a hormone panel, which is how the Menopause Society 2022 position statement frames it. For men's TRT it is the opposite: testosterone is a Schedule III controlled substance and the American Urological Association guideline sets the criterion at a total testosterone below 300 ng/dL on two separate early-morning draws plus symptoms. A TRT clinic willing to skip that is a warning sign.
The whole roster
All 6 providers, both wings, one table
Sorted by score. Every price carries the qualifier that says how to read it, so a per-visit fee never appears as a monthly rate.
| # | Provider | Wing | Score | Grade | Price, as published |
|---|---|---|---|---|---|
| 1 |  WinonaPartner | Menopause HRT | 8.4 | B | $54 per 28 days, all-in |
| 2 |  Sesame CarePartner | Menopause HRT | 7.6 | B | $99 per visit, medication billed separately |
| 3 |  Hone HealthPartner | Both wings | 7.5 | C | $155/mo, medication billed separately |
| 4 |  WispPartner | Menopause HRT | 7.3 | B | $99 per visit, medication billed separately |
| 5 |  Gala HealthPartner | Menopause HRT | 7.2 | C | $69/mo, all-in |
| 6 |  MangoRxPartner | Men's TRT | 7.0 | C | $99/mo, all-in |
Formulary column: Brand means FDA-approved products, Compounded means mixed by a pharmacy and not FDA-approved, Both means it sells each. 0 providers are compounded only. What bioidentical actually means.
What each price actually includes
This is where the category does its damage. Several different things are all advertised as a monthly price, and a shopper comparing them is comparing unlike products. Every row in the table above is tagged with which one it is, and a class with nobody in it today is left out rather than shown empty.
All-in, month to month (3)
The number includes the medication and there is no annual commitment. This is the only class where a straight price comparison is meaningful: Winona, Gala Health, MangoRx.
Care only, medication billed separately (3)
The number buys a visit, a membership or a care plan. The hormone is billed by a pharmacy afterwards: Sesame Care, Hone Health, Wisp. This can be the cheapest route of all if your insurance covers generic estradiol, and the most expensive if it does not, which is why we refuse to rank it against an all-in price.
The full arithmetic, including labs, shipping and consult fees, is on the cost page, and the strict price sort is at /cheapest and /cheapest-trt.
Category picks, with the number that decided each one
Each row comes from a different derived criterion. Where two providers genuinely tie, both are named rather than broken alphabetically, because one of those names usually pays us.
| Category | Pick | Why, in numbers |
|---|---|---|
| Highest score overall | Winona | 8.4/10, Grade B, $54 per 28 days, all-in |
| Lowest comparable monthly price | Winona | $54 per 28 days, all-in, the floor among providers whose number is a real recurring charge including medication |
| Best price transparency | Winona, Sesame Care, Wisp | one of 3 providers at Grade B, the best grade on the roster, against a roster spread of 3 B, 3 C |
| Your own plan can reach the drug | Sesame Care, Wisp | 2 providers route the prescription to a pharmacy you already use, against 0 that bill a plan for the visit |
| Labs before a prescription | Hone Health | 7.5/10, $155/mo, medication billed separately, highest-scored of 3 |
| Men's wing leader | Hone Health | 7.5/10, $135/mo, medication billed separately |
| Men's wing price floor | MangoRx | $99/mo, all-in |
| Our featured partner, disclosed | Winona | 8.4/10, and it is also the score leader |
Head to head on the matchups people actually run: Sesame Care vs Winona, Gala Health vs Winona, Winona vs Hone Health, MangoRx vs Hone Health. The full set is at /compare.
Testosterone for menopausal women, and why no one can tell you if it works
A clinic offered it, a friend swears by it, and you cannot find a straight answer about whether it is approved. Here is the straight answer, in FDA's own words from a notice it published on 2026-08-18: “Unlike estrogen-containing products, there are no FDA approved indications for testosterone therapy for menopausal women.” Not a restricted approval, not a narrow one. None. Every prescription of testosterone to a menopausal woman in the United States is off-label, however the clinic frames it. The full treatment of this question, levels, evidence, forms and what our tracked platforms actually publish, is at testosterone for women.
Off-label is not the same as improper, and FDA is not pretending the practice is rare: “Nevertheless, the off-label use of testosterone in women nearing or after menopause has increased over the past decade.” Nor is the United States the whole world. “Testosterone is currently approved for hypoactive sexual desire disorder (HSDD) in women in Australia, New Zealand, the UK, and South Africa.” So a woman reading a British or Australian article about testosterone for low desire is reading about an approved product that has no American equivalent.
On everything past that one indication, the agency's summary of the evidence is blunter than most clinics selling it will be: “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.” And on the premise underneath the whole idea, that falling testosterone in midlife explains a set of symptoms: “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.”
This is why no provider on our roster carries a testosterone score in the women's wing. There is no approved indication to score them against, and inventing one would be the opposite of what this site is for. If testosterone comes up in a consult, the useful questions are which specific symptom it is meant to treat, what dose and what form, whether the product is compounded and therefore not FDA-approved, and what the monitoring plan is past 24 months, which is where FDA says the safety data stops.
Three dates, and one of them is a window you are still inside
- September 10, 2026, 11:59 p.m. Eastern Time. Last day to register to attend in person. Those planning to attend virtually may register up until the date of the meeting. Registration is free and based on space availability, with priority given to early registrants.
