Hormone Replacement in Houston, with the workup it deserves.
Get back to sleeping through the night, thinking clearly, and feeling like yourself — with bioidentical estrogen, progesterone, and testosterone dosed to your labs and symptoms, not a generic protocol.
Replacing what the ovaries stop making, in the forms your body recognizes.
Hormone replacement therapy restores estrogen, progesterone, and (where appropriate) testosterone to physiological levels during perimenopause and menopause. Bioidentical formulations match the molecular structure of the hormones your body produced before the transition — which is why side-effect profiles and safety data look different from older synthetic preparations like conjugated equine estrogens or medroxyprogesterone. What we prescribe is Bioidentical Hormone Replacement Therapy (BHRT) — that’s the standard of care today.
Most of what we prescribe is FDA-approved: estradiol patches, gels, and oral tablets; oral micronized progesterone; testosterone for women in physiologic doses. Compounded preparations are used in specific clinical situations where FDA-approved options don’t fit — not as a default. Pellet therapy is one of several delivery methods; we offer it when it’s the right fit for a specific patient, and recommend other delivery methods when adjustable dosing would serve the patient better.
The framework we work in is consistent with current Menopause Society and Endocrine Society guidance: HRT, started within ten years of menopause onset, has a favorable benefit-risk profile for most healthy women — and the question of “should I be on this” deserves a real conversation, not a 90-second screening. Read more about our women’s hormone approach.
The symptoms HRT can actually help with.
Perimenopause and menopause produce a constellation of symptoms across multiple systems — and most women have been told some version of “it’s just stress” or “you’re getting older” for at least one of them. Here’s what’s typically driven by the hormonal shift, grouped by category.
Hot flashes & night sweats
The most recognized symptom — and the one HRT is most clearly effective for. Disrupts sleep, work, and quality of life. Estradiol therapy reduces frequency and severity by 75% or more in most women.
Evidence: Strong · First-line indicationInsomnia, brain fog, memory
Often the symptom women care about most but mention last. Fragmented sleep from night sweats compounds with progesterone-mediated sleep effects and direct cognitive changes from estrogen withdrawal.
Evidence: Strong for sleep · Evolving for cognitionAnxiety, irritability, low mood
Perimenopause is the highest-risk period for new-onset depression in a woman’s life outside of postpartum. Estrogen replacement often helps where SSRIs alone haven’t.
Evidence: Moderate · Often underrecognizedVaginal dryness, painful sex, UTIs
Vaginal estrogen — separate from systemic HRT — is highly effective and very safe for genitourinary syndrome of menopause. Often appropriate even for women who can’t take systemic estrogen.
Evidence: Strong · First-line indicationWeight gain, body composition
Menopause shifts fat distribution toward the abdomen and reduces lean mass. HRT doesn’t cause weight loss, but the metabolic and body-composition picture is generally better on therapy than off — particularly when paired with resistance training and adequate protein.
Evidence: Moderate · Adjunct, not primaryLow libido & arousal
Multifactorial — estrogen affects tissue and lubrication, testosterone affects desire and arousal. Where appropriate, low-dose testosterone for women is part of the conversation.
Evidence: Strong for tissue · Moderate for desire (testosterone)HRT addresses the symptoms. Real care goes further.
Hormone replacement is the most direct treatment for vasomotor and genitourinary symptoms of menopause. The broader picture — bone, cardiovascular, metabolic, cognitive — deserves attention too. We treat that picture as part of the program, not as fine print.
HRT makes life feel like yours again. The rest of the picture matters too.
Hormone therapy can resolve symptoms that have been making life unworkable. The decade after menopause is also when bone density loss accelerates, when cardiovascular risk shifts, and when sleep architecture changes. HRT helps those too — and the broader picture supports what HRT can do.
- Bone density: weight-bearing activity supports what estrogen preserves
- Sleep architecture and how perimenopause changes it
- Cardiovascular and metabolic markers — timing of HRT initiation matters here
- Pelvic floor and genitourinary care, often underaddressed in standard menopause care
From consultation to first prescription, in real medicine.
HRT prescribing follows the same clinical pattern as any other thoughtful prescribing decision — proper workup first, then a decision based on what your labs, history, and symptoms actually show.
Initial consultation
In person at our Houston clinic. We map your symptoms across all categories (vasomotor, sleep, mood, cognitive, genitourinary, sexual), review your medical and family history, and discuss what HRT can and cannot do. No prescription written this day.
Lab work
Comprehensive baseline labs at LabCorp or Quest near you — FSH, LH, estradiol, progesterone, total and free testosterone, SHBG, thyroid panel, metabolic panel, lipids, and inflammatory markers. We also confirm screening status for mammography and other age-appropriate care.
