**Attached at the bottom is the most current re-review of the Women’s Health Initiative (1998) findings and updated guidelines (2024-2025) for women starting hormone therapy.

Hormone Optimization Program Fees & Financial Consent

New Patient Hormone Evaluation

I understand that a valid payment method (credit card) must be kept on file prior to my hormone optimization evaluation consultation. If a valid payment method is not on file before the scheduled appointment time, Wellbeings Medical reserves the right to cancel the appointment and offer a rescheduled date and time.

Initial New Patient Consultation Fee, $299

Should I choose to enroll in the hormone optimization program following the consultation, the $299 consultation fee will be credited toward my first month's program fee. If I decide not to enroll in the program after the consultation, the $299 consultation fee remains non-refundable.

Hormone Optimization Membership: $299/month

The initial evaluation phase typically lasts 1–3 months, depending on the complexity of my symptoms, laboratory findings, treatment plan, and response to therapy.

The $299 monthly fee includes:

• Initial comprehensive hormone evaluation

• Review and interpretation of laboratory testing

• Development and adjustment of my individualized treatment plan

• Follow-up laboratory review

• Follow-up video visits, generally at a monthly cadence during the evaluation phase

• Medication management and prescribing, when appropriate

I understand that I will remain in the evaluation phase until my provider determines that my hormone treatment plan is sufficiently established and I am ready to transition to maintenance management.

If prescription hormone therapy is not needed, there is no ongoing hormone membership fee once the initial evaluation and workup are complete.

Hormone Maintenance Membership

$49/month

Patients who require ongoing prescription hormone therapy will transition to the Hormone Maintenance Membership once the initial evaluation phase is complete.

The maintenance membership provides ongoing medical oversight necessary for continued hormone prescribing and includes:

• Medical provider oversight

• Medication management, refills, and ordering

• Review of follow-up laboratory testing

• Video visits as medically appropriate or needed

• Ongoing treatment adjustments when indicated

• Access to eligible low-cost GLP-1 medications and peptide therapies when medically appropriate

The maintenance membership fee does not include the cost of medications, laboratory testing, or specialty testing.

Current Weight Loss Program Members

If I am already enrolled in a Wellbeings Medical weight loss program, the following hormone program pricing applies:

Active Weight Loss Membership — $299/month
Hormone evaluation and management may be added for an additional $99/month.

Bridge Weight Loss Membership — $199/month
A new hormone evaluation may be added for an additional $99/month. Once the hormone evaluation is complete, ongoing hormone maintenance is $49/month.

Current GLP-1 Maintenance Members
If I am currently in GLP-1 maintenance and begin a new hormone optimization evaluation, the standard $299/month Hormone Evaluation fee will be added to my existing GLP-1 maintenance membership during the evaluation phase.

Once both my GLP-1 and hormone programs have reached maintenance status, they will be combined into one:

GLP-1 + Hormone Optimization Maintenance Membership: $129/month

This lower monthly maintenance fee is designed to make continued provider oversight and expertise more affordable by distributing the cost of ongoing care throughout the year rather than requiring larger annual or quarterly payments.

Medication Costs

I understand that medications are not included in my monthly membership fee.

• Prescription medication costs vary depending on the medication, dose, formulation, and route of administration.

• Medications obtained through partner pharmacies are provided at wholesale pricing without an additional medication markup from the practice.

• FDA-approved medications, such as estradiol patches, oral progesterone, or testosterone gel for men, may be eligible for insurance coverage when filled through a retail pharmacy.

• Compounded medications, including certain specialty creams, injections, or oral formulations, are generally paid out of pocket.

Laboratory & Specialty Testing Costs

I understand that laboratory and specialty testing costs are separate from my monthly membership fee.

Routine laboratory testing may be completed using insurance or through available self-pay options. Insurance coverage is not guaranteed, and I am responsible for any deductible, copay, coinsurance, or non-covered charges assessed by the laboratory or my insurance company.

Specialty testing, including testing such as the DUTCH hormone test or 4-point salivary cortisol testing, is generally an out-of-pocket expense.

