Hormone Replacement in Houston, with the workup it deserves.
Hormone replacement therapy for perimenopause and menopause symptoms — mostly FDA-approved bioidentical estradiol and progesterone, prescribed after labs and a real clinical evaluation.
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. We prescribe bioidentical hormones (BHRT), in FDA-approved forms whenever possible.
Most of what we prescribe are FDA-approved products: estradiol patches, gels, and oral tablets, and oral micronized progesterone. Testosterone for women in physiologic doses is prescribed off-label or as a compounded preparation, which is not FDA-approved. 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 (compounded estradiol pellets are not FDA-approved); we offer it for selected patients when it’s the right fit, 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 treating bothersome hot flashes and preventing bone loss in 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. In clinical trials, estrogen therapy reduced hot flash frequency by about 75% on average. Individual results vary.
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: Sleep helped mainly via fewer night sweats · Not a cognition treatmentAnxiety, irritability, low mood
Perimenopause is the highest-risk period for new-onset depression in a woman’s life outside of postpartum. We screen for mood changes and coordinate appropriate care; HRT is not a treatment for depression.
Evidence: Screen and coordinate care · Often underrecognizedVaginal dryness, painful sex, UTIs
Vaginal estrogen — separate from systemic HRT — is FDA-approved and effective for genitourinary symptoms of menopause, with low systemic absorption. It may be considered for some women who can’t take systemic estrogen, in coordination with their care team.
Evidence: Strong · First-line indicationWeight and metabolic changes
Menopause shifts fat distribution toward the abdomen. HRT is not a weight-loss or body-composition treatment; we address metabolic health through nutrition, activity, and other evaluated options.
Evidence: Not an indication for HRTLow libido & arousal
Multifactorial — estrogen affects tissue and lubrication, testosterone affects desire and arousal. Where appropriate, low-dose testosterone for women (off-label; not FDA-approved for women) is part of the conversation.
Evidence: Strong for tissue · Moderate for desire (testosterone, off-label)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 treats specific symptoms. The rest of the picture matters too.
Hormone therapy can relieve 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 changes. Estrogen therapy is FDA-approved to help prevent postmenopausal osteoporosis; it is not used to prevent heart disease.
- Bone density: weight-bearing activity supports what estrogen preserves
- Sleep architecture and how perimenopause changes it
- Cardiovascular and metabolic markers, monitored as part of care
- 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 provider 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 improve within several 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 providers. 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 may do
- Reduce hot flashes and night sweats — about 75% fewer on average in clinical trials; individual results vary
- Improve sleep disrupted by night sweats
- Treat vaginal dryness and painful sex due to menopause (especially vaginal estrogen)
- Help prevent postmenopausal osteoporosis (an FDA-approved use)
What it can’t do
- Replace physical activity, sleep, nutrition, or stress management
- Cause significant weight loss on its own
- Prevent heart disease or dementia — it is not approved for these uses
- 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?
Consultations start at $49 (see pricing). 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 for treating bothersome symptoms. We discuss your specific risk picture during consultation.
Do you do pellet therapy?
Yes, for selected patients. Pellets are one of several delivery methods — see hormone pellets. Compounded estradiol pellets are not FDA-approved, testosterone pellets for women are off-label, and pellet doses can’t be adjusted once placed, so for many patients we recommend FDA-approved transdermal, oral, or topical options first.
What about bioidentical hormones?
“Bioidentical” means the hormone molecule matches what the body produces. Most of what we prescribe are bioidentical, FDA-approved products — estradiol and micronized progesterone are both available as FDA-approved bioidentical products. 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 example for ongoing symptoms or bone protection, after an individual benefit-risk discussion. 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 (consultations starting at $49; 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 providers. We’ll review your situation, decide together whether HRT fits, and what comes next.