Who Can Prescribe HRT for Menopause? 7 Routes, State Rules, and What to Do If You've Been Told No
Start with the door that fits your question
Match your state, symptoms, insurance, medication goal, and need for in-person care before booking another appointment.
Who can prescribe HRT for menopause? In the United States, the standard routes are a physician, nurse practitioner, physician assistant, or certified nurse-midwife. Certified midwives, clinical nurse specialists, and naturopathic physicians can prescribe only where state law gives their license that authority. Testosterone adds separate Schedule III controlled-substance rules.
Last verified August 2026 · United States guide · Editorial research by The HRT Index Editorial Team — not medically reviewed by a clinician · How we verify · Affiliate disclosure
Best for: women who do not know which appointment to book, were told no without a clear reason, want to verify an online prescriber, or are wondering whether an NP, PA, or midwife is allowed to prescribe.
Not for you if: you are trying to self-clear for treatment. Unexplained bleeding after menopause, a current or past hormone-sensitive cancer, a clot or stroke history, active liver disease, a new breast or pelvic finding, or anything needing an examination belongs with an in-person clinician first. That is not caution for the sake of it. It is the difference between getting treated and getting evaluated.
Two things genuinely change the answer. Testosterone is a Schedule III controlled substance, so it carries different federal and state rules. And a telehealth clinician must be licensed or otherwise legally permitted to treat you in the state where you are physically located during the visit — not merely where the company is headquartered.[1]
So the legal answer is broad. The useful answer is narrower.
Here is the part nobody tells you: legal permission and a real appointment are two different things. In a national survey of family medicine, internal medicine, and OB-GYN residents, 34.4% said they would not offer hormone therapy to a symptomatic, newly menopausal woman with no contraindications, and only 6.8% felt adequately prepared to manage menopause.[2] That is not a prescribing law. That is a training gap. And it may be why you are reading this page instead of holding a prescription.
This page covers menopausal hormone therapy in the United States. NHS and UK prescribing rules are different. Gender-affirming hormone care is also governed by a different clinical and regulatory framework.
The HRT Index is the independent decision resource for online menopause and HRT care — comparing telehealth providers on clinical legitimacy, care quality, medication fit, price transparency, and access, with every claim verified and dated, so women can choose the path that fits their situation before their first consult.
Who can prescribe HRT for menopause in the United States?
Four clinician routes are available nationwide when the individual is properly licensed and practicing within state rules: physicians, nurse practitioners, physician assistants, and certified nurse-midwives. Three additional credentials can prescribe in some jurisdictions. The title alone never proves authority; the active state license and scope rules do.
| Prescriber route | Can prescribe estrogen or progesterone? | Can prescribe testosterone? | What changes by state? | Where you may find them |
|---|---|---|---|---|
| Physician (MD or DO) — family medicine, internal medicine, OB-GYN, endocrinology | Yes, when licensed to treat you in your state | Yes, with the required DEA registration and compliance with federal and state controlled-substance rules | Licensure, telehealth permission, and any state-specific prescribing rules | Primary care, gynecology, health systems, menopause clinics, telehealth |
| Nurse practitioner (NP) | NPs have prescriptive authority nationwide, but practice requirements differ by state | Only where the NP's state authority, DEA registration, and controlled-substance rules permit it | Full, reduced, or restricted practice requirements; transition-to-practice rules in some states | Primary care, women's health, menopause clinics, telehealth |
| Physician assistant/associate (PA) | PAs have prescriptive authority in all 50 states and DC | Only where the PA's state authority, DEA registration, and controlled-substance rules permit it | Collaboration, delegation, or practice-agreement rules vary | Primary care, gynecology, specialty practices, telehealth |
| Certified nurse-midwife (CNM) | CNMs have prescriptive authority in all 50 states, DC, and US territories | Varies by state and controlled-substance authority | Independent, collaborative, or supervisory requirements vary | Women's health, gynecology, primary care, midwifery, telehealth |
| Certified midwife (CM) | State-dependent. ACNM currently lists recognition in 12 states plus DC | State-dependent | The credential must be recognized and granted prescribing authority by that jurisdiction | Midwifery and women’s health practices in recognizing jurisdictions |
| Clinical nurse specialist (CNS) | State-dependent. CNS prescriptive authority is not uniform | State-dependent | The state must grant prescribing authority; collaboration or supervision may also apply | Specialty nursing, health systems, outpatient practices |
| Naturopathic physician (ND/NMD) | Only where the jurisdiction licenses the credential and includes the drug within its formulary or scope | Do not assume; verify the exact state law and license | Recognition, formulary, and physician-relationship rules differ sharply | Licensed-state naturopathic practices |
PAs have held prescriptive authority in all 50 states and DC since 2007.[3] The American College of Nurse-Midwives states that CNMs have prescriptive authority nationwide, while the CM credential is currently recognized in Arkansas, Colorado, Delaware, Hawaii, Maine, Maryland, Minnesota, New Jersey, New York, Oklahoma, Rhode Island, Virginia, and DC.[4] A CM is not the same credential as a certified professional midwife, and the two should not be grouped.
Who cannot generally start menopause HRT on their own authority: registered nurses without an advanced-practice license and prescriptive authority, LPNs, health coaches, nutritionists, “hormone consultants,” and people selling supplements. Pharmacist prescribing authority varies by state and usually operates under a defined protocol, collaborative practice agreement, or specific condition; it is not a general nationwide route to starting menopause HRT.
The original finding worth keeping: NP and CNM independence counts do not line up neatly. That means the answer can change depending on which advanced-practice credential is behind the same medication in the same state. The drug did not change. The professional statute did.
Why isn't legal prescribing authority enough?
Every prescription has to clear four separate gates: the clinician's license, authority in your state, actual menopause experience, and whether the treatment fits your history. Law controls the first two. The last two decide whether the appointment is useful. A legal prescriber can still be a poor menopause fit.
Gate 1 — License. Is this person an MD, DO, NP, PA, CNM, CM, CNS, or a state-authorized ND/NMD? A job title on a website is not a license. “Menopause specialist,” “hormone expert,” and “wellness practitioner” are not standalone prescribing credentials.
Gate 2 — State authority. Is the license active where you will be located during care, and does that role need a practice agreement, collaboration, supervision, transition period, or special prescribing authorization there?
Gate 3 — Menopause experience. Does this clinician actually manage perimenopause and menopause every week? Can they explain local versus systemic treatment, FDA-approved versus compounded medication, uterine protection, follow-up, and what would make them refer you in person?