Typical Laboratory Monitoring Schedule

Laboratory monitoring is individualized based on my treatment plan and clinical needs. In general:

• New patients: Initial repeat laboratory testing is typically performed approximately 8–12 weeks after starting or changing treatment, with additional testing approximately every 3 months until a stable treatment plan is established.

• Established maintenance patients: Laboratory testing is typically performed approximately every 6 months, although more frequent monitoring may be required based on medications, symptoms, laboratory abnormalities, or treatment changes.

Estimated Self-Pay Laboratory Fees

Initial Comprehensive Labs

• Male: approximately $200

• Female: approximately $170

Repeat Labs

• Male: approximately $110

• Female: approximately $85

These prices are estimates and may vary depending on the specific laboratory tests ordered.

I may alternatively choose to use insurance for laboratory testing through Quest Diagnostics. I understand that insurance coverage is not guaranteed and that I may be responsible for a copay, deductible, or the full cost of testing depending on my insurance benefits. Patient responsibility may be up to approximately $250 or more, depending on the tests ordered and my individual insurance plan.

When choosing the self-pay option, I will be informed of the applicable self-pay cost in advance. My provider may also customize my laboratory panel based on my individual medical history, treatment plan, and clinical needs.

Financial Acknowledgment

By consenting below, I acknowledge that I have reviewed and understand the program fees described above. I understand that membership fees cover professional medical management and do not include medications, routine laboratory testing, specialty testing, or other third-party charges unless specifically stated otherwise.

I understand that my monthly membership level may change as I transition from the initial evaluation phase to maintenance care or if I participate in both the Weight Loss and Hormone Optimization programs.

Program Details

• The initial Hormone Optimization consultation will include a comprehensive review of your current symptoms, health goals, menstrual and reproductive history when applicable, medical and family history, current medications and supplements, previous hormone therapy, nutrition, exercise, sleep, stress, and other lifestyle factors that may influence hormone health.

• Laboratory testing will typically be ordered as part of your initial evaluation. Testing is individualized and may include assessment of sex hormones, thyroid function, adrenal-related markers, glucose and insulin metabolism, cardiovascular and metabolic risk markers, nutritional status, and other relevant health markers. Testing may include blood, urine, and/or saliva depending on your clinical needs.

• Once your initial laboratory results are available, your provider will review the results in the context of your symptoms and medical history and develop an individualized treatment plan. Hormone levels are not interpreted in isolation; your provider will consider your overall hormonal and metabolic picture when determining whether treatment is appropriate.

• Hormone Optimization does not automatically mean starting hormone replacement therapy. Depending on your symptoms, laboratory findings, health history, age, menstrual status, and goals, recommendations may include lifestyle and nutritional interventions, supplements, treatment of metabolic or nutritional abnormalities, prescription hormone therapy, adjustment of existing hormone therapy, additional testing, or referral to another healthcare professional when appropriate.

• During the initial evaluation and treatment-adjustment phase, follow-up visits may occur more frequently while symptoms, laboratory values, medication tolerance, and response to treatment are assessed. Once a stable treatment plan has been established, follow-up visits are generally scheduled approximately every 3–6 months, or more frequently when medically indicated.

• When hormone therapy is initiated or significantly adjusted, follow-up blood testing is commonly performed approximately 8–12 weeks later. Medication doses, formulations, or routes of administration may be adjusted during the first several months based on clinical response, side effects, laboratory findings, and treatment goals.

• Your provider may recommend advanced hormone testing such as the DUTCH (Dried Urine Test for Comprehensive Hormones) when additional information regarding hormone production, metabolism, or cortisol patterns may be clinically useful. I understand that specialty testing is generally not covered by insurance and is offered separately at approximately $300–$400, depending on the test selected.

• Prescription medications may be obtained through a traditional retail pharmacy or a compounding pharmacy depending on the medication, formulation, and individual treatment plan. Medications obtained through participating compounding pharmacies are provided at cost without an additional medication markup by the practice. FDA-approved prescription medications may be eligible for insurance coverage; however, coverage is determined by my insurance plan. Compounded medications are generally not covered by insurance and require out-of-pocket payment.

