Which Online HRT Providers Prescribe What? 2026 Medication Map

Best for you / not for you

Where to start — 10-second version

Find the row that sounds like you, then read on.

Which online HRT providers prescribe what? The full map

Online HRT providers fall into two camps. Some prescribe only FDA-approved hormones filled at a pharmacy — Midi, Alloy, Sesame, Hers, Pandia, Gennev, Stella, MyMenopauseRx, and Wisp. Others are built around compoundedbioidentical creams mixed for you at a pharmacy — Winona and Inner Balance (a couple, like Evernow and Hone, offer both). The camp you choose decides your forms, whether insurance can help, and what “bioidentical” really means for you.

Most “best HRT” lists rank providers 1-2-3. This isn’t that. This is a map of who prescribes what, so you can skip straight to the two or three that fit and stop opening tabs. We built it by reading each provider’s own current pages and checking them against FDA and medical-society sources.

Scroll horizontally on narrow screens. Prices and formularies move — verify at checkout. Sources listed at bottom. Verified July 2026.

Sources: each provider’s own site (formulary, pricing, states), verified July 2026. Regulatory facts: FDA and The Menopause Society (full list at the end).

FDA-approved vs. compounded: the one difference that changes everything

FDA-approved HRT (like estradiol patches, pills, gels, and micronized progesterone) has passed the FDA’s review for safety, quality, and consistent dosing. Compounded HRT is mixed for one person at a pharmacy and is notFDA-reviewed as a finished product — even when the raw ingredients are FDA-approved. The FDA advises women to use FDA-approved hormone therapies, and The Menopause Society says compounded hormones are not safer or more effective than approved ones. Compounded can still be the right fit in specific cases — but it is not “safer,” “more natural,” or “the same as” FDA-approved.

This is the distinction most provider websites blur — and it’s the one thing we won’t let slide.

A quick word on “bioidentical.” It sounds high-tech, but it only means the hormone has the same chemical structure as the one your body made. Here’s the trick: many FDA-approved products are bioidentical too — estradiol patches, estradiol gel, and micronized progesterone (Prometrium) are all bioidentical andFDA-approved. So “bioidentical” does not mean “compounded,” and it does not mean “not FDA-approved.” The Menopause Society is blunt about it: you do not need a compounded product to get hormones that are chemically identical to your own.

Who’s in each camp, at a glance

What changed in 2026, and what it means

In November 2025, the FDA began removing the old “boxed warning” from menopausal hormone therapy, and on February 12, 2026it approved the first updated labels on six products — including Prometrium (progesterone), Divigel (estradiol gel), Estring (a vaginal estradiol ring), and Bijuva (an estradiol-plus-progesterone capsule). The warnings about heart disease, breast cancer, and dementia were removed after a fresh review of the science. One warning stays: the uterine-lining (endometrial) cancer warning on estrogen-only systemic products. The FDA also approved a new generic version of Premarin and a new non-hormonal option for hot flashes.

In plain terms: the FDA’s reassessment found that for women who start within about 10 years of menopause (generally before 60), the benefits of FDA-approved hormone therapy tend to outweigh the risks. This applies to FDA-approved products. It does not change the status of compounded hormones. Read our full FDA-approved vs. compounded HRT explainer.

Pick by the form you want (patch, pill, gel, vaginal, progesterone)

If you already know the form you want, choose by form first and brand second. A woman who wants the estradiol patch should compare different providers than one who wants vaginal estrogen only, or testosterone, or a compounded cream.

Quick definition: systemic means the hormone travels through your body and is used for symptoms like hot flashes and night sweats. Local or vaginal estrogen stays mostly in one area (for dryness, burning, painful sex, and repeat UTIs) with very little reaching the bloodstream.

If you want the estradiol patch

Prescribed by: Midi, Alloy, Hers, Pandia, Evernow, Wisp. The patch sticks to your skin and releases a steady dose. Because it skips the liver, transdermal estrogen carries a lower blood-clot risk than pills, per The Menopause Society. Alloy ships a 3-month supply so a pharmacy patch shortage doesn’t leave you stranded; Pandia lists the patch for about $54 cash, or $0 with many insurance plans.

If you want estradiol pills

Prescribed by: Alloy, Sesame, Hers, Midi, Pandia, Evernow, Winona (tablets). Pills are simple and usually the cheapest form. One trade-off worth knowing: oral estrogen has a somewhat higher clot risk than the patch or gel because it passes through the liver. A clinician can help you weigh that.