Gate 4 — Clinical fit. Given your symptoms, age, history, medications, bleeding pattern, and whether you have a uterus, is hormone therapy appropriate — and is this the right setting to decide it?
Most women assume they got stuck at Gate 1. Often they did not. They got stuck at Gate 3.
The right online HRT provider isn't the same for every woman — it depends on your symptoms, your age and whether you have a uterus, your medication route preference (patch, pill, gel, or vaginal estrogen), your risk history, your insurance or cash-pay situation, and your state. Some situations belong with an in-person clinician first. Because a general answer can't resolve those for you, use The HRT Index's Find My HRT Path tool to match your situation to the right provider — and to flag when online care isn't the right starting point — before your first consult.
Do I need an OB-GYN, or can my primary care doctor prescribe HRT?
A primary care physician can prescribe menopausal hormone therapy; an OB-GYN referral is not a universal legal requirement. The better door depends on what else needs evaluating. Routine symptoms may fit primary care, gynecology, or menopause-focused telehealth. Bleeding, pelvic findings, or anything needing an exam changes the route.
Let us kill the endocrinologist myth first, because it wastes time.
In an analysis presented at The Menopause Society's 2025 Annual Meeting, 64.4% of nearly 5,500 women with a menopause-related outpatient encounter were seen by OB-GYN, 17.6% by internal medicine, 12.4% by family medicine, and 4.5% by endocrinology.[5] Endocrinologists can prescribe HRT. Routine menopause care simply was not where most visits in that dataset happened.
Primary care is a genuinely good first stop when:
- You already have a clinician who knows your medication list and medical history.
- The practice actually manages menopause and will provide follow-up.
- You want heart, bone, sleep, mood, and preventive-care questions considered together.
An OB-GYN is the better first stop when:
- You have bleeding that needs explaining.
- You have pelvic pain, a new breast or pelvic finding, or a complicated uterine or ovarian history.
- You may need an examination, imaging, endometrial evaluation, or a procedure.
Endocrinology earns the wait when:
- Menopause arrived unusually early or primary ovarian insufficiency is suspected.
- You have an existing complex endocrine condition that interacts with the decision.
- Your gynecology or primary care clinician needs endocrine input.
Here is the finding from the same 2025 analysis that should reset your expectations: patients seen by internal medicine or family medicine were more likely to receive an SSRI, while those seen by OB-GYN were most likely to receive systemic estrogen. Provider type mattered too: nurse practitioners and midwives were more likely than physicians to prescribe systemic estrogen, while physician assistants were more likely to prescribe SSRIs.[5]
⚠️ That analysis was conference research, not a peer-reviewed published trial. It can show patterns in the dataset. It cannot prove why an individual clinician chose a treatment.
→ Not sure whether primary care, gynecology, or online care fits your situation? Get a personalized starting route from Find My HRT Path — including a flag when online care is not the right first step. Free, nothing stored, no email required.
Can a nurse practitioner, PA, nurse-midwife, or clinical nurse specialist prescribe HRT?
Yes — but not as one interchangeable category. NPs, PAs, and CNMs have nationwide prescriptive authority frameworks, while CNS and CM authority is state-specific. Estrogen and progesterone do not carry testosterone's Schedule III restrictions, but the clinician still must satisfy professional, state, and telehealth rules.
This is the question that stops more women than it should, so answer it with credentials instead of reassurance.
Nurse practitioners. NPs diagnose and prescribe throughout the United States, but the amount of physician involvement, required transition experience, and controlled-substance authority depends on the state. Population focus matters: a women's health NP and a family NP may both hold prescribing authority, but their training and day-to-day caseload are not identical. Verify the individual through the state board of nursing or Nursys QuickConfirm.
Physician assistants/associates. PAs have prescriptive authority in all 50 states and DC.[3] Do not turn that into “every PA can prescribe every drug independently.” The PA must comply with the state's practice structure and the employer's credentialing rules; controlled substances add DEA and state requirements.
Certified nurse-midwives. CNMs are not limited to labor and birth. Their scope includes gynecologic and reproductive care, prescribing, and primary care, with state-specific practice requirements.[4] They remain one of the most overlooked menopause-prescriber routes in the country.
Certified midwives. CMs complete graduate midwifery education and the same national certification examination as CNMs, but they are not also licensed as nurses. ACNM currently lists recognition in 12 states plus DC. Their prescribing authority depends on recognition and state scope.[4]
Clinical nurse specialists. A CNS is an advanced-practice nurse, but prescriptive authority is not uniform. Some states grant it independently, some require a physician relationship, and some do not grant it for the role. Check the state board rather than assuming from the title.[6]
Read this twice: the 2025 conference analysis found women in its dataset were more likely to receive systemic estrogen from nurse practitioners and midwives than from physicians.[5] That does not prove one credential is “better.” It destroys the assumption that an advanced-practice credential automatically means less real menopause care.
Does my state let a nurse practitioner prescribe HRT without a doctor's sign-off?
Maybe. AANP classifies states as full, reduced, or restricted practice, but a one-word map label cannot capture transition hours, exemptions, special applications, or a new law's effective date. The requirement belongs to the practice. It can change access, but it is not a personal ban on estrogen or progesterone.
Do not publish a static 50-state list and pretend it will stay current. Three current examples show why.
| State | What current law or board guidance says | What it means for a patient | Verified |
|---|---|---|---|
| New York | NPs with more than 3,600 practice hours remain exempt from the written physician practice agreement and protocol requirements through July 1, 2030. A different collaborative-relationship framework is written to take effect on that date.[7] | The draft's claimed July 1, 2026 lapse did not happen. An experienced NP can still use the current exemption. | August 26, 2026 |
| New Jersey | P.L. 2026, c. 6 created a route for qualifying advanced practice nurses to prescribe without a joint protocol after meeting the law's experience and transition requirements; it is not a one-line declaration that every APN has identical authority for every service.[8] | Ask whether the specific APN qualifies under the statute instead of relying on an old map label. | August 26, 2026 |
| Oklahoma | Eligible APRN-CNPs, APRN-CNSs, and APRN-CNMs may apply for independent prescriptive-authority recognition under HB 2298, effective November 1, 2025.[9] | The authority is not automatic. The clinician needs the recognition before practicing under it. | August 26, 2026 |
That is the lesson: a national map is a starting point, not the final legal record. Use AANP's current State Practice Environment, then check the state board or statute for the credential in front of you.
The thing everyone gets backwards about state restrictions
The belief goes like this: “My state restricts NPs, so online HRT must be unavailable here.”