Protocol design
Your physician designs your specific protocol — estrogen route (transdermal patch, gel, or oral), progesterone (oral micronized for most), testosterone where indicated, and starting doses calibrated to your labs and symptom severity. We discuss the reasoning so you understand the choice.
First prescription
FDA-approved medications filled at retail pharmacy where possible. Compounded formulations are used in specific clinical situations. We review administration, expected timeline for symptom improvement (vasomotor symptoms often within 2–4 weeks; cognitive and mood effects can take 8–12 weeks), and what to watch for.
Monitor & adjust
Structured check-ins at 6 weeks, 3 months, 6 months, then annually. Lab repeat where indicated. Dose adjustments based on actual response — and an honest conversation about long-term use, including when and how to consider tapering.
Ready to start the conversation?
A 45-minute consultation with one of our physicians. We’ll review your specific situation and decide together whether HRT fits — or whether something else makes more sense for what you’re experiencing.
What HRT can — and can’t — do.
Setting expectations honestly is part of the work. The evidence for HRT in symptomatic women within ten years of menopause is strong; the picture is more nuanced for older women starting late, and for specific risk profiles. Here’s what to realistically expect.
What HRT does well
- Reduces hot flashes and night sweats by 75% or more in most women
- Improves sleep quality, often within the first 4–6 weeks
- Resolves vaginal dryness, painful sex, and recurrent UTIs (especially with vaginal estrogen)
- Often improves mood, anxiety, and cognitive symptoms during the perimenopause transition
- Preserves bone density and reduces osteoporotic fracture risk
- Has a favorable cardiovascular profile when started within 10 years of menopause
What it can’t do
- Replace strength training, sleep, protein, or stress management
- Cause significant weight loss on its own
- Reverse changes already established before treatment (advanced osteoporosis, longstanding GSM)
- Be a fit for women with active or recent estrogen-sensitive cancers, certain clotting disorders, or unexplained vaginal bleeding
- Be appropriately prescribed without baseline labs and a real clinical workup
- Continue indefinitely without periodic reassessment of benefit-risk balance
Before you book.
How much does HRT cost in Houston?
The initial consultation is $349. Most FDA-approved HRT medications (transdermal estradiol, oral micronized progesterone) are covered by insurance and inexpensive even without coverage — typically $20–$60 per month at retail. Compounded preparations, when used, run $40–$100 per month. We discuss specific costs during consultation, with no surprises.
Isn’t HRT supposed to cause breast cancer?
The Women’s Health Initiative (WHI) findings from 2002 are more nuanced than how they were originally reported. The increase in breast cancer risk seen in the WHI was small in absolute terms, was driven by the combined estrogen + medroxyprogesterone arm (not estrogen-only), and was specific to a population that started HRT on average 12 years after menopause. For symptomatic women starting HRT within ten years of menopause, current Menopause Society guidance recognizes a favorable benefit-risk profile. We discuss your specific risk picture during consultation.
Do you do pellet therapy?
No. Pellet therapy delivers supratherapeutic peaks of estrogen and testosterone that aren’t necessary to relieve symptoms and that are difficult to titrate or reverse if side effects develop. We use FDA-approved transdermal, oral, and topical formulations as default, with compounded preparations in specific clinical situations.
What about bioidentical hormones?
“Bioidentical” means the hormone molecule matches what the body produces. Most of what we prescribe is bioidentical and FDA-approved — estradiol, micronized progesterone, and testosterone are all available as FDA-approved bioidenticals. Compounded “bioidentical hormone replacement therapy” (BHRT) is sometimes appropriate for specific situations but is not inherently safer or more effective than FDA-approved bioidenticals. We discuss the distinction during consultation.
How long do I have to be on HRT?
There is no fixed answer. Some women take HRT for the duration of acute symptoms (typically 5–10 years through the transition). Others continue longer for ongoing benefits (bone, cognitive, cardiovascular). The benefit-risk balance shifts over time, which is why we reassess annually rather than treating it as set-and-forget. Tapering, when appropriate, is done gradually with attention to symptom return.
I’m in perimenopause but still cycling. Can I start HRT now?
Often yes. Perimenopause is when many women experience the worst symptoms — and treating those symptoms doesn’t require waiting for menopause to be “complete.” Starting therapy in perimenopause requires more careful protocol design (cyclic vs continuous, contraception considerations) but is well within standard practice. We discuss timing during consultation.
Do you accept insurance?
FDA-approved HRT medications are typically covered by insurance and inexpensive even without coverage. Our clinical service fees ($349 initial consultation; ongoing program fees) cover physician oversight, lab review, and structured monitoring — separate from medication costs. We don’t bill insurers directly but can provide documentation suitable for HSA/FSA submission and out-of-network reimbursement.
Start with a conversation, not a prescription.
A 45-minute consultation with one of our Houston physicians. We’ll review your situation, decide together whether HRT fits, and what comes next.