If you want estradiol gel or spray

Prescribed by: Alloy, Midi. Gel and spray also go through the skin (lower clot risk than pills) and let you fine-tune your dose. Alloy has the clearest published menu here, including a spray.

If you want vaginal estrogen

Prescribed by: Alloy, Sesame, Stella, Pandia, Wisp, Evernow, Hers. This is low-dose, local estrogen for the genitourinary symptoms of menopause — vaginal dryness, burning, painful sex, and frequent UTIs. It comes as a cream, a tablet/insert, or a ring. See our detailed vaginal estrogen guide.

If you want progesterone

Prescribed by: Midi, Alloy, Winona, Hers, Sesame, Pandia, Evernow, Stella, MyMenopauseRx, Inner Balance (in Oestra).

If you want DHEA

Prescribed by: Winona (compounded capsules), MyMenopauseRx, Hone (cream). DHEA is a hormone your body converts into other hormones. The one FDA-approved form is a vaginal insert(prasterone) for painful sex; oral or topical DHEA is generally a supplement or compounded, not an FDA-approved drug. Winona’s DHEA capsules are compounded.

Once you know your form, the fastest path is a video visit that sends the script to your own pharmacy. Sesame’s $99/month plan lets you choose your clinician, meet by video, and pick up an FDA-approved generic at a pharmacy near you. The $99/month plan covers the visit; you pay for the medication separately at the pharmacy.

Can you get testosterone for women online — and who prescribes it?

There is no FDA-approved testosterone product for women in the U.S., so any prescription is off-label, and testosterone is a Schedule III controlled substance (a regulated medicine with limits on how it’s prescribed). That’s why most menopause telehealth providers don’t offer it. Among the providers on this page, Midi prescribes an off-label testosterone cream in 25 states with real oversight; Winona states it does not prescribe testosterone; Sesame notes its providers can’t prescribe controlled substances online; and Hone lists testosterone but leans toward a broader longevity model.

The best-supported reason to consider testosterone for women is low libido that genuinely bothers you— clinically called hypoactive sexual desire disorder (HSDD). The Global Consensus Position Statement supports that one use, at low doses, for postmenopausal women. Testosterone is not a proven fix for energy, weight, mood, or brain fog on its own, even though it’s often marketed that way.

The five providers most women compare — and who each one is really for

For most women, Midi is the strongest all-around starting point (FDA-approved hormones, insurance, and testosterone in 25 states); Sesame wins if you want a video visit and local pharmacy; Hers is the simplest low-commitment entry; Winona is the pick if you specifically want compounded custom creams; and Inner Balance’s Oestra is for women who want one all-in-one daily cream.

Which online HRT providers take insurance, HSA/FSA, or send prescriptions to a local pharmacy?

How you pay matters as much as the medicine. Midi, Gennev, Stella, and MyMenopauseRx work with insurance for the visit, and Pandia bills insurance for the medication (often $0). Sesame and Wisp are cash-pay for the visit, but you use insurance for the drug at your pharmacy. Winona, Inner Balance, Alloy, and Hers are cash-pay but accept HSA/FSA. On pickup: Sesame, Wisp, Pandia, and most FDA-approved providers use your local pharmacy, while Winona, Inner Balance, and Alloy mail from their own or partner pharmacies.

Two quick definitions: HSA/FSA are pre-tax health spending accounts — many cash-pay providers accept them even when they don’t take insurance. Async means no live appointment; you fill out a questionnaire and a clinician reviews it.

If insurance is your deciding factor, start with Midi, Gennev, or MyMenopauseRx for the visit — and Pandia if you want your medication billed to insurance. If you’d rather pay cash and grab it at your neighborhood pharmacy today, Sesame or Wisp is the cleanest fit. For the full cost picture see our HRT cost guide.

What to verify before you pay for any online HRT consult

Before you pay, confirm five things: the exact form the provider can prescribe in your state, whether the final medicine is FDA-approved or compounded, whether progesterone is included if you have a uterus, whether you can use insurance or your local pharmacy, and the real monthly cost after any intro price. This is where most bad HRT-shopping experiences happen — and all of it is avoidable.

Screenshot this checklist and bring it to any provider’s intake — it’s yours, free.