That does not follow.
Winona currently says its prescriptions are written by 30-plus board-certified physicians and lists service in 37 states plus Puerto Rico.[10] Its footprint includes states across the AANP practice tiers and skips other states with broad NP autonomy. That is enough to prove the point without fragile arithmetic: telehealth availability is a clinician-licensing, operations, and business decision. It is not a direct readout of your state's NP category.
Stop using an NP map to guess whether a company serves you. Check the provider's dated state list, then verify the clinician assigned to your case.
Why did my doctor say no to HRT?
Sometimes “no” is the correct clinical answer. Sometimes it reflects limited menopause training, a practice that does not manage HRT, or a clinician who is more comfortable with another treatment. Your job is not to argue until someone agrees. Your job is to make the reason specific enough to act on.
The training numbers are real.
Kling and colleagues surveyed residents in family medicine, internal medicine, and OB-GYN across 20 US programs. Of 183 respondents:[2]
- 34.4% would not offer hormone therapy to a symptomatic, newly menopausal woman without contraindications.
- 38.7% would prescribe hormone therapy until the natural age of menopause for a woman with premature menopause.
- 20.3% reported receiving no menopause lectures during residency.
- 6.8% felt adequately prepared to manage menopause.
- 93.8% believed menopause training was important or very important.
The response rate was 26%. That matters. It was a resident survey, not a census of every practicing doctor. But the correct version is still damning. It does not need exaggeration.
The 2025 conference analysis found that only 17.1% of 5,491 women in its dataset had a pharmacologic menopause treatment recorded; among those treated, 34% received systemic estrogen, 47% vaginal estrogen, and 16% an SSRI.[5] Turn that around carefully: more than eight in ten did not have a pharmacologic menopause treatment recorded in that dataset. That is not the same as proving every untreated woman was wrongly dismissed.
The statistic people keep quoting wrong
The two most repeated numbers from the training literature are routinely stripped of their denominators. This table keeps the emotional force of the finding without turning a resident-level survey into a claim about every OB-GYN or every residency program.
| What gets repeated | What the study actually reported |
|---|---|
| “Only 7% of OB-GYN residents felt prepared.” | The 6.8% figure covered responding residents across family medicine, internal medicine, and OB-GYN. The published abstract did not report an OB-GYN-only 6.8% figure.[2] |
| “Only 20% of residency programs have menopause training.” | Kling reported that 20.3% of responding residents received no menopause lectures. That is not a program-level curriculum rate.[2] |
What this does not mean: it does not mean your doctor is wrong. It does not mean you should ignore a contraindication. It means a general refusal and a patient-specific refusal are not the same thing — and asking which one you received is completely reasonable.
You and your clinician may both be downstream of the same training gap. That is not a fight. It is a fixable conversation.
What do I actually say at the appointment?
Ask for a specific clinical reason instead of arguing the general case. A clear reason separates “something in your history makes this unsafe” from “this practice does not manage menopause.” Requesting documentation turns a vague refusal into information you can use for follow-up, referral, or a second opinion.
Four sentences. Copy them.
1. “I'd like to talk about hormone therapy for [your main symptom]. Can we discuss whether I'm a candidate?”
2. “Is your concern specific to something in my medical history, or is menopause management outside this practice's scope?”
3. “If there's a specific contraindication that rules it out, I'd like it noted in my chart.”
4. “If this isn't something you manage, can you refer me to someone who does?”
Question 2 is the sharpest one on this page. It is not confrontational, and it splits the answer cleanly. “It is your history” is a medical answer you can act on. “It is not what we do here” is an access answer — and it makes question 4 a normal referral request, not a rejection of your doctor.
Question 3 changes the room. If there is a real contraindication, you now know what it is and can bring it to a second opinion. If the concern is general rather than patient-specific, that becomes clearer.
Question 4 protects the relationship. A referral is a normal clinical act. You are not asking your clinician to prescribe something they do not manage. You are asking them to point you toward someone who does.
Two things not to do
Do not hide your history to get a yes. Not from an in-person clinician and not on an online intake. Every safety judgment depends on complete information.
Do not shop indefinitely until someone says yes. A second opinion is reasonable. Repeatedly ignoring the same patient-specific concern is not advocacy; it is a warning that needs resolving.
→ Bring the four questions, then choose the next door based on the answer. Build your personalized next-step plan before booking another appointment. Free, nothing stored, no email required.
When is “no” the right answer?
Some refusals are clinically correct, and some situations need evaluation before a prescription. Postmenopausal bleeding, a new breast or pelvic finding, possible cancer, prior clot or stroke, active liver disease, or unusually early menopause can change both the risk discussion and the right setting. Online speed is not the priority there.
We just spent a section explaining why “no” can reflect a training gap. Now the counterweight, because a page that only did the first half would be dangerous.
Unexplained bleeding after menopause needs prompt evaluation. ACOG's guidance is explicit that the clinical approach should efficiently exclude or diagnose endometrial cancer.[11] The FDA did approve major labeling changes for six menopausal hormone therapy products in February 2026, but those changes did not turn unexplained bleeding into an online-checkout problem.[12]
Start with an in-person clinician when you have:
- Bleeding after menopause or unexplained abnormal bleeding
- A current or past hormone-sensitive cancer
- A previous blood clot, stroke, or known clotting disorder
- Active liver disease
- Menopause that arrived unusually early or suspected primary ovarian insufficiency
- A new breast or pelvic finding
- Symptoms that require an examination, imaging, endometrial evaluation, or biopsy
- Records that a new clinician needs but cannot obtain
This is not a self-clearance list. Checking “no” to every item does not prove HRT is appropriate. The formulation matters too: systemic estrogen, local vaginal estrogen, progestogen, and nonhormonal treatment do not share one identical risk discussion.
The honest limit of every online service, including the ones we recommend: telehealth removes the drive. It does not remove the clinical boundary. A legitimate service should be willing to tell you it cannot finish the evaluation remotely.
Can a telehealth provider legally prescribe HRT?
Yes, when the treating clinician is licensed or otherwise legally permitted to practice where the patient is located and the encounter follows state rules. “Telehealth provider” is not a credential. It is a delivery method. Estrogen and progesterone avoid the extra federal telemedicine rules for controlled substances; testosterone does not.
Underneath every online prescription is a stack:
Platform → treating clinician → professional license → authority in your state → prescription → dispensing pharmacy
The platform name is the top layer and the least important one. The middle layers are what make the prescription real.
