Medically reviewed by the Physician’s Plan clinical team. Educational only — whether HRT is right for you is a clinical decision made with your provider after labs and history.

The 30-second version

Medically supervised hormone replacement therapy follows a defined sequence: comprehensive baseline labs → clinical evaluation → a delivery method matched to your life → scheduled re-testing and dose adjustment. It is data-driven medicine, not a wellness subscription. Here’s what each step actually involves — and what the current evidence says about safety for both women and men.

Step 1: Baseline labs and an honest evaluation

A legitimate HRT workup starts with bloodwork — typically estrogen, progesterone, total and free testosterone, DHEA, cortisol, and thyroid function — alongside a thorough symptom and health history.

One nuance worth knowing, because it separates rigorous clinics from formulaic ones: for women of typical menopausal age, menopause is a clinical diagnosis, not a lab number. ACOG guidance does not recommend using FSH or estradiol levels to direct therapy, because hormones swing widely during perimenopause. Treatment decisions rest on age, 12 months without a period, and symptom severity — labs establish a safe baseline and rule out other causes rather than serving as a pass/fail score. (For men, it’s the opposite: numbers matter a great deal — more below.)

Step 2: Choosing a delivery method

There is no single best route — each has a real trade-off profile, and cost ranges below are typical 2026 U.S. figures:

Pellets (inserted under the skin every 3–6 months): the steadiest hormone levels with zero daily upkeep; $400–$800 per insertion (roughly $1,600–$3,200/year). Trade-off: doses can’t be adjusted quickly once inserted.
Injections (weekly or biweekly): reliable absorption, easy dose changes; roughly $800–$2,400/year. Trade-off: levels peak 1–3 days after injection and dip by day 6–7, which some people feel as a mood/energy “rollercoaster.”
Topical creams/gels (daily): needle-free and easy to micro-adjust; roughly $1,200–$2,400/year. Trade-off: absorption varies, and skin-to-skin transfer risk makes them a poor fit for parents of young children or shared beds.
Oral pills (daily): familiar and most often insurance-covered. Trade-off: oral estrogens pass through the liver, which raises clot risk versus transdermal routes — a reason they’re avoided for patients with cardiovascular or clotting histories.

Step 3: Monitoring — the part that makes it “supervised”

Levels are re-checked at 4–8 weeks, dosing is adjusted, and once stable you’re monitored every 3–6 months. For men on testosterone, hematocrit is checked at baseline and then at 3, 6, and 12 months, because testosterone stimulates red-blood-cell production and unmonitored elevation increases clot risk. If a clinic hands you hormones without a re-testing calendar, that’s not supervision.

What the evidence actually says for women

If you researched HRT years ago and came away scared, the science has moved. The 2002 Women’s Health Initiative findings that collapsed HRT prescribing were drawn from a cohort averaging age 63 — often more than a decade past menopause — and generalized to everyone. Age-stratified re-analyses and subsequent trials established the “timing hypothesis”: current Menopause Society guidance holds that for healthy women who start within 10 years of menopause onset (or before 60), benefits — the most effective relief available for hot flashes, plus bone-density preservation and favorable cardiovascular effects — outweigh the risks. Contraindications still matter (history of breast cancer or thromboembolic disease among them), and progesterone is mandatory alongside estrogen for anyone with a uterus. That’s exactly what evaluation is for.

What the evidence says for men

Testosterone therapy is appropriate for men with genuine hypogonadism: compatible symptoms plus consistently low levels (generally under ~264 ng/dL) confirmed on two separate early-morning fasting tests — one afternoon reading isn’t a diagnosis. On safety: the landmark TRAVERSE trial (5,200+ men) found testosterone therapy did not increase major adverse cardiac events, and the FDA subsequently removed its cardiovascular boxed warning. The same trial saw slightly higher rates of atrial fibrillation, pulmonary embolism, and acute kidney injury — which is precisely why the monitoring schedule above is non-negotiable, not optional fine print.

Questions that reveal whether a clinic does this right

Which labs do you draw before treatment, and when do you re-test?
Why this delivery method for me, and what would make you switch it?
For men: do you require two morning tests before diagnosing low T?
For women with a uterus: how do you handle progesterone?
What symptoms or lab changes would make you stop or adjust my therapy?

Get evaluated in the Carolinas

Physician’s Plan provides medically supervised HRT for women and men at clinics in Charleston (West Ashley), Mount Pleasant, Summerville, Florence, and Rock Hill, SC and Hickory and Huntersville, NC — labs, evaluation, and ongoing monitoring under one roof. Schedule a consultation or call (843) 769-5510 and get answers grounded in your own bloodwork.