Best Compounded HRT Providers Online (2026)
The best compounded HRT providers online in 2026 are Winona and Inner Balance (Oestra) — the two dedicated compounded routes — and for most women searching this, Winona is the one to check first. It custom-makes a combined estrogen-and-progesterone body cream through its own pharmacy, starts around $89/month, needs no lab work to begin, and includes unlimited messaging with the doctor. If you want a live video visit with prescriptions sent to your own pharmacy, Sesame ($59/month membership) is the flexible alternative. And if insurance or FDA-approved medication is your real priority, Midiis the honest off-ramp — and we say so plainly.
As of May 2026, The HRT Index does not have active affiliate partnerships with the providers on this page. Provider links are non-affiliate editorial links pointing directly to provider websites. If affiliate relationships are added later, affected links and this disclosure will be updated. Full affiliate disclosure · methodology.
Start here — pick the row that sounds like you
| If you want… | Start with | Why |
|---|---|---|
| Custom compounded menopause HRT, cash-pay, simple | Winona | Compounded estrogen/progesterone cream, ~$89/mo, clear about what’s compounded vs FDA-approved |
| One daily whole-body cream with a money-back guarantee | Inner Balance (Oestra) | A single compounded formula, 6-month refund window |
| A live video visit and prescriptions sent to your local pharmacy | Sesame | $59/mo membership, video + labs included, meds filled locally |
| Insurance to cover it, or FDA-approved medication | Midi | In-network with most PPO plans, all 50 states, FDA-approved hormones |
| To figure out if compounded is even right for you | Our 60-second quiz | Personalized path, no pressure |
Is compounded HRT FDA-approved or safe?
Compounded HRT is not FDA-approved.That means the U.S. Food and Drug Administration has not checked the final medication for safety, quality, or how well it works — unlike off-the-shelf prescription hormones. It's legal, a licensed doctor still prescribes it, and it can be a reasonable choice in specific cases. But major medical groups say to start with FDA-approved hormones first for most people.
“Compounded” means a pharmacy mixes your medication to order, to a doctor's exact recipe, instead of you getting a mass-produced pill or patch off a shelf. That custom step is the whole appeal — and the whole catch. Here is how the people who set the rules see it:
- The FDAsays compounded drugs should generally be used when a patient's medical need can't be met by an approved drug — for example, an allergy to an ingredient in the approved version, or needing a form that isn't sold ready-made.
- A 2020 National Academies report called the widespread use of compounded hormones a public health concern, and recommended limiting it to two situations: an allergy to an ingredient in an FDA-approved product, or needing a dose or form not available FDA-approved.
- ACOG (American College of Obstetricians and Gynecologists) says compounded bioidentical menopausal hormone therapy should not be prescribed routinely when FDA-approved versions exist.
- Mayo Clinicnotes that compounded bioidentical products aren't held to the same quality standards as commercial hormones, so the dose and purity can vary from batch to batch.
Compounded HRT is NOT FDA-approved, and we're not going to pretend it is.
If FDA-approved medication or insurance coverage is your top priority, a compounded provider is the wrong tool, and Midiis the better route — FDA-approved hormones, in-network with most PPO plans, in all 50 states. But here's why so many women still want compounded: it can offer custom forms, combos, and doses that aren't sold ready-made, and sometimes that's the only way to get exactly what you need.
One more thing worth knowing. In November 2025, the FDA initiated labeling changes to remove prominent “boxed” warnings about heart disease, breast cancer, and probable dementia from menopause hormone products containing estrogen — a shift toward a more nuanced, age-based view of risk. One important exception: the FDA is not removing the boxed warning about endometrial (uterine) cancer for systemic estrogen-only products. This matters regardless of whether you go FDA-approved or compounded.
Compounded vs. bioidentical vs. FDA-approved: what's the difference?
“Bioidentical” and “compounded” are not the same thing, and mixing them up is the single biggest mistake people make here. Bioidenticaldescribes the hormone's structure — it's built to match the hormones your body makes. Compoundeddescribes how it's made — mixed to order by a pharmacy. Some bioidentical hormones are FDA-approved (like estradiol patches and micronized progesterone capsules); compounded ones are not.