1. Route: Can you prescribe the form I want (patch, pill, gel, spray, or vaginal estrogen) in my state?
2. FDA-approved or compounded? Is the final product FDA-approved, compounded, or a mix? If compounded, which pharmacy makes it?
3. Progesterone: If I have a uterus, how do you decide if I need it — and is it included in the price?
4. Insurance & pharmacy: Can I use insurance for the visit, the medicine, or labs? Can the script go to my local pharmacy?
5. Real cost: What’s the total monthly cost after any intro or first-order discount ends?
6. Labs: Are labs required, optional, included, or billed separately?
7. Testosterone (if you want it): Do you prescribe it, in my state, and with what monitoring?
8. Cancellation: Can I cancel online, and is there a refund window with conditions?
9. Supply: What happens if my patch or product is out of stock?
10. Safety flags: What symptoms or history would mean I should see someone in person first?

Getting straight answers to these before you pay is the difference between relief and a wasted month.

When online HRT isn’t the right starting point

Online HRT is not always the right first step. Women with unexplained vaginal bleeding, a history of breast or uterine cancer, blood clots or stroke, liver disease, or significant heart disease usually need an in-person clinician first — and some symptoms need hands-on evaluation. A website can’t safely clear you for hormones.

We’d rather lose the click than send the wrong person down the wrong path. If any of these apply to you, please start with an in-person visit:

• Unexplained or heavy vaginal bleeding
• A personal history of breast, uterine, or endometrial cancer
• A history of blood clots, stroke, or serious heart disease
• Liver disease
• Pregnancy, breastfeeding, or a recent birth
• A new breast lump, new pelvic pain, or severe symptoms
• Any emergency symptom — call your doctor or 911

This is exactly what The Menopause Society flags: for some women, the risks of hormone therapy outweigh the benefits without careful, in-person review. Knowing this before you pay is a win, not a setback.

How we built this map (and what we actually verified)

We built this using The HRT Index Verification Standard: we read each provider’s published pages, separated FDA-approved from compounded options, confirmed insurance and pharmacy paths where they’re public, and labeled anything unclear as “verify” instead of guessing. We re-check top providers monthly and the full roster quarterly. Our goal isn’t to crown the highest-paying provider — it’s to help you avoid paying for the wrong consult.

Our five pillars, always in this order: clinical legitimacy, care quality, medication fit, price transparency, access.

What we verified for this page (July 2026)

• Each provider’s publicly listed medication forms
• Whether products are FDA-approved or compounded, where the provider states it
• Insurance vs. cash-pay positioning, for both the visit and the medication
• Local pharmacy vs. shipped medication
• State availability where it’s public (e.g., Midi testosterone in 25 states; Winona in 37 states plus Puerto Rico)
• Testosterone availability where it’s public
• Current regulatory context (the FDA’s 2026 label changes; testosterone’s Schedule III status)

We’re The HRT Index — the independent menopause-HRT decision resource for women. We don’t take money to move a provider up a list, and we don’t invent scores or fake reviews.

What women tell us they care about most

The biggest worry usually isn’t “does HRT work?” It’s “will this provider actually listen, take my insurance, prescribe the form I want, get it to me fast, and not surprise me after I pay?” Those are the real decision points — which is why this whole page maps them.

When women describe choosing an online provider, the same themes come up again and again: being heardafter feeling dismissed, using insurance instead of another cash subscription, getting the specific form they asked for, and not waiting weeks for a refill. Match insurance, pharmacy, form, and FDA-vs-compounded to your situation, and the “which provider” question mostly answers itself.

Frequently asked questions

Can you get HRT prescribed online?

Yes. Many telehealth platforms can prescribe HRT if a licensed clinician decides it is appropriate after reviewing your symptoms, health history, risks, and your state’s rules. The provider, the form, the pharmacy path, and who is eligible all vary.

Which online HRT providers prescribe the estradiol patch?

Midi, Alloy, Hers, Pandia, Evernow, and Wisp all prescribe the FDA-approved estradiol patch. Winona also lists a patch; confirm at intake whether it is the FDA-approved product or compounded. The patch delivers estrogen through the skin and carries a lower blood-clot risk than pills.

Which online HRT providers prescribe progesterone?