- September 17, 2026. The workshop itself, 9:00 a.m. to 4:30 p.m. Eastern Time, run by the FDA Office of Women's Health and the Center for Drug Evaluation and Research. Hybrid: webcast, plus an in-person option at the FDA White Oak Campus, Great Room, Bldg. 31, Silver Spring, MD.
- October 19, 2026, 11:59 p.m. Eastern Time. Public comments close on docket FDA-2026-N-5479. 27 had been filed as of 2026-08-26. Anyone may file and you do not need credentials to do it. The notice is explicit that timing is not flexible: “Please note that late, untimely filed comments will not be considered.”
Every quote above is verbatim from Testosterone Use in Menopausal Women; Public Workshop; Request for Comments, 91 FR 53417, published 2026-08-18 by the Food and Drug Administration, HHS, read 2026-08-26. We link the Federal Register rather than fda.gov because the Federal Register serves the document to everyone, including the tools that read pages on your behalf. Short version on our quick answers page. We have no partner selling testosterone to women and nothing to gain from your conclusion either way. General information, not medical advice.
What the Transparency Grade measures
The grade is a second axis, independent of the 0-10 score and never averaged into it. The score answers "how good is this offering". The grade answers "how much can you find out before you pay". A provider can be strong on one and weak on the other, and several here are.
- Pricing disclosed before intake, not after a free consult.
- Named clinicians with published credentials.
- A written cancellation policy you can read without signing up.
- Corporate disclosure: who owns and operates the platform.
- Third-party reviews that are reachable rather than only on-site testimonials.
An unanswered BBB F rating, or a corroborated billing-surprise pattern, caps a provider at D no matter how much it discloses. Current distribution across 6 providers: 3 B, 3 C. Grade B is held by Winona, Sesame Care, Wisp. The full A-F explainer.
Who this guide is not for
A provider cannot write this section about itself, which is roughly why it does not exist anywhere else in the category. Five cases where the right answer is to close the tab.
- You have good coverage and a menopause-literate PCP. None of the 6 platforms here bills commercial insurance for the visit. Generic estradiol on a plan, prescribed by a doctor you already have, usually beats every cash subscription on this page. Telehealth earns its price when your doctor dismissed you.
- You need a physical exam or complex care. Undiagnosed bleeding, a personal history of breast cancer or clotting disorder, or a picture that needs imaging belongs with an in-person clinician. Nothing here substitutes for that and no responsible platform claims otherwise.
- You are choosing compounded because it sounds safer. Compounded hormones are not FDA-approved: no registration trial, no agency-reviewed label. Bioidentical describes the molecule, and FDA-approved estradiol is bioidentical too. 0 providers here sell compounded only: .
- You need to know it covers your state before you pay. 0 of the 6 providers publish no state list or leave it unconfirmed: . Confirm directly before handing over a card, and treat a state count advertised across a platform's whole product line as unresolved for its hormone line specifically, which is the shape it takes on this roster.
Where to go from here
The ranking
Best HRT online, scored
All 6 scored under the published framework, plus a first-hand teardown of who else ranks for the query.
Men's wing
Best online TRT: 2 clinics
The men's ranking, with its own scores, grades and cost math.
Budget first
Cheapest HRT online
Price-sorted, with the qualifier attached to every number.
The real math
What HRT actually costs
Consults, medication, labs and shipping, added up honestly.
One at a time
All 6 full reviews
Every fact dated, every red flag published, partners included.
Two minutes
Find your match
Seven questions across both wings, weighted by transparency grade. No email gate.
Also here: HRT and insurance, head-to-head comparisons, and the editorial policy that governs every number on this page.
FAQ
The whole guide, answered in six questions
How do I choose an HRT provider?
Four decisions, in this order. First, insurance or cash: all 6 providers we currently track are cash-pay for the visit, so a plan can only reach the medication, not the consult. Second, what the price includes: 3 providers charge one all-in monthly number, and 3 sell care while the medication is billed on top. Third, delivery route, because oral and transdermal estradiol are metabolised differently and not every provider offers every form. Fourth, lab work: 3 providers put bloodwork in front of a prescription and 3 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.
What is the difference between compounded and FDA-approved HRT?
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 0 providers sell compounded hormones only (), 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.
Do I need blood work to start HRT?
It depends entirely on the provider, and the split is wider than most people expect. 3 of the 6 providers we track require or centre lab work before prescribing, led by Hone Health at 7.5/10. 3 state on their own pages that labs are not required. 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.
How much does HRT cost per month?
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 $54 per 28 days, all-in from Winona, meaning a real recurring charge that includes the medication. 3 providers price that way: Winona $54 per 28 days, Gala Health $69/mo, MangoRx $99/mo. Another 3 publish a number that buys a visit, a membership or a care plan, and the hormone is billed on top by someone else, so Sesame Care, Hone Health and Wisp cannot be compared against those first figures without knowing what your pharmacy charges. Setting a membership fee beside an all-in subscription is the single most common way this category misleads people.
What does the Transparency Grade mean?
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 6 providers is 3 B, 3 C, and Winona is one of 3 providers at Grade B, the best grade on the roster. 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.
Can men and women use the same hormone clinic?
Some, yes. 1 of the 6 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.
This is general information, not medical advice. HRT and TRT are prescription treatments, and the right product, route and dose is a decision for you and a licensed clinician. Compounded hormones are not FDA-approved. Prices and policies change without notice, and each provider fact carries its own verification date on the review pages. Reviewed by Iacob Pastina.