Read that twice, because the marketing blurs it on purpose. You can have a bioidentical hormone that isFDA-approved. You can have one that's compounded and isn't. “Bioidentical” is a description of the molecule, not a safety stamp. The word “natural” gets thrown around too. The National Academies found that claims of superior safety, effectiveness, and “natural” or anti-aging benefits for compounded bioidentical hormones are not backed by well-designed studies.
Quick translator: what the marketing says vs. what to ask
| You'll see this word | It sounds like | What it actually means | What to ask before you pay |
|---|---|---|---|
| “Bioidentical” | “Safer, more natural” | Same molecular structure as your body’s hormones — not a safety rating | Is this specific product FDA-approved, or compounded? |
| “Compounded” / “custom” | “Made just for me” | Mixed to order; the final product is not FDA-approved | Which pharmacy makes it, and is it third-party tested? |
| “Natural” / “plant-derived” | “Gentler, lower risk” | A source description, not an evidence claim | What’s the actual dose, and what are the risks for me? |
| “Pharmaceutical-grade” | “FDA-quality” | Refers to ingredient quality, not approval of the final mix | Are the active ingredients FDA-approved even if the blend isn’t? |
What “503A” means (and why it's on this page)
When you see a compounding pharmacy described as 503A, that's the part of U.S. law it operates under:
- 503A pharmacy— makes patient-specific prescriptions, one person at a time, overseen mainly by state pharmacy boards.
- 503B outsourcing facility— makes larger batches and is regulated more directly by the FDA.
Neither one means the final compounded medication is FDA-approved. It isn't. But a pharmacy that's transparent about its licensing and does third-party testing is a better sign than one that's vague about where your medication comes from.
The cheat sheet
| FDA-approved hormones | Compounded hormones | |
|---|---|---|
| Reviewed by FDA for safety/quality | ✅ Yes | ❌ No |
| Made | Mass-produced, standard doses | Mixed to order per prescription |
| Insurance | Often covered | Rarely covered |
| Typical cash cost | ~$30–$120/mo | ~$100–$350/mo |
| Dose/form flexibility | Limited to what’s manufactured | High — custom doses, combos, forms |
| What guidelines say | Recommended first for most people | Reserve for specific reasons |
The best compounded HRT providers online, compared
The fastest way to choose is to sort the options into three groups: providers that truly compound (Winona, Inner Balance), a flexible live-video marketplace that can go either way (Sesame), and the FDA-approved route for everyone who decides compounded isn't worth it (Midi). Most people who type “compounded HRT” should still glance at all of them, because the cheaper or more FDA-backed answer might be one of them.
Every figure here was verified June 2, 2026, against the source noted in the last column.
| Provider | Compounded? | FDA-approved final HRT product? | Pharmacy | Labs to start | Visit type | Insurance / HSA-FSA | Verified starting price |
|---|---|---|---|---|---|---|---|
| Winona | Yes — estrogen/progesterone creams | Its patches, tablets & capsules are FDA-approved; creams are not | Own 503A pharmacy | No | Online intake (async) | No insurance billing; HSA/FSA yes | Estrogen + progesterone cream ~$89/mo |
| Inner Balance (Oestra) | Yes — daily cream (estradiol + progesterone) | No — final compounded product is not FDA-approved | 503A or 503B — verify | No | Online intake (async) | No insurance; HSA/FSA yes | $199/mo first 6 months, then $99.50/mo; 6-mo money-back |
| Sesame | Sometimes — provider’s call; can also do FDA-approved | Yes — FDA-approved generics/brands via local pharmacy | Marketplace; meds filled locally | Provider’s call | Live video | No insurance billing for Sesame; HSA/FSA may apply | $59/mo membership (visits + labs; meds extra) |
| Midi (FDA-approved route) | Backup/shortage option only, not compounded-first | Yes — FDA-approved hormones + non-hormonal options | Standard pharmacies; ships compounded in limited cases | As clinically needed | Live video | In-network most PPO, all 50 states; HSA/FSA yes | $250 initial / $150 continued (self-pay); copay with insurance |
A note on Winona: not everything Winona sells is compounded. Winona states its estrogen patches, estrogen tablets, and progesterone capsules are FDA-approved, while its estrogen and progesterone body creams are patient-specific compounded formulations that are not FDA-approved (though made with FDA-approved ingredients). The cream is the compounded part most people come for.
