Safety
Compounded hormones have no FDA label or boxed warning, but the risks of the hormones in them still apply: estrogen without a progestogen raises the risk of endometrial cancer in women with a uterus, and estrogen raises the risk of blood clots. Strength can vary from pharmacy to pharmacy. Estriol is not in any FDA-approved US drug, so there is no approved label or safety data for it. Hormone pellets are not covered on this site; they need an in-office procedure and cannot be removed once placed.
Talk to a licensed clinician about your health history and every medication you take before you start.
Legal status
Prescription only; compounded and not FDA-approved; Schedule III only when the formula contains testosterone. Compounded bioidentical hormones (BHRT) are prepared by a compounding pharmacy for an individual prescription. Compounded products are not FDA-approved, and the FDA does not review them for safety, effectiveness or quality. Lawful when a state-licensed 503A pharmacy prepares it for an individual patient with a prescription and it is not an essential copy of an approved drug. It is not FDA-approved; the FDA proposed a list of drugs that are demonstrably difficult to compound in 2017 but has not finalized it.
What compounded bioidentical hormones (BHRT) are
Compounded bioidentical hormones (BHRT) contain estradiol, estriol, progesterone or testosterone, depending on the formula. Not FDA-approved. FDA-approved bioidentical estradiol (tablets, patches, gels, sprays) and progesterone (capsules) exist, so compounded versions are alternatives rather than the only option.
Dosing
Cream, gel or troche prepared by a compounding pharmacy, usually once a day, as the prescription directs. There is no labeled dose. The prescriber picks the strength and the compounding pharmacy prepares it, and the FDA does not review compounded drugs for safety, effectiveness or quality before they are sold.
How well it works
A 2020 National Academies report, requested by the FDA, found few well-designed trials of compounded bioidentical hormones and concluded that the evidence does not support their clinical utility. It recommended limiting them to patients who cannot use an FDA-approved product. Individual results vary.
Compounded bioidentical hormones (BHRT) cost
None of the online providers we compare publishes a price for compounded estrogen or progesterone creams. For a full breakdown, read How much does HRT cost without insurance?. For the steps, read How to get HRT online.