How to get HRT online

Getting hormone therapy online works much like a visit to a menopause clinic, minus the waiting room. You fill in a health history, a licensed clinician reviews it, and if hormone therapy suits you, a prescription goes to a pharmacy or ships to your door. What differs from one service to the next is how you reach the clinician, what is included in the price and whether your insurance can help.

This guide walks through each step, the three ways online clinics charge, and the safety checks a careful prescriber runs before writing a prescription. Prices are as of October 2026, read from each provider’s own site.

Who online HRT is for

Hormone therapy is the main treatment for hot flashes and night sweats. The North American Menopause Society’s 2022 position statement calls it the most effective treatment for these symptoms and for the genitourinary syndrome of menopause, and notes it prevents bone loss and fracture. For women under 60, or within 10 years of their last period, who have no reason to avoid it, the society says the benefit-risk ratio is favorable.

The FDA moved its labels the same way. On Nov 10, 2025 it said product labeling would recommend starting systemic hormone therapy within 10 years of menopause onset or before age 60, and that it would remove the broad cardiovascular, breast cancer and dementia statements from the boxed warnings. The endometrial cancer warning for estrogen taken alone stays. We cover what changed, and what the labels say today, in HRT risks and benefits.

Online care is a poor fit if you have bleeding after menopause that hasn’t been checked, a history of breast cancer, a blood clot, stroke or heart attack, or liver disease. Those are contraindications on the estradiol labels, and they need in-person care.

How it works, step by step

1. The intake

Every service starts with a questionnaire: your age, your periods, your symptoms, whether you still have a uterus, your medicines and your personal and family history. Answer the history questions fully. The clinician uses them to rule out the conditions above, and a missing answer can delay the review.

2. The clinician review

Here the services split in two:

• Asynchronous review. A clinician reads your intake and messages you with questions or a plan. Winona, Musely, Alloy and Hers work this way. Winona says it has no phone or video visits; Alloy says you are connected with your doctor in less than 12 hours; Musely says a doctor reviews within 24 hours.
• Live video visits. You book a time and talk to a clinician. Midi Health’s first visit is 30 minutes and return visits 15 minutes; Elektra Health’s first visit is also 30 minutes; Gennev’s visits are with menopause-trained OB/GYNs. Evernow offers text or video, and Henry Meds uses video or, in some states, a review without video.

Neither model is wrong. A video visit gives you more back-and-forth; a written review is faster and usually cheaper. If your history is complicated, a live visit is the safer choice.

3. Labs, when they apply

Hormone blood tests aren’t needed to start estrogen. The generic estradiol tablet label says dosing should be guided by how you respond rather than by blood levels of estradiol or FSH, and most of the services we compare don’t ask for labs. Joi + Blokes is the exception: it requires a lab test and a clinician visit before you start, then repeats both at about six weeks, all included in a $50 monthly membership. Two treatments do need labs. Veozah carries a boxed warning for liver injury and requires liver tests before you start and during the first nine months. Testosterone needs blood levels checked before and during treatment.

4. The prescription

Some services ship the medication themselves; others send the prescription to your local pharmacy. Winona, Musely, Alloy, Henry Meds and Joi + Blokes ship. Wisp sends menopause prescriptions to your local pharmacy, where you pay for the medication, and Joi + Blokes can send estrogen and progesterone prescriptions to a local pharmacy so you can use your insurance.

5. Follow-up

Doses get adjusted. The estradiol labels say to start at the lowest effective dose and re-evaluate periodically. Ask how follow-up works before you pay: Joi + Blokes schedules check-ins about every three months, Midi and Elektra book return video visits, and Alloy, Evernow and Nurx offer unlimited messaging.

The three ways online clinics charge

The headline price means different things depending on the model.