A note on Midi: it's FDA-approved-first, not “no compounding ever.” Midi also offers compounded progesterone capsules and compounded estradiol gel and cream as out-of-pocket, shipped options in shortage or continuity-of-care situations. It's still the cleanest FDA-approved pick on this page — just not a “compounded-first” provider.
Which providers did we exclude, and why?
We didn't rank every telehealth brand — only the ones that fit this exact search and that we could verify. Here's where the others land, so you can see the boundary we drew instead of guessing.
| Provider | Why it's not a “compounded-first” pick here | What to verify if you're curious |
|---|---|---|
| Hers | Its menopause line uses FDA-approved estradiol (pill, patch, cream) and progesterone — not clearly compounded | Whether any cream option is compounded; current price |
| Midi | FDA-approved-first; compounding is a backup/shortage option, not the main model | Whether your needed compounded form is available in your state |
| Alloy, Evernow, Gennev | Menopause-focused but built around FDA-approved hormones, not compounding | Their formularies, if you specifically want compounded |
| Hone | Broader hormone-optimization model; verify current compounded offerings and pricing | Membership cost vs. medication cost; testosterone caveats |
Which online compounded HRT provider fits your situation?
The “best” provider changes with what you actually need: a custom cream, one whole-body formula, a live video visit, insurance, or FDA-approved medication. Find yourself below.
- “I want custom compounded HRT and simple cash pricing.” → Winona. Compounded cream, transparent starting price, no labs to begin.
- “I want one simple daily cream that works on whole-body symptoms.” → Inner Balance (Oestra). A single compounded formula with a money-back window.
- “I want to talk to a real clinician on video and use my own pharmacy.” → Sesame. Live visit, prescriptions sent locally.
- “I want insurance to cover it, or I'd rather have FDA-approved medication.” → Midi.This is the honest off-ramp — don't pay cash for compounded if a covered, approved option fits.
- “I have a complicated health history” or “I'm just not sure.” → Take the quiz, then bring the result to a licensed clinician.
Winona review: the best all-around compounded HRT provider online
Winona is our top pick for women who want tailored, cash-pay compounded HRT for menopause. It custom-makes a combined estrogen-and-progesterone body cream through its own pharmacy, starts around $89/month, needs no lab work to begin, and includes unlimited doctor messaging. It's not the right fit if you want insurance billing, pickup at a local pharmacy, or FDA-approved-only medication.
Here's why it earns the spot. Winona is built around one job — menopause and perimenopause hormone care — so it's not a side feature buried in a general telehealth app. It owns and operates its own 503A-regulated compounding pharmacy, which is why it can offer that two-in-one cream instead of making you juggle separate prescriptions. The care model is low-friction: you fill out a detailed intake, a board-certified doctor reviews it, and if you're a good candidate, your medication ships to your door with free shipping and ongoing message access. Winona does not require lab tests before prescribing.
A detail that matters for honesty and for trust: Winona is upfront that only part of its lineup is compounded. The creams are; the patches, tablets, and capsules are FDA-approved. That kind of plain labeling is exactly what most competitor pages hide.
What it costs:Winona's most popular option, the estrogen body cream with progesterone, starts at about $89/month, ships free, and includes unlimited follow-ups and 24/7 doctor messaging at no extra cost. Other forms are priced separately — confirm current pricing on Winona's site. Winona doesn't bill insurance directly, but you can submit receipts for possible reimbursement, and it accepts HSA/FSA.
One thing to know about testosterone:Winona states it does not prescribe testosterone, and may prescribe DHEA supplements instead. Don't think of DHEA as a stand-in for a testosterone prescription — it's a different thing, and the Endocrine Society recommends against routine DHEA use because the data on its benefit and safety is limited. If a testosterone prescription is specifically what you're after, see the testosterone section below.
Where Winona isn't the answer: Winona does not bill insurance and does not send prescriptions to your local pharmacy. If either of those is your priority, Midi (insurance) or Sesame (local pharmacy) is the better first step.