The patient-location rule
Federal telehealth guidance says health professionals must meet the licensure requirements where they are located and be licensed or legally permitted to practice where the patient is located.[1]
That produces consequences most sales pages do not explain:
- Traveling? The state you are physically in during the visit governs the encounter.
- Snowbird with two addresses? Same rule. Your location at the time of care matters.
- Just moved? Your former provider may not be able to continue treating you in the new state.
- Refill after moving? A new state-licensed prescriber may need records and an evaluation before continuing the prescription.
A legitimate online menopause service should disclose:
- The treating clinician's name and credential
- The states it serves
- Whether care is video, phone, asynchronous messaging, or a combination
- Whether labs are required, optional, included, or billed separately
- Which medications are FDA-approved and which finished products are compounded
- Which pharmacy dispenses
- The visit price, medication price, and what is not included
- How follow-up, refills, cancellation, and refunds work
- When it will send you to in-person care
If a company will not answer the last one, that is your answer.
Who actually writes the prescription at major online menopause providers?
Online providers use different clinician models, and the difference is material. Some show the individual credential before booking; some assign a clinician after intake; some use video; some are asynchronous. We verified each row from the provider's own public pages and separated the prescription model from the platform's marketing.
| Provider | Provider-stated prescriber model | Credential visible before payment? | Encounter model | Medication lane relevant here | Verified |
|---|---|---|---|---|---|
| Midi Health | Standard visits are with a board-certified NP or CNM specializing in women's health; physician-developed protocols support care.[13] | No — clinician is assigned | Live video visit | Prescriptions go to the patient's pharmacy; its separate testosterone program uses compounded testosterone in 25 states | August 26, 2026 |
| Sesame | The marketplace shows individual clinicians, ratings, time slots, and upfront prices; prescribing remains at that clinician's discretion.[14] | Yes | Video visits for listed online services; its menopause program advertises ongoing care | Local-pharmacy prescriptions may use the patient's drug benefit; Sesame says its clinicians do not prescribe controlled substances online | August 26, 2026 |
| Winona | Prescriptions are written by 30-plus board-certified physicians licensed for the patient's state.[10] | No — physician is assigned | Asynchronous only; no phone or video visits; typical message response 24–48 hours | FDA-approved estrogen tablets, progesterone capsules, and estrogen patches are listed separately from compounded creams | August 26, 2026 |
| Hers | A licensed provider trained in women's health reviews the intake; the public menopause page does not promise one specific clinician credential before intake.[15] | No | Online intake and provider review | Treatment options depend on provider evaluation and location; not available in all states | August 26, 2026 |
| Inner Balance / Oestra | The company says a board-certified provider reviews the health quiz and a licensed clinician approves each prescription; no separate appointment is required.[16] | No | Asynchronous quiz review | Oestra is a compounded vaginal estradiol-and-progesterone prescription; the finished product is not FDA-approved | August 26, 2026 |
“Board-certified” is not a complete credential. It tells you that a certifying body exists. It does not tell you which board, which specialty, whether that board is an American Board of Medical Specialties member, or whether the individual treating you holds the credential being advertised.
The question to ask before paying: “What professional license and specialty credential does the clinician reviewing my intake hold, and are they licensed where I will receive care?”
A note on Hers. On July 29, 2026, the FTC, joined by Utah and California through Los Angeles County, filed a federal lawsuit alleging that Hims & Hers shared sensitive health information contrary to privacy representations and used deceptive billing and cancellation practices.[17] The case is pending; the allegations have not been adjudicated. Because those allegations directly concern trust and online health-data handling, Hers is not monetized on this page.
Is a nurse practitioner as good as a physician for menopause care?
The credential alone cannot answer that. For routine presentations, menopause-specific experience, follow-up, and clinical boundaries may matter more than whether the license says NP or MD. For complex histories, the desired level of physician involvement can reasonably change the route. This is a fit decision, not a hierarchy contest.
Now the part where we tell you something about a company that pays us.
The standard clinician you book with at Midi is an NP or CNM, not a physician. Midi publishes that on its own site.[13] If you have unexplained bleeding, a complex cancer or clotting history, suspected primary ovarian insufficiency, a transplant, or another situation where you specifically want a physician making the initial call, Midi is not that standard door. An in-person menopause physician, gynecology practice, or academic menopause clinic is the better starting point. Go there instead.
That is the damaging admission. Here is the pivot it earns.
For a common presentation — disruptive hot flashes, night sweats, sleep problems, or genitourinary symptoms without a red flag — an NP or CNM whose caseload is built around midlife women's health may have far more working menopause exposure than a generalist who rarely manages it. The 2025 conference analysis found systemic estrogen prescribing was more common from NPs and midwives than from physicians in that dataset.[5] It does not prove superior outcomes, but it does make “NP means less likely to treat me” a bad assumption.
Midi also separates the visit from the medication: it bills many commercial insurance plans for care and sends prescriptions to the patient's pharmacy. Current self-pay prices are $250 for a first visit and $150 for a return visit. Medicare beneficiaries may use Midi as self-pay but cannot submit Midi-related claims; Medicaid and Medi-Cal patients are not accepted.[18]
If any of that rules Midi out:
- You want a physician from the first visit → use an in-person physician, Gennev, Winona's physician review model, or The Menopause Society directory.
- You have Medicaid or Medi-Cal → start with your own plan's directory; Elektra accepts selected government plans in certain markets, but coverage must be verified by plan and location.
- You have Medicare → Midi permits self-pay but not Medicare claims; verify an in-network plan option before booking elsewhere.
- You need testosterone → Midi's current program is compounded, available in 25 states, and uses lab review plus a second visit before prescribing when clinically appropriate.[19]
→ Does a live visit with a menopause-focused NP or CNM fit what you were missing? Check Midi's current insurance and state availability. Self-pay is $250 for the first visit and $150 for follow-up; labs and medication may be separate.
Partner link — we may earn a commission. It does not change your price or the facts above.
What does “menopause specialist” actually mean?
There is no standalone medical-board specialty called “menopause.” The closest widely recognized US credential is The Menopause Society Certified Practitioner, or MSCP. It verifies that a licensed healthcare professional passed a menopause competency examination. It does not prove that the underlying professional license permits prescribing.
That last sentence is the one to remember.
The Menopause Society says all licensed healthcare professionals may sit for the MSCP examination. The public credential glossary includes physicians, nurse practitioners, physician assistants, pharmacists, nurses, physical therapists, social workers, and other professions.[20] The credential is valid for three years and may be maintained through a new examination or qualifying continuing education.