Midi, Alloy, Winona, Hers, Sesame, Pandia, Evernow, Stella, MyMenopauseRx, and Inner Balance (inside Oestra) all address progesterone. It matters most if you have a uterus and take systemic estrogen, because progesterone helps protect the uterine lining.

Which providers prescribe vaginal estrogen?

Alloy, Sesame, Stella, Pandia, Wisp, Evernow, and Hers offer low-dose vaginal estrogen for dryness, burning, painful sex, and frequent UTIs. It is local therapy, with very little estrogen reaching the bloodstream, and comes as a cream, tablet/insert, or ring.

Do online HRT providers prescribe testosterone for women?

Some do, but not all. Midi prescribes an off-label testosterone cream in 25 states with lab review and repeat visits, and Hone lists testosterone within a broader longevity model. Winona says it does not prescribe testosterone, and Sesame says its providers cannot prescribe controlled substances online. There is no FDA-approved testosterone product for women, and testosterone is a Schedule III controlled substance.

Is compounded HRT FDA-approved?

No. A custom-compounded product is not FDA-approved as a finished product, even if its ingredients are. Compounding is legal and can be appropriate, but it is not tested the same way for safety, dosing consistency, or absorption, so it should not be presented as safer than or equal to FDA-approved medicine.

Which online HRT provider takes insurance?

Midi is in-network with most PPO plans (not Medicare, Medicaid, or Medi-Cal); Gennev, Stella, and MyMenopauseRx also work with insurance for the visit; and Pandia bills insurance for medication (often $0). Sesame and Wisp are cash-pay for the visit, but you can use insurance for the medication at your pharmacy. Winona, Inner Balance, Alloy, and Hers are cash-pay but accept HSA/FSA.

Which provider is best for local pharmacy pickup?

Sesame and Wisp are the cleanest fits — you meet a clinician by video and pick up the medication at a pharmacy near you. Pandia, Gennev, Stella, and MyMenopauseRx also route prescriptions to local pharmacies. Winona, Inner Balance, and Alloy mail instead.

Which provider is best for a compounded cream?

Compare Winona (custom estradiol and progesterone creams) and Inner Balance (Oestra, a combined estradiol-and-progesterone vaginal cream) first. Keep compounded options clearly separate from FDA-approved ones in your own decision.

Related reading from The HRT Index

• Best online HRT providers for menopause — ranked by clinical legitimacy, price transparency, and access
• Best online HRT providers for perimenopause — includes insurance-first options
• FDA-approved vs. compounded HRT — plain-English explainer
• Vaginal estrogen — low-dose local estrogen guide
• How much does HRT cost in 2026? — real prices by form and provider
• Midi Health review — clinical quality, pricing, and who it fits
• Sesame HRT review — cash-pay menopause care in depth
• Find My HRT Path — match your situation to the right provider in 60 seconds

Sources

• U.S. FDA — HHS Advances Women’s Health, Removes Misleading FDA Warnings on Hormone Replacement Therapy (Nov 10, 2025) and FDA Approves Labeling Changes to Menopausal Hormone Therapy Products (Feb 12, 2026). fda.gov
• U.S. FDA — Menopause and Hormone Replacement Therapies Can Help Women with Bothersome Menopausal Symptoms (four categories of HRT; no FDA-approved estriol drugs). fda.gov
• The Menopause Society — Menopause Topics: Hormone Therapy (systemic vs. local routes; compounded vs. FDA-approved; who may not be a candidate). menopause.org
• Global Consensus Position Statement on the Use of Testosterone Therapy for Women (HSDD as the evidence-based indication). Via PMC / peer-reviewed literature.
• U.S. DEA — Controlled Substance Schedules (testosterone is Schedule III). dea.gov
• Provider pages (formulary, pricing, availability — verified July 2026): joinmidi.com, bywinona.com, sesamecare.com, forhers.com, innerbalance.com, myalloy.com, pandiahealth.com, evernow.com, gennev.com, us.onstella.com, mymenopauserx.com, hellowisp.com, honehealth.com

The HRT Index is the independent menopause-HRT decision resource for women. Educational only; not medical advice. FDA-approved and compounded options are always labeled distinctly, and compounded is never implied to be safer than, more natural than, or equivalent to FDA-approved medication. Last verified: July 2026. Find My HRT Path collects sensitive health information and is handled under our consumer-health-data and privacy policy. See our affiliate disclosure.