Inner Balance (Oestra) review: best if you want one simple whole-body cream
Inner Balance makes Oestra, a compounded cream applied vaginally that combines estradiol and progesterone in a single daily pump and is marketed for whole-body symptoms — not just local dryness. There's no lab work required to start, and it comes with a six-month money-back guarantee. It fits women who want one simple formula.
Oestra is the whole product here — Inner Balance isn't a broad menu, it's one focused formula, listing roughly 3 mg estradiol and 100 mg micronized progesterone per pump. The company is LegitScript-certified and offers a six-month money-back guarantee on Oestra. Like Winona, Inner Balance does not require lab testing before prescribing.
A fairness note on the marketing:Inner Balance promotes Oestra for everything from menopause to PCOS, endometriosis, and postpartum. Treat those as the brand's claims, not settled facts. The FDA has said it does not have evidence that compounded bioidentical hormones are safe and effective, or safer or more effective than FDA-approved hormone therapy. Whether Oestra is right for your history is a conversation for the prescribing clinician.
Where to be careful:Oestra comes in one form only — if you want a patch or pill, Winona fits better. It isn't covered by insurance (HSA/FSA is accepted). At $199/month for the first six months, it's the priciest option here up front before dropping to $99.50/month. The six-month guarantee is generous, but confirm the current price and the exact refund and cancellation terms on Inner Balance's site. Also: Inner Balance's own pages currently describe its pharmacy as both “503A” and “503B” in different places — verify which it is before you decide.
Sesame review: best for a live video visit and local pharmacy pickup
Sesame is a telehealth marketplace where you book a live video visit and a licensed clinician can prescribe hormone therapy — compounded if appropriate, or FDA-approved filled at your local pharmacy. Its menopause membership is $59/monthand includes video visits and lab work, with medication costs separate. It's best for people who want a real conversation and flexibility, not a single packaged formula.
Sesame's menopause subscription runs $59/month and includes same-day video visits, essential lab work, access to hormonal and non-hormonal therapies, and ongoing treatment adjustments. Because it's a marketplace, you can land on an FDA-approved prescription sent to a pharmacy near you. Sesame is refreshingly upfront that bioidentical HRT is prescribed and dispensed outside of formal FDA regulation, and that studies have not shown it is safer or more effective than traditional hormone therapy.
Where to be careful:Sesame is a marketplace, so the clinician and continuity can vary from one provider to the next, and it isn't a dedicated “compounded HRT” program — its featured menopause options are largely FDA-approved generics and brands. It doesn't bill your insurance for its own service, though prescriptions and labs may be covered by your plan, and HSA/FSA may apply. If you want one consistent, packaged compounded plan, Winona is cleaner; if you want choice and a live visit, Sesame shines.
Midi review: the FDA-approved route (and our pick if compounded isn't right)
Midi is FDA-approved-first — and that's the point. It's the best first step for anyone who wants insurance coverage, FDA-approved hormones, and a live clinician. Self-pay visits are $250 to start and $150 for continued care, or a copay if you use insurance, and Midi is in-network with most PPO plans across all 50 states.
We're featuring Midi on a compounded page on purpose, because the most useful thing we can tell a lot of you is: you may not need compounded at all. Midi prescribes FDA-approved bioidentical hormones — pills, patches, and vaginal formulations — and notes that insurance is more likely to cover these than compounded preparations, which aren't FDA-regulated. It also offers non-hormonal options and can provide compounded progesterone or estradiol as a shipped, out-of-pocket backup in shortage situations.
Two trust signals worth noting: Midi is NCQA-accredited and LegitScript-certified.
Midi does not work with Medicaid/Medi-Cal, and isn't covered by Medicare (Medicare patients can self-pay but can't submit claims).
Where it's not the answer:Midi isn't the cheapest cash-pay path, and it's not what you want if you've decided you specifically want a custom compounded cream shipped to you. But if insurance and FDA-approved medication are what you care about, that's exactly why it's the stronger starting point.
How much does compounded HRT cost online in 2026?
