My Doc won't prescribe Hormone Replacement Therapy, what do I do?
- Peggy Bronson
- 3 minutes ago
- 7 min read
Have you found yourself in a place where your doc won't prescribe Hormone Replacement and you are wondering what to do? Keep reading and I'll help you understand your options as you navigate your menopause journey.,
Have you done all the research and made the decision you want to try HRT? Only to learn that your GP or GYN isn’t supportive and refuses to prescribe it? You are not alone. I get at least one message per day from women indicating that their GYN wouldn’t write them a prescription and so now they feel lost or worse, they are second guessing if HRT is safe? And should they even try it?
I get it. We are obedient patients. We go to our GYN every year for our annual check-up like they suggest. Then when the time comes that you can’t handle the hot flashes, night sweats, mood swings and weight gain any longer, you finally strike up the nerve to bring up the conversation at your annual. Then your trusted doc tells you, “It’s just what happens, and it won’t last forever.”
What? That can’t be the answer. If you are like me, as I’ve gotten older and wiser, I realize our trusted medical partners are also mere mortals who mean well. They want to do the right thing, but they are not perfect and sometimes we find ourselves on opposite sides of an argument. And you know what? That is okay. It’s okay to not agree with your doc and to seek help elsewhere, that’s what many menopausal women are doing today. That's why I created the Hormone Therapy Hub Website and Trusted Provider Page.
How to start HRT without the hassle or your doctor's support
I started HRT in 2019. The night sweats, weight gain and moodiness were more than I could bear. I didn’t like myself or anyone else for that matter. I didn’t feel like me and the excess weight was really eating away at my self-esteem.
Fortunately for me, I found a GP doc who specialized in weight loss and believed in and prescribed HRT. His preferred formulation came from a compound pharmacy rather than a traditional pharmacy which meant I was paying for it out of pocket to the tune of $75 per month.
His office was 45 minutes away from my home and after realizing the ease of telehealth during COVID, the thought of getting dressed, driving to his office, sitting in the waiting room only to have eight-minutes of his precious time, started to seem ridiculous.
Online HRT Reviews
Once I came to the decision that I no longer wanted to drive to the doctor’s office, I began a quest to see if there were any online options for HRT. To my delight, there were several.
It’s been my mission over the past 14 months to “shop and test” online HRT providers. As I’ve continued to build out my Hormone Therapy Hub Website, I’ve become a patient of Winona, Alloy, Midi Health, Joi Women’s Wellness and MyMenopause Rx. In all cases, you need a prescription for Hormone Replacement Therapy and depending on how the provider and doctor have their practice set up, the prescriptions may come from a compound pharmacy, or they may come from a traditional neighborhood pharmacy.
Winona, Alloy and Joi Women’s Wellness work closely with compound pharmacies for filling prescriptions. Midi Health and MyMenopauseRx do take medical insurance, and you can use your prescription insurance to cover cost of meds. Each of the five have a different business model, see this page to get the scoop on all five providers.
Is Hormone Replacement Therapy FDA Approved
Here is what you need to understand when it comes to insurance. If a doctor/practice is providing the HRT directly to you via shipping to your home, then they are likely getting their meds from a compound pharmacy and may or may not be making a bit of profit from the purchase, as the middleman between you and the compound pharmacy.
Compound pharmacies have a place in our healthcare system, specifically when a patient has a need for a drug that needs to be customized. For example, if you are allergic to gluten and you need to take a drug that has gluten in it, then a compound pharmacy can “hand make” that drug for you minus the gluten. They also step in when a customized dose or formulation needs to be administered to you as the patient.
HRT comes in several formulations and dosages; some have been approved by the FDA and some have not. If your provider or doc prefers a formulation or dosage that isn’t FDA approved, then it must come from a compound pharmacy. Compound versions, in many cases, are not FDA approved and will not be covered by prescription insurance.
What is the norm with HRT is that the ingredients are FDA approved. However, if you are being prescribed a dose or formulation that isn’t FDA approved, then it will likely come from a compound pharmacy and therefore not covered by prescription insurance. Prescription insurance will only cover HRT formulations and dosages that have been approved by the FDA. Custom doses or formulations are typically not covered.
