Most women's HRT programs center on estrogen, progesterone, and sometimes testosterone. Estrogen is the primary driver of symptom relief — it addresses hot flashes, sleep disruption, vaginal dryness, and mood changes most directly. Progesterone is prescribed alongside estrogen in women who have a uterus to protect the uterine lining. Bioidentical progesterone (micronized progesterone) behaves differently than synthetic progestins and is often better tolerated. Testosterone is less commonly discussed but increasingly prescribed for libido, energy, and cognitive clarity in women, typically at much lower doses than in men's TRT programs.

How you take HRT affects absorption, symptom timing, and side effect profiles. Patches and gels deliver estrogen transdermally, bypassing first-pass liver metabolism, which many practitioners prefer for cardiovascular risk reasons. Pills are convenient but involve liver processing. Vaginal estrogen is highly effective for local symptoms like dryness and urinary urgency with minimal systemic absorption. Pellets, offered through networks like BioTE, deliver bioidentical hormones subcutaneously over three to six months without daily administration, though dose adjustability is limited once placed. Telehealth-first platforms generally favor patches, gels, or oral formulations because they are easiest to ship and dose-adjust remotely.

Bioidentical hormones have the same molecular structure as the hormones your body produces. Most major telehealth HRT platforms now use bioidentical estradiol and micronized progesterone as a baseline. Compounded bioidentical hormones go further, allowing custom doses and delivery forms, but they are not FDA-approved as finished products and quality can vary by pharmacy. Custom compounded HRT should come from licensed 503A or 503B compounding facilities. Regulatory bodies and many endocrinologists recommend FDA-approved bioidentical options first, reserving compounding for cases where standard formulations do not work.

The best telehealth HRT platforms share a few consistent traits: upfront pricing with clear disclosure of what labs, refills, and follow-ups cost; physician-reviewed intake rather than algorithm-only prescribing; flexibility to adjust dose and delivery method based on your response; and ongoing monitoring cadence. Platforms focused exclusively on women's hormones — such as Midi Health, Evernow, Gennev, Winona, Alloy, and Elektra Health — tend to have more nuanced clinical protocols than general telehealth platforms that offer HRT as a secondary service. If a provider is not asking about your personal and family history, cardiovascular risk, and preferred delivery method, that is a red flag.

Perimenopause, the transition phase that can last years before your final period, is increasingly recognized as an appropriate time to start HRT rather than waiting for full menopause. Estrogen levels fluctuate significantly in perimenopause, which drives many of the worst symptoms — irregular periods, sleep disruption, mood swings, and brain fog. Starting HRT earlier in the transition, rather than only after symptoms are severe, is consistent with current evidence and the clinical philosophy of providers like Midi Health and Elektra Health. Your provider should distinguish between perimenopausal and postmenopausal hormonal needs when building your protocol.