• Participation in the Hormone Optimization Program is voluntary. I may discontinue the program at any time by providing written notice to my medical provider or their designated staff. Discontinuing the program will end ongoing hormone prescribing, monitoring, and management through the program, subject to any medically appropriate transition-of-care instructions provided by my clinician.

Purpose of Hormone Optimization & Treatment

The purpose of the Hormone Optimization Program is to evaluate symptoms and health concerns that may be associated with hormonal changes or dysfunction and to develop an individualized treatment plan based on symptoms, medical history, laboratory findings, risk factors, and personal treatment goals.

Hormonal symptoms can occur across different stages of life and are not limited to menopause. Evaluation may include concerns associated with menstrual-cycle hormone fluctuations, luteal-phase symptoms, premenstrual symptoms, perimenopause, menopause, estrogen deficiency, androgen deficiency, thyroid dysfunction, adrenal/stress physiology, and metabolic health, when clinically appropriate.

For women experiencing perimenopause or menopause, symptoms potentially addressed through evaluation and treatment may include hot flashes, night sweats, sleep disruption, mood changes, cognitive concerns, menstrual changes, vaginal or vulvar dryness and irritation, discomfort with intercourse, urinary symptoms, changes in sexual function or desire, and loss of bone density.

Hormone therapy may also be considered for appropriate patients experiencing significant symptoms associated with hormonal fluctuations even when they continue to have regular menstrual cycles. Treatment decisions are based on the patient's overall clinical presentation rather than a single hormone laboratory value.

When clinically appropriate, treatment may include estrogen, progesterone, testosterone, thyroid medication, or other prescription therapies, as well as non-hormonal interventions. Not every patient will require or be an appropriate candidate for hormone therapy.

For women with bothersome vasomotor symptoms associated with menopause, menopausal hormone therapy is considered the most effective available treatment. Systemic estrogen therapy may also help prevent bone loss while treatment is being used in appropriately selected patients. Genitourinary symptoms of menopause may be treated with local vaginal hormone therapy or other appropriate therapies.

Testosterone therapy in women may be considered in select patients, particularly for hypoactive sexual desire disorder (HSDD) following appropriate clinical evaluation and after other contributing causes have been considered. I understand that testosterone therapy for women is generally prescribed off-label in the United States and requires appropriate monitoring.

Hormone therapy is not prescribed solely for the primary prevention of cardiovascular disease, dementia, or other chronic diseases. The potential benefits, risks, alternatives, contraindications, and uncertainties of hormone therapy will be considered individually based on factors including age, reproductive or menopausal status, symptoms, medical and family history, cardiovascular and thrombotic risk, cancer history and risk, and personal treatment goals.

I understand that the goal of Hormone Optimization is not to achieve a predetermined or universally "optimal" laboratory number. Treatment is individualized and is intended to use the lowest appropriate effective dose and treatment strategy necessary to address clinical goals while maintaining appropriate safety monitoring.

Hormone Replacement Therapy Prescription Options Reviewed

This practices utilizes bioidentical hormones, meaning they are the same chemical structure as the hormones your body naturally produces providing maximal support with minimal side effects.

Estrogen Therapy

Estrogen options include:

• Transdermal estrogen (patches, creams) - first line  

• Oral estrogen - last line

• Local vaginal estrogen cream only does not absorb systemically and does not need opposing progesterone to protect endometrium. 

Progesterone Therapy

In individuals with an intact uterus, progesterone is required when systemic estrogen is used to reduce the risk of endometrial hyperplasia and endometrial cancer. For women without a uterus, progesterone is still recommended.

Options include:

• Oral micronized progesterone - first line 

• Progesterone cream

• Progesterone vaginal suppository.

• Synthetic progestins - will not be used in this practice 

Testosterone Therapy

Testosterone therapy for women is only FDA-approved for the treatment of hypoactive sexual desire disorder in postmenopausal women after appropriate evaluation. Testosterone is not FDA-approved for general use for energy, mood, weight loss, or overall vitality. When considering testosterone replacement therapy in women, a thorough evaluation will be completed including lab testing.