So an MSCP badge answers one question: Did this licensed healthcare professional demonstrate menopause knowledge on the Society's examination?
It does not answer the next one: Can this person prescribe medication in my state?
Always check both. The menopause credential and the underlying license are two separate records.
The Menopause Society also maintains a public practitioner directory. It is useful, but it is not a complete national census of every certified clinician or every qualified menopause prescriber. Use it as a search tool, then verify the license and whether the practice accepts new patients, your insurance, and telehealth patients in your location.
The unverified number we cut: the draft reported roughly 1,500 active MSCP holders based on a secondary directory. We could not verify that count from The Menopause Society, so it does not belong on a last-stop-before-publish health page.
How do I verify an HRT prescriber before I book?
Verify the clinician, not the company. Confirm an active license where you will receive care, confirm what that role's state rules require, look for real menopause experience, and get written answers about medication source, follow-up, and total cost before paying. Four checks take less time than one bad appointment.
Check 1 — Active professional license.
- Physician: state medical board or FSMB DocInfo
- NP, CNM, or CNS: state board of nursing or Nursys
- PA: state medical or PA board plus NCCPA Verify PA
- CM: the state licensing board identified by that jurisdiction
- ND/NMD: the state naturopathic board or licensing authority, plus the current formulary or scope rule
Certification and licensure are different records. Check the license.
Check 2 — State authority. Does this role need a collaborative or supervisory agreement, a transition period, or a special controlled-substance authorization where you are located? You do not have to become a health-law expert. The practice should be able to answer in one sentence.
Check 3 — Menopause experience. Look for menopause named explicitly as part of current practice. Ask how often the clinician manages it and how follow-up works. Listen for whether they distinguish local from systemic therapy and FDA-approved medication from compounded medication correctly. That is a fast, useful tell.
Check 4 — Medication and money, in writing. Which medication is being considered? Is the finished product FDA-approved or compounded? Which pharmacy dispenses it? Is medication included in the visit price? Are labs included, extra, or ordered only when indicated? How do refills, follow-up, cancellation, and refunds work?
→ If seeing the individual clinician, credential, price, and available time before you commit matters most, that is Sesame's model. See current menopause clinicians and availability. Sesame's menopause subscription is currently $59 per month; medication is separate, and prescribing remains the clinician's decision.[14]
Partner link — we may earn a commission. It does not change your price.
Do I need blood tests or a pelvic exam before HRT?
Often not for the sole purpose of identifying menopause in a healthy woman aged 45 or older with typical symptoms, but that is not a rule against testing. Age, bleeding, surgical history, diagnostic uncertainty, suspected primary ovarian insufficiency, thyroid or anemia symptoms, and the planned medication can all change what a clinician needs.
Hormone levels can fluctuate substantially during perimenopause. NICE recommends identifying perimenopause or menopause clinically in otherwise healthy people aged 45 or older with typical symptoms and says not to use several laboratory and imaging tests to identify menopause in that group.[21]
Testing can genuinely matter when:
- Symptoms begin unusually early
- Hysterectomy or an unclear bleeding history makes cycle timing unhelpful
- Symptoms overlap with thyroid disease, anemia, pregnancy, or another condition
- Primary ovarian insufficiency is suspected
- The clinician needs baseline information for a specific treatment or another health issue
- Testosterone is being considered and the clinician needs baseline and follow-up monitoring
A pelvic exam is not a universal legal prerequisite to prescribing HRT. It becomes the right next step when bleeding, pelvic pain, a new finding, overdue evaluation, or another symptom cannot be resolved safely by telehealth.
Provider-by-provider lab policy, verified August 2026
Provider lab policies are not interchangeable. “No routine hormone testing” is different from “we never order labs,” and “labs included” is different from “labs required.” This table separates the current provider-stated policy from what a clinician may decide after reviewing the patient.
| Provider | Public lab policy | What the price includes | Practical meaning |
|---|---|---|---|
| Midi | Labs are ordered when indicated | Visit price does not include labs or medication[18] | Your insurance or cash price may add separate lab and pharmacy charges |
| Sesame | The clinician may order five core tests: CBC, A1c, thyroid function, lipid panel, and CMP | Included in the subscription when ordered, except patients in NY, NJ, RI, and ND pay the laboratory directly under the published state exceptions[14] | Included testing is not automatic and does not mean hormone panels are routinely needed |
| Winona | No bloodwork is required for its standard program | Intake and physician review are included in the medication model[10] | No routine lab gate, but the asynchronous model cannot perform an examination |
One boundary belongs in bold: salivary and urinary steroid hormone tests are not FDA-approved tools for managing menopause, and ACOG does not recommend adjunct hormone tests for prescribing or dosing compounded menopausal hormone therapy.[22]
A service that builds its dose around a proprietary saliva or dried-urine panel owes you a better answer than “your hormones are out of balance.”
Who can prescribe vaginal estrogen?
The same licensed prescriber routes can prescribe local vaginal estrogen within their state scope: physicians, NPs, PAs, CNMs, and the state-limited credentials described above. An OB-GYN is not automatically required. Bleeding, pelvic pain, a new finding, or anything needing an examination changes the starting point.
Worth separating, because women regularly buy the wrong treatment category.
“Local” describes where the medication is used and where its primary effect is intended — not whether a prescription is required. Vaginal estrogen products in the United States are prescription medications.
If the problem is vaginal dryness, painful sex, burning, or urinary symptoms without hot flashes or night sweats, ask whether local treatment is the appropriate lane. You may not need a systemic HRT subscription at all. Buying a full systemic program for a local problem can add cost and complexity you did not need.
If local and systemic symptoms are both present, that is a real prescriber conversation, not a checkbox. Read the vaginal estrogen guide.
Who can prescribe testosterone for menopause?
Testosterone is a Schedule III controlled substance in the United States. The prescriber needs the professional authority, state controlled-substance authority, and DEA registration required for the prescription. No testosterone product is FDA-approved for women in the United States, so treatment for a woman is off-label or uses a compounded product.
This is a genuinely different question from estrogen and progesterone.
Federal law places testosterone and its salts, isomers, and esters in Schedule III.[23] A Schedule III prescription may be refilled no more than five times within six months after the prescription date under federal rules; after that, a new prescription is required. State law and provider policy may be stricter.[24]
Do not translate that into “testosterone is easy to get online.” The clinician still has to evaluate whether it is appropriate, verify state authority, meet DEA requirements, document the prescription, and monitor the treatment. A provider that guarantees testosterone before evaluating you is advertising a conclusion before doing the clinical work.