Compounded HRT online usually runs about $100 to $350 a monthand is rarely covered by insurance. Among our picks, Winona's compounded estrogen/progesterone cream starts around $89/month, Sesame's membership is $59/month (medication extra), and Inner Balance/Oestra is $199/month for the first six months, then $99.50/month. FDA-approved hormones are often cheaper — roughly $30 to $120 a month — and frequently covered.
Here's a realistic first-90-day picture. These are estimates from each provider's published pricing; your actual cost depends on your prescription, state, and plan.
| Provider | Month 1 (estimate) | First 90 days | What's included | Likely extra |
|---|---|---|---|---|
| Winona | ~$89 (cream) | ~$267 | Compounded cream, free shipping, messaging | Other forms priced separately |
| Sesame | $59 membership + meds | ~$177 + meds | Video visits, labs | Medications (filled at pharmacy) |
| Inner Balance (Oestra) | $199 | ~$597 (first 3 months) | Oestra cream, 6-mo guarantee | Drops to $99.50/mo after month 6 |
| Midi (self-pay) | $250 visit + meds | $250 + follow-up + meds | Live clinician visit | Medications, $150 follow-ups |
| Midi (insurance) | Copay + meds | Plan-specific | Covered visit if eligible | Deductible, coinsurance, meds |
See our full HRT cost guide for 2026 for a deeper breakdown.
Does insurance cover compounded HRT online?
Usually, no.Insurance is far more likely to cover a visit or an FDA-approved prescription than custom compounded hormones, because compounded products aren't FDA-approved. Compounded bioidentical hormones are typically excluded, while FDA-approved estradiol and progesterone are often covered — though it always depends on your specific plan, pharmacy, drug, and provider.
| Provider | Visit covered by insurance? | Medication covered? | HSA/FSA | Local pharmacy? |
|---|---|---|---|---|
| Winona | No (submit receipts to try for reimbursement) | Unlikely for compounded creams | ✅ Yes | No (ships to you) |
| Inner Balance | No | No | ✅ Yes | No (ships to you) |
| Sesame | No (Sesame’s own fee is cash-pay) | Possibly, via your plan at the pharmacy | May apply | ✅ Yes |
| Midi | Yes — in-network with most PPO plans | FDA-approved meds often covered | ✅ Yes | ✅ Yes |
A few honest levers to make compounded affordable: use HSA/FSA(pre-tax money, not coverage, but it helps — confirm at checkout); ask Winona for reimbursement receipts to submit to your insurer (no guarantees); or, if price is your real concern, go FDA-approved instead through an insurance-friendly provider like Midi, where copays often land at $10 to $50.
Can you get compounded HRT online without lab tests?
Yes.Winona and Inner Balance both prescribe based on your symptoms and medical history without requiring lab work first, and a clinician may order labs later if needed. Skipping labs makes starting faster — but it's worth knowing what labs are, and aren't, for.
- Winona: no labs required to start.
- Inner Balance (Oestra): no labs required to start; a clinician may order them later.
- Sesame:basic lab work is included with the membership if your provider decides it's needed.
- Midi: labs as clinically needed.
The providers that skip labs explain it this way: hormone levels swing throughout the day, so a single blood draw can be a misleading snapshot. There's real support for that. ACOG says hormone-level testing is notrecommended as the basis for prescribing or dosing compounded bioidentical menopausal hormone therapy. Basic labs can still help check other health factors when there's a clinical reason. Our take: no-labs is a convenience, not a virtue. If your symptoms don't improve or you get side effects, ask about appropriate testing.
What about testosterone?
For women in the U.S., there is no FDA-approved testosterone product, so it's prescribed off-label or compounded — and testosterone is a controlled substance that always requires a prescription and clinician oversight. It is not an energy, weight-loss, or anti-aging shortcut, and it shouldn't be treated like one.
The Endocrine Society recommends against general testosterone use in women for things like energy, mood, cognitive, cardiovascular, metabolic, or bone reasons, and recommends against routine DHEA use — while noting some evidence for short-term testosterone in postmenopausal women with low sexual desire (HSDD), with careful monitoring. If testosterone is part of your conversation, it belongs with a clinician who knows your history — full stop. Note that Winona doesn't prescribe testosterone at all; it may use DHEA instead.