In my case, for whatever reason my first “HRT” doc preferred the compound version and at the time I didn’t really understand the role of compound pharmacies or that there were FDA approved meds I could have taken and used my prescription insurance. It would have cost me about one-half of what I was paying for the compound version.
Is Hormone Replacement Therapy Covered
Over the years, I’ve been on creams, troches, pills, patches and injections. Currently my regimen is a .050 Estradiol patch, 200 mg progesterone tablet and 25 mg of DHEA, which I take in the morning. I’ve discovered that I do best with the estrogen patch over the creams and I take my progesterone tablets at night as they help with sleep. I’ve used estrogen creams in the past, but they didn’t seem to absorb as well for me. I’ve also taken troches which melt under your tongue, but after some in depth research, I wanted to get my estrogen trans dermally (through the skin) and that’s when I started experimenting with the creams and the patches.
In searching for a provider who prescribes FDA approved HRT that can picked up at your local pharmacy it requires finding a doc or GYN who knows which formulations and doses have been approved by the FDA. There are two companies that are good at this, Midi Health and MyMenopauseRx. Both take medical insurance and will call in prescriptions to your local pharmacy.
Midi Health charges $250 for an initial 30-minute consultation and MyMenopauseRX has a self-pay discount option for $99 for a 20-minute appointment. If your insurance is in the Midi Health Network of providers, your appointment or a portion of it might be covered. In my case, they didn’t take my insurance, so I had to pay out of pocket. You can reach out to either of these two providers to confirm if they take your medical insurance.
Will my insurance cover HRT (Hormone Replacement Therapy)
Once the provider of your choice has called in your medications, you also need to download the GoodRx app on your phone. You’ll want to compare the cost of the prescriptions using your insurance compared to using a GoodRx coupon. Sometimes I use my insurance and sometimes I find the GoodRx coupon is a better deal. It makes no sense to me that the costs vary from one quarter to the next, but they do and each time I must do a bit of research to see which is the most affordable option. See this blog on my out of pocket when using insurance compared to GoodRx coupon code.
Is Bioidentical Hormone Replacement Therapy FDA approved
Technically, Bioidentical is a marketing gimmick to make us think that it’s better or more natural than the versions that have been around for decades. It is the ingredients that make it bioidentical or not. For example, Estradiol is one form of estrogen and is considered bioidentical. You can get it as a cream, patch or a pill. Progesterone is also considered bioidentical; it comes in pill and cream.
Both Estradiol and Progesterone have been FDA approved and are referred to as Bioidentical. Some come from a compound pharmacy and others, the ones whose formulation and dosages has been approved by the FDA can be picked up at your local pharmacy. Also meaning your insurance would likely cover them.
Don’t let the term Bioidentical confuse you. If what you are being prescribed or what you are taking is Estradiol and Progesterone, regardless of the formulation or the dose, it is considered Bioidentical. It may or may not be FDA approved, depending on the formulation and the dose you are being prescribed.
My doc won’t prescribe Hormone Replacement Therapy, what do I do?
That’s exactly why I created this website, to help you navigate your options when you have to step outside your relationship with your GYN. Sure, it’s disappointing that we are not on the same page, but unfortunately when it comes to HRT, that’s the case for many women.
OB/GYN’s are trained to be surgeons. That is their primary focus. They were not taught in med school about hormones, perimenopause or menopause. Some have taken the time to educate themselves so they can help us, but others tend to shy away from it. I assume much of this is due to lack of knowledge or motivation to want to think outside the box of what they’ve done for so many years.
The Women’s Health Initiative (WHI) study that happened in the early 2000’s didn’t help our cause either. The articles and follow up news stories printed were half-truths all of which have been debunked. However, so many of our GYN’s were in college during this time or started practicing at this time and they don’t seem to be able to get past the myths and learn the truth for themselves.
It's sad, but true. If your doctor isn’t being supportive of you wanting to have a conversation around going on HRT, then consider one of the trusted providers that I’ve vetted in the past year or so. They all offer online, telehealth options to make it easy and simple to get started.