The telemedicine rule has an expiration date
DEA and HHS extended the temporary federal telemedicine flexibilities for controlled medications through December 31, 2026.[25] The extension allows qualifying DEA-registered practitioners to prescribe controlled medications by telemedicine without a prior in-person medical evaluation when all applicable conditions are met. It does not override state law, and it does not guarantee that a provider will prescribe.
If testosterone is part of your plan, ask the provider now: “What changes for my care if the federal rule changes after December 31, 2026?”
Where the providers on this page stand
- Midi offers a compounded testosterone pathway in 25 states. It uses lab review and generally a second visit before a prescription decision.[19]
- Sesame says providers on its platform cannot prescribe controlled substances online.[14]
- Winona says it does not offer testosterone.[10]
The absence of an FDA-approved testosterone product for women is current as of August 2026.[26] Read the evidence and access guide for testosterone for women.
Does compounded HRT change who can prescribe it?
No. The prescriber's professional authority is the same kind of question; the medication lane is different. FDA-approved drugs have been reviewed as finished products for safety, effectiveness, and quality. Compounded drugs are not FDA-approved and do not undergo FDA premarket review. Do not let marketing merge those lanes.
FDA-approved means the finished medication at that formulation and strength was approved under the FDA process. Compounded means a licensed pharmacy prepared a medication for a patient or healthcare setting under compounding law. Both may be lawfully prescribed in appropriate circumstances. They are not regulatory equivalents.
The FDA says compounded drugs are not FDA-approved and are not reviewed for safety, effectiveness, or quality before marketing.[27] ACOG recommends FDA-approved menopausal hormone therapies over compounded products when an approved option can meet the patient's needs.[28]
The finished product matters. A compounded product does not become FDA-approved because one of its ingredients appears in an FDA-approved drug.
When compounding can answer a real need: a documented allergy to an excipient in available products, or a dose or dosage form that is not commercially available. That should be a patient-specific clinical reason, not an automatic “bioidentical” upgrade.
Questions to ask before accepting a compounded prescription:
- “Which pharmacy will compound this, and is it operating as a 503A pharmacy or a 503B outsourcing facility?”
- “Why does an FDA-approved option not meet my needs?”
- “I have a uterus. What is the endometrial-protection plan, and how will it be monitored?”
- “What follow-up will change the dose or stop the medication?”
Inner Balance's Oestra is a compounded finished product. The company's public FAQ says a licensed clinician approves each prescription, but that review does not convert the product into an FDA-approved drug.[16]
This section is a no-CTA zone on purpose. The right action here is not “click.” It is “get the medication lane and rationale in writing.”
Which route works with insurance, Medicare, Medicaid, or cash pay?
The visit and the medication are separate coverage questions. A provider may be in-network for the visit while the drug is excluded, or the visit may be cash-pay while the prescription runs through your pharmacy benefit. Check the visit, drug formulary, and dispensing pharmacy separately before booking.
Three questions, in order:
- Is the visit in-network?
- Is the prescribed drug on my formulary?
- Is the dispensing pharmacy in-network?
A yes on the first tells you nothing about the other two.
Provider-stated visit pricing and coverage, verified August 2026
Current commercial facts must carry dates because they move. These are provider-published prices and coverage statements, not promises of what your plan will pay. Confirm eligibility and benefits before the visit; medication, labs, and pharmacy charges may be separate.
| Provider | Visit model | Provider-stated self-pay price | Provider-stated coverage lane | Material limit | Verified |
|---|---|---|---|---|---|
| Midi Health | Live video; NP or CNM | $250 first visit; $150 return visit | Many commercial PPO plans; Medicare beneficiaries may use self-pay but may not submit Midi-related claims; Medicaid and Medi-Cal not accepted[18] | Labs and medication separate | August 26, 2026 |
| Sesame menopause program | Video plus messaging | $59/month | Sesame does not bill health insurance for the subscription; medication coverage may use the patient's plan[14] | Medication separate; refund and cancellation rules apply | August 26, 2026 |
| Gennev | Live video physician visit | $250 first visit; $199 follow-up | Lists Aetna, Anthem, and UnitedHealthcare among accepted plans; plan and state participation vary[29] | Verify network status before booking | August 26, 2026 |
| MyMenopauseRx | Virtual physician visit | $150 per visit | Accepts named commercial plans in eligible states[30] | Not a $99 visit; state and plan eligibility vary | August 26, 2026 |
| Elektra Health | Live virtual clinical care | $249 initial; $149 follow-up | Selected commercial, Medicare, and Medicaid plans in eligible markets[31] | Clinical care currently published in 16 states; exact plan coverage is location-specific | August 26, 2026 |
| Winona | Asynchronous physician review | No separate consultation fee; medication price shown during selection | Cash-pay; no insurance billing for the program[10] | Ages 35–59; 37 states plus Puerto Rico; no video or phone visit | August 26, 2026 |
There is no defensible universal “cheapest” winner. A $59 subscription can cost more after medication; a $250 visit can cost less with insurance; your own clinician plus generic pharmacy prescriptions can beat both. The cheapest honest route is the one you calculate with all three charges visible.
Medicare and Medicaid need plan-by-plan language
Do not publish “Elektra takes Medicare and Medicaid” as though that means every beneficiary in every state. Elektra publishes plan participation that includes selected Medicare and Medicaid products, but only in eligible markets, and it currently lists virtual clinical care in New York, Connecticut, Massachusetts, Florida, Pennsylvania, New Jersey, Illinois, Arizona, Georgia, Iowa, Missouri, Nebraska, Ohio, Oklahoma, Tennessee, and Texas.[31]
Midi's policy runs the other way: Medicaid and Medi-Cal patients are not accepted, while Medicare beneficiaries may use the service only as self-pay and agree not to submit Midi-related claims.[18]
Your own insurer's directory remains the first stop for government-plan coverage.
The Winona route — and the limits that matter
Winona is built for someone who wants an asynchronous physician-review model rather than a live appointment. The intake and consult do not carry separate fees, but the program is not universally available and the medication is the product you pay for.
Current gates: ages 35–59, 37 states plus Puerto Rico, no phone or video visits, typical messages answered within 24–48 hours, and a refund request window tied to the 24-hour processing period.[10] Its billing cadence is every 28 days for a 30-day supply or every 84 days for a 90-day supply. Its FDA-approved tablets, capsules, and patches are listed separately from compounded creams.
→ Does an asynchronous physician-review model fit you better than another live appointment? Check Winona's current age, state, medication, and pricing eligibility before completing the intake.