See our dedicated guide: Best online menopause clinic that prescribes testosterone.
Who should NOT use compounded HRT online?
You should pause and talk to a clinician before any online HRT — compounded or not — if you have certain conditions. A comparison page is a starting point, never a substitute for individual medical advice. And if your priority is insurance coverage or FDA-approved medication, compounded simply isn't your route.
Hold off and get personal medical guidance first if any of these apply:
- A history of breast cancer or other hormone-sensitive cancer
- Blood clots, stroke, or “mini-stroke” (TIA), or coronary heart disease
- Active liver disease
- Unexplained vaginal bleeding
- Pregnancy, breastfeeding, or recent childbirth
- You're over 60 or more than 10 years past menopause (the risk/benefit math shifts)
Hormone therapy may not be safe for people who have or are at high risk for conditions like blood-clotting disorders, cardiovascular disease, breast cancer, or stroke. None of this means HRT is off the table forever — it means the decision is individual, and it's worth a real conversation. A good telehealth provider will screen for these in your intake.
How we checked these providers
We ranked these providers by what changes your real experience — not by who pays us most. We read each provider's own public pricing, product, pharmacy, and insurance pages, separated commercial facts from medical facts, and labeled every recommendation as our editorial opinion built on those verified facts.
What we weighted: whether a provider truly offers compounded HRT, whether it's honest about compounded-vs-FDA-approved, pricing transparency, pharmacy transparency, clinical oversight, insurance and pharmacy flexibility, and how clearly it states its own limits. What we did notreward: “safer” or “more natural” claims without evidence, vague pricing, or hidden fees.
✅ What we verified (June 2, 2026)
- Winona: compounded creams vs. FDA-approved patches/tablets/capsules; own 503A pharmacy; no labs to start; does not prescribe testosterone (may use DHEA); ~$89/mo cream combo; HSA/FSA; no direct insurance. Source: bywinona.com
- Midi: FDA-approved-first hormones plus compounded backup in shortages; $250 initial / $150 continued self-pay; in-network most PPO; all 50 states; not Medicaid/Medicare; HSA/FSA; NCQA + LegitScript. Source: joinmidi.com/pricing-insurance
- Sesame: $59/mo menopause membership incl. video visits + labs; meds filled at local pharmacy; honest BHRT disclosure. Source: sesamecare.com
- Inner Balance (Oestra):compounded daily cream (~3 mg estradiol + 100 mg progesterone/pump); no labs; six-month money-back guarantee; $199/mo first 6 months then $99.50/mo; HSA/FSA. Pharmacy 503A-vs-503B status conflicts on their site — verify directly. Source: innerbalance.com
- Medical/regulatory facts: sourced to the FDA, the National Academies, ACOG, The Menopause Society, Mayo Clinic, and the Endocrine Society.
What we did not do: test treatments clinically, or make any safety or effectiveness claims of our own. What you still must confirm in intake: your eligibility, state availability, final prescription, exact formula, insurance, and whether HRT is right for you.
See also: how we rank all providers.
What real patients say
Reviews are useful for one thing — what the experience is actually like (how fast, how kind, how much hassle). They are not proof that a medication is safe or works. Individual results vary.
“For the first time, someone actually listened to me during my visit without typing or multitasking. It felt like a luxury to be genuinely heard.”
— Shyla D., via Midi’s testimonials page
“Midi was so easy: I got a same-day appointment and they took my insurance.”
— Victoria W., via Midi’s testimonials page
“I saw Michele for perimenopause HRT and she was very helpful. She asked me about my symptoms and provided me with HRT prescriptions. I was able to pick them up from my local Costco in a few hours.”
— Patient review, via Sesame’s menopause page
Testimonials reflect individual experiences and are not evidence that any treatment is safe, effective, or right for you.
Frequently asked questions
What is the best compounded HRT provider online?
For most cash-pay women seeking online compounded menopause HRT, Winona is the best overall fit, because it offers a custom estrogen/progesterone cream, transparent starting prices, and clear labeling of what’s compounded versus FDA-approved. If you want insurance or FDA-approved medication, Midi is the better first step.
Is compounded HRT FDA-approved?