Scroll sideways to see the full table

All-in prices are the easiest to compare. Musely’s estradiol pill is $35 a month and its progesterone $20, shipped as two-month supplies with the doctor included. Alloy’s estradiol pill starts at $39.99 a month after a one-time $49 consult. Winona’s tablets start at $54. Henry Meds charges $149 a month for any of its HRT options, with visits, medication and shipping included.

Memberships look cheaper until you add the medication. Wisp’s consult starts at $33 a month, but you pay for the hormones at your pharmacy. Evernow’s membership is $49 a month, or $35 a month on a $420 prepaid 12-month plan, and its medication prices aren’t published. Nurx’s Solstice plan starts at $95 a month, and its footnote excludes prescription costs and lab work.

Insurance-billed clinics can cost the least if you have a commercial plan they take. Midi Health says it is in-network with most major plans and most PPOs. Without coverage, Midi charges $250 for a first visit and $150 for a return visit, Gennev $250 and $199, and Elektra $249 and $149. See HRT cost without insurance for full-year totals and is HRT covered by insurance for what plans pay.

What you can be prescribed

• Estradiol, the estrogen most HRT uses, as a pill, patch, gel or spray. All are FDA-approved and sold as generics.
• Progesterone, if you still have a uterus. Micronized progesterone capsules are FDA-approved and sold as Prometrium and generics.
• Vaginal estrogen for dryness, irritation and painful sex: a cream, insert or 3-month ring.
• Non-hormonal options for hot flashes, such as Veozah and low-dose paroxetine. Evernow lists both; Alloy lists low-dose paroxetine at $34.99 a month.
• Compounded bioidentical hormones, creams a pharmacy mixes for your prescription. They are not FDA-approved. Winona, Musely, Henry Meds and Joi + Blokes sell them.
• Testosterone, offered by Joi + Blokes and Henry Meds. No testosterone product is FDA-approved for women, so it is off-label, and it is a Schedule III controlled substance.

The FDA’s guidance for telehealth companies says compounded drugs are not approved by the agency and are not reviewed for safety, effectiveness or quality before marketing. FDA-approved estradiol and progesterone are bioidentical too, so “bioidentical” on its own does not tell you whether a product is approved. Our guide to bioidentical vs synthetic HRT covers the difference.

The safety checks to expect

A careful prescriber will ask about, and should decline or refer you for:

• Vaginal bleeding after menopause that hasn’t been diagnosed.
• Breast cancer now or in the past, or another estrogen-dependent cancer.
• A past blood clot in the legs or lungs, a stroke or a heart attack.
• Liver disease, or a known clotting disorder such as protein C or S deficiency.

These come from the contraindications on the Divigel label. The other non-negotiable is the uterus rule. Estrogen alone raises the risk of endometrial cancer if you have a uterus, which is why the boxed warning on every estradiol pill, patch and gel label we read starts there. On the Prometrium label, adding progesterone 200 mg for 12 days a cycle cut endometrial hyperplasia over three years to 6% of women, from 64% on estrogen alone.

How to choose a service

Before you sign up, check:

• Whether the price includes the medication, and for how long that price holds.
• Any one-time consult fee or membership on top.
• How you reach a clinician: messages only, or video when you need it.
• Whether it offers the form you want (patch, pill, gel, spray, vaginal).
• Whether it says plainly which products are compounded.
• Whether it serves your state. Evernow and Wisp say they cover all 50 states; Winona serves 37 states plus Puerto Rico.
• LegitScript certification, which most of the providers we compare display.

Our ranked list of online menopause providers scores each one on these points, and the lowest-price list sorts them by estradiol pill price. The menopause hub collects every review.

The bottom line

Getting HRT online takes an intake, a clinician review and, for most people, no lab work. As of October 2026, FDA-approved estradiol pills start at $35 a month and progesterone at $20 at the providers we compare, while insurance-billed clinics charge $249 to $250 for a self-pay first visit. Choose the model that fits how you want to pay and how much contact you want with a clinician, and make sure the person prescribing has asked about bleeding, cancer, clots and your uterus first.