When used, therapy should aim to maintain testosterone levels within the normal physiologic female range.

Medication Options and Estimated Cost

As you could guess, optimizing women’s hormones proves a bit more challenging than optimizing mens (go figure…)

Together we will decide which option or combination of options is best for you based on symptoms, lifestyle/convenience factor, lab results, genetics etc. As a rough estimate, see below for different options and estimated pricing.

• Estrogen Replacement: patch, cream, vaginal cream, newer injectable option and less likely to be prescribed oral.

• Progesterone: oral, cream, and less likely vaginal suppository.

• Testosterone: cream, oral troche, newer liposomal oral option, injectable

• Creams can be custom compounded to include all 3.

• Estrogen patch and oral progesterone can be typically be covered by insurance at your retail pharmacy.

• All creams and custom oral formulations, and testosterone creams are out of pocket expenses, usually < $100/month.

Chosen and Preferred Treatment Regimen

After discussion of available options, benefits, risks, and alternatives, the preferred regimen consists of:

• Transdermal estradiol patch, applied twice weekly

• Oral micronized progesterone, taken nightly, for endometrial protection, sleep, and anxiety improvement

• Topical (transdermal) testosterone or testosterone troche for women with small children who want to avoid transfer risk
  

Rationale for This Regimen

Transdermal Estradiol
Transdermal estradiol avoids first-pass metabolism in the liver and has been associated in multiple studies with a lower risk of venous blood clots and less impact on clotting factors compared with oral estrogen. This route is generally considered safer for individuals with cardiovascular or thrombotic risk factors, though no therapy is risk-free. The dose given through patch is low and will not induce menstrual cycling or interfere with current cycling. It provides a baseline estrogen level to prevent the low dips of estrogen levels which help control the hot flashes and mood swings. 

Oral Micronized Progesterone
Oral micronized progesterone (generic Prometrium) is an effective option for endometrial protection when used with systemic estrogen. Some observational data suggest potential differences in breast cancer risk between micronized progesterone and certain synthetic progestins, though evidence is not uniform and ongoing research continues. **Levonorgestrel-releasing intrauterine device (IUD) releases enough progestin into the body to protect the uterus, however, if you would like symptomatic relief then an oral progesterone can also be added. 

Topical Testosterone
Topical testosterone allows for lower, more physiologic dosing and is preferred over oral or injectable forms to minimize adverse metabolic effects. Use is limited to appropriate indications and requires ongoing monitoring.

Expected Benefits

Potential benefits of hormone therapy include

• Improvement in stress tolerance, anxiety, and depression

• Improvement in metabolic and hormonal functioning across all systems - cortisol, sex, and thyroid, and insulin regulation.

• Improvement in weight balance and body composition

• Improvement in sleep

• Improvement in sexual desire and response

• Reduction in hot flashes and night sweats

• Improvement in genitourinary symptoms when systemic therapy is indicated

• Prevention of bone loss and reduction in fracture risk while therapy is continued
  

Risks and Side Effects

Estrogen-Related Risks

Risks of systemic estrogen therapy may include:

• Venous thromboembolism (blood clots) - risk is very low with estrogen patch 

• Stroke  - risk is very low with estrogen patch 

• Gallbladder disease

• Breast cancer risk, particularly when estrogen is combined with synthetic progestogens and used long-term (Only bioidentical progesterone is used in this practice) 

• Endometrial cancer when estrogen is used without adequate progesterone in individuals with a uterus (Progesterone is always prescribed with Estogen, especially in those with a uterus, except for vaginal only estrogen)

• Very important to test your hormone metabolism with DUTCH panel if you plan to take hormones long-term. This will look at how your body metabolizes estrogen, ensuring it is metabolizing down the protective pathway (2OH) instead of a potentially carcinogenic (4OH) or proliferative pathway (16OH) leading to fibroids etc.
  

Common side effects may include breast tenderness, nausea, headaches, skin irritation at patch sites, irregular bleeding, or emotional swings. If side effects occur dosing or formulation can be