No. The FDA does not approve compounded preparations and does not verify their safety, quality, or effectiveness before they’re sold. They’re legal and prescribed by licensed clinicians, but they sit outside the FDA approval system.
Is bioidentical HRT the same as compounded HRT?
No. “Bioidentical” describes a hormone’s structure, while “compounded” describes how it’s made. Some bioidentical hormones (like estradiol patches) are FDA-approved; compounded ones are not.
Is Winona’s HRT compounded or FDA-approved?
Both, depending on the form. Winona states its estrogen patches, estrogen tablets, and progesterone capsules are FDA-approved, while its estrogen and progesterone body creams are compounded and not FDA-approved.
Does insurance cover compounded HRT?
Rarely. Compounded hormones are usually excluded because they aren’t FDA-approved, though it depends on your plan, pharmacy, and drug. FDA-approved estradiol and progesterone are more likely to be covered, and HSA/FSA can sometimes be used for compounded.
How much does compounded HRT cost online?
Compounded HRT typically runs about $100–$350 a month. Among our picks, Winona’s cream starts around $89/month, Sesame’s membership is $59/month (medication extra), and Oestra is $199/month for the first six months, then $99.50/month. FDA-approved hormones are often $30–$120/month and frequently covered.
Can I get compounded HRT online without lab tests?
Yes. Winona and Inner Balance prescribe based on symptoms and medical history, with labs ordered later only if needed. ACOG notes hormone-level testing isn’t recommended as the basis for dosing compounded hormones anyway.
Should I choose compounded or FDA-approved HRT first?
For most people, start with FDA-approved hormones when they fit your needs — they’re tested, often covered, and usually cheaper. Consider compounded when there’s a specific reason and a clinician agrees it’s appropriate.
Is testosterone part of HRT for women?
Sometimes, but carefully. There’s no FDA-approved testosterone product for women in the U.S.; it’s a controlled substance requiring a prescription and clinician oversight, and it’s not an energy or weight-loss shortcut.
Still deciding?
Still not sure which HRT program is right for you?
Related guides
- Best Online HRT Providers for Menopause (all types)
- Best Online HRT Providers for Women Over 60
- Best Online Menopause Clinic That Prescribes Testosterone
- Online HRT Providers That Accept Insurance
- HRT Cost Guide 2026
- Vaginal Estrogen: What It Is and When You Need It
- How We Rank Providers
- Affiliate Disclosure
Sources
- FDA — Compounding and the FDA: Q&A: fda.gov
- National Academies (2020) — The Clinical Utility of Compounded Bioidentical Hormone Therapy: nationalacademies.org
- ACOG — Compounded Bioidentical Menopausal Hormone Therapy (2023): acog.org
- Mayo Clinic — Bioidentical hormones FAQ: mayoclinic.org
- Cleveland Clinic — Bioidentical hormones: clevelandclinic.org
- HHS/FDA — Fact sheet on removal of boxed warnings from menopausal HRT products (Nov 2025); labeling changes (endometrial cancer exception retained).
- The Menopause Society — Comment on FDA hormone therapy announcement: menopause.org
- Endocrine Society — Androgen Therapy in Women (DHEA and testosterone guidance): endocrine.org
- Winona — HRT page & FAQ (compounded vs FDA-approved forms; own 503A pharmacy; no labs; ~$89/mo cream; HSA/FSA): bywinona.com
- Midi — Pricing & Insurance; Bioidentical hormone therapy page; HRT shortage and compounded options: joinmidi.com/pricing-insurance
- Sesame — Menopause treatment service page (BHRT disclosure; $59/mo membership; meds to local pharmacy): sesamecare.com
- Inner Balance / Oestra — Product pages (~3 mg estradiol + 100 mg progesterone/pump; $199/mo first 6 months then $99.50/mo; 6-month guarantee; LegitScript-certified): innerbalance.com
The HRT Index is an independent comparison resource for HRT telehealth providers. This guide was researched and written by our editorial team and last verified on June 2, 2026. This article is for information only and is not medical advice; talk with a licensed clinician about your situation. Where links are affiliate links, we may earn a commission at no extra cost to you, and it does not change our recommendations or rankings.