Partner link — we may earn a commission. It does not change your price or the limitations above.
Which clinician should I start with?
Start with the door that can resolve the uncertainty you actually have. Typical symptoms and a reliable clinician can begin in primary care, gynecology, or menopause-focused telehealth. Bleeding, complex history, unusual timing, examination needs, controlled substances, and government-plan coverage change the route more than a generic ranking ever could.
Find your row.
| Your situation | Best starting point | Why | When to escalate or redirect |
|---|---|---|---|
| Typical hot flashes, night sweats, or sleep disruption — and you trust your PCP | Your PCP, menopause-experienced NP, PA, CNM, or OB-GYN | They can review the full history and discuss options | If menopause care is outside the practice, ask for a referral rather than another vague no |
| Vaginal dryness, painful sex, burning, or urinary symptoms without systemic symptoms | A prescriber comfortable with genitourinary syndrome of menopause; ask specifically about local treatment | You may not need systemic HRT | Bleeding, pelvic pain, or a new finding → in-person evaluation |
| Bleeding after menopause | In-person clinician who can arrange prompt evaluation | The cause needs evaluating before treatment decisions | Do not start with an online prescription flow |
| Menopause before 45, suspected primary ovarian insufficiency, or complex surgical menopause | OB-GYN, reproductive endocrinology, or endocrinology coordinated with primary care | Diagnosis, bone, cardiovascular, fertility, and long-term planning may all matter | Prefer a clinician who can coordinate testing and longitudinal follow-up |
| Current or prior cancer, clot, stroke, clotting disorder, or active liver disease | In-person clinician familiar with the condition | The decision needs records and individualized risk assessment | This is not an intake-form problem |
| Your clinician refused without a clear reason | Use the four-question script, then seek a second opinion or MSCP-listed clinician if needed | You need the reason before you need another appointment | If multiple clinicians identify the same concern, resolve it rather than shopping around it |
| Local access is poor or waits are months | State-authorized telehealth with a clear clinician model and medication source | Removes geography and scheduling friction | Any examination, imaging, or urgent evaluation need |
| Medicare or Medicaid coverage is essential | Your plan directory first; then verify plan-specific telehealth options such as Elektra | Most cash-pay menopause platforms do not solve government-plan coverage | Confirm both visit network and pharmacy coverage before booking |
| You moved and need a refill | A prescriber authorized where you now live, with records from the prior clinician | The new state governs the encounter | Do not assume a same-day continuation |
| You want testosterone | A clinician whose state authority and DEA registration cover Schedule III prescribing | Different federal and state rules apply | Confirm labs, follow-up, refill rules, and what happens after December 31, 2026 |
The one-sentence decision rule: choose the clinician who can both legally treat you and resolve the hardest unanswered part of your case. A fast prescriber is not a win if the thing you need is an examination. A famous specialist is not a win if routine care can start tomorrow with someone who already knows your history.
What did The HRT Index actually verify?
This page uses primary statutes, regulator guidance, peer-reviewed research, conference research labeled as such, and provider-published commercial facts. We did not infer prices, turn marketing credentials into licenses, or treat a state map as the statute. Anything that could not survive that standard was removed rather than softened.
For this page, we verified:
- The common and state-limited prescriber routes
- PA and CNM nationwide prescriptive-authority frameworks
- Current CM recognition states
- New York's experienced-NP exemption through July 1, 2030
- New Jersey's 2026 APN law and Oklahoma's application-based recognition
- The 2019 resident-training statistics and their denominators
- The 2025 provider-type study as conference research, not peer-reviewed publication
- The patient-location rule for telehealth
- Testosterone's Schedule III status, federal refill limit, and the temporary federal telemedicine extension through December 31, 2026
- The absence of an FDA-approved testosterone product for women in the United States as of August 2026
- FDA's February 2026 labeling action for six menopausal hormone therapy products
- Each named provider's public prescriber model, current price or program charge, major insurance rule, lab policy, state footprint, or cancellation term used on this page
- Hers' pending FTC/state lawsuit and its procedural status
The HRT Index Verification Standard
The HRT Index Verification Standard is the documented process used to review providers: read every published price, separate FDA-approved from compounded, verify state availability and insurance, and re-check on a fixed schedule. Providers are evaluated on five pillars, in this order: clinical legitimacy, care quality, medication fit, price transparency, access.
No provider on this page receives a fabricated score. No clinician is presented as having reviewed this article. No testimonial is used to imply medical efficacy. No compounded product is presented as FDA-approved.
Provider-stated versus independently verified
- Provider-stated: clinician model, price, states served, lab inclusion, refund window, medication menu, and insurance participation published by the company.
- Independently verified: active statutes and board guidance, FDA status, federal controlled-substance rules, FTC action, peer-reviewed research, and the cited conference source.
- Editorial judgment: which door may fit a reader's stated situation. Those judgments are based on the verified facts above and are not medical advice.
What this page cannot tell you
It cannot tell you that HRT is right for you or promise that any clinician will prescribe it. That takes an individual evaluation with a complete history. It also cannot freeze state law, insurance participation, or provider pricing. Re-check the dated source before paying.
Affiliate disclosure: The HRT Index may earn commissions from Midi Health, Sesame, and Winona. We do not receive compensation from the government, The Menopause Society, AANP, ACOG, FDA, Gennev, MyMenopauseRx, or Elektra for appearing here. Hers is deliberately not monetized on this page while the cited federal case is pending.
Found an error? Email partners@thehrtindex.com. We correct verified errors and date the change.
Frequently asked questions about who can prescribe HRT for menopause
These answers close the practical follow-ups that most often send women back to search: primary care, advanced-practice clinicians, referrals, online prescriptions, travel, vaginal estrogen, testosterone, and what to do after a refusal. They are summaries of the verified sections above, not a substitute for individual care.
Can my primary care doctor prescribe HRT?
Yes. A primary care physician can prescribe menopausal hormone therapy without a universal requirement for an OB-GYN or endocrinology referral. Whether that clinician manages menopause in practice is a separate question. Ask at the start of the appointment, not after repeating your symptoms for twenty minutes.
Can a nurse practitioner prescribe HRT?
Yes. NPs have prescriptive authority nationwide, but the practice structure varies by state. Some NPs practice independently; others work under transition, collaboration, or supervision requirements. Those rules affect the practice behind the prescription, and controlled substances such as testosterone add separate limits.
Can a physician assistant prescribe HRT?
Yes. PAs have prescriptive authority in all 50 states and DC. The individual PA still must comply with the state's practice rules, employer credentialing, and any controlled-substance restrictions. Do not assume that nationwide authority means every PA can prescribe every medication without another requirement.
Can a certified nurse-midwife prescribe menopause HRT?
Yes. CNMs have prescriptive authority in all 50 states, DC, and US territories, with state-specific practice requirements. Their scope is not limited to pregnancy and birth. Menopause experience still matters, so verify that the individual clinician currently manages midlife care.
Can a clinical nurse specialist prescribe HRT?
Sometimes. CNS prescriptive authority varies by state. Verify the active license, the state's authority for the CNS role, and whether any physician relationship or additional recognition is required. The title by itself is not enough.
Can a naturopathic physician prescribe HRT?
Only where the jurisdiction recognizes the credential and the medication falls within that license's formulary or scope. “Naturopath,” “naturopathic doctor,” and “naturopathic physician” do not create one uniform national license. Check the state board record and current prescribing rules.
Can a pharmacist prescribe HRT for menopause?
Not as a general nationwide route. State law may permit pharmacist prescribing under a defined protocol, collaborative practice agreement, or limited condition. A pharmacist dispensing or compounding medication is not automatically the prescriber of record. Ask who wrote the prescription.
Do I need a referral for HRT?
Not universally. Your insurance plan may require a referral for a specialist or certain in-network benefits even when state law does not. Check the plan and the clinic separately.
Is online HRT a real prescription?
Yes, when a clinician legally permitted to treat you where you are located issues it and a licensed pharmacy dispenses it. The platform is not the credential. Verify the treating clinician, state authorization, medication source, and pharmacy.
What happens if I travel or move to another state?
The state where you are physically located during the telehealth encounter matters. A move can end a provider's legal ability to continue treating you. Contact the provider before you run low, transfer records, and do not count on an automatic refill in the new state.
Who can prescribe vaginal estrogen?
The same licensed prescriber routes described above can prescribe it within state scope. An OB-GYN is not always required, but bleeding, pelvic pain, or a new finding makes in-person gynecologic evaluation the better start.
Who can prescribe testosterone for a woman?
A clinician with the professional and state controlled-substance authority plus DEA registration required for a Schedule III prescription. No testosterone product is FDA-approved for women in the United States, and telehealth prescribing remains subject to federal conditions, state law, and the provider's policy.
What if my doctor says HRT causes breast cancer?
Ask whether the concern is specific to your history, the medication being considered, and the route and timing — or whether the practice does not manage menopause. A general slogan is not an individualized assessment. A documented patient-specific reason is information you can take to a second opinion.
How fast can I get an HRT prescription?
It depends on the door and the evaluation. Some online services advertise same-day or 24–48-hour access; specialist waits can be much longer. No legitimate provider can promise a prescription before reviewing your history. Fast access is valuable only when the clinical setting fits the problem.
Still not sure which HRT program is right for you?
The answer depends on your state, symptoms, uterus status, medication route, risk history, insurance, and whether the problem needs an examination. A generic ranking cannot resolve all of that. The tool turns those factors into a starting route and flags when online care is not the right first step.
Take the free Find My HRT Path quiz →
It takes about 90 seconds. Nothing is stored. No email is required.
The HRT Index · Last verified August 2026 · Educational research only. This page is not medical advice and is not a substitute for care from a licensed clinician. For unexplained bleeding, severe symptoms, or an urgent concern, contact an appropriate clinician or emergency service.
Sources
1 US Department of Health and Human Services, Licensing across state lines.
2 Kling JM, et al. Menopause Management Knowledge in Postgraduate Family Medicine, Internal Medicine, and Obstetrics and Gynecology Residents: A Cross-Sectional Survey. Mayo Clinic Proceedings. 2019;94(2):242–253.
3 American Academy of Physician Associates, AAPA History — notes that Mississippi became the final state to grant PA prescribing authority in 2007.
4 American College of Nurse-Midwives, Frequently Asked Questions and The Certified Midwife Credential.
5 The Menopause Society, Likelihood of Being Prescribed Hormone Therapy May Depend on the Type of Provider Seen, October 20, 2025.
6 National Association of Clinical Nurse Specialists, Scope of Practice.
7 New York State Senate, Education Law § 6902.
8 State of New Jersey, Governor Murphy Signs Legislation Expanding Access to Health Care by Eliminating Certain Practice Restrictions for Advanced Practice Nurses, March 30, 2026; and S2996 committee substitute text.
9 Oklahoma Board of Nursing, Independent Prescriptive Authority Recognition.
10 Winona, Frequently Asked Questions, verified August 26, 2026.
11 American College of Obstetricians and Gynecologists, The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Women With Postmenopausal Bleeding.
12 US Food and Drug Administration, FDA Approves Labeling Changes to Menopausal Hormone Therapy Products, February 12, 2026.
13 Midi Health, Meet Our Women's Health Clinicians, verified August 26, 2026.
14 Sesame, Online Menopause Treatment, verified August 26, 2026.
15 Hers, Menopause treatment, verified August 26, 2026.
16 Inner Balance, Oestra FAQ and The Science, verified August 26, 2026.
17 Federal Trade Commission, FTC and States Act Against Hims & Hers for Deceptive and Unlawful Privacy Practices, July 29, 2026.
18 Midi Health, Pricing & Insurance, verified August 26, 2026.
19 Midi Health, Testosterone for Women, verified August 26, 2026.
20 The Menopause Society, How to Find a Certified Menopause Practitioner.
21 National Institute for Health and Care Excellence, Menopause: identification and management — recommendations.
22 American College of Obstetricians and Gynecologists, Compounded Bioidentical Menopausal Hormone Therapy.
23 Electronic Code of Federal Regulations, 21 CFR § 1308.13 — Schedule III.
24 Electronic Code of Federal Regulations, 21 CFR § 1306.22 — Refilling of prescriptions.
25 Drug Enforcement Administration and Department of Health and Human Services, Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications, effective through December 31, 2026.
26 Kling JM. Testosterone for the Treatment of Hypoactive Sexual Desire Disorder in Women. 2025. The source states that no testosterone formulation is currently FDA-approved for women in the United States.
27 US Food and Drug Administration, Compounding and the FDA: Questions and Answers.
28 American College of Obstetricians and Gynecologists, Compounded Bioidentical Menopausal Hormone Therapy.
29 Gennev, Menopause Relief, verified August 26, 2026.
30 MyMenopauseRx, Treatment Costs, verified August 26, 2026.
31 Elektra Health, Frequently Asked Questions and Health Plans, verified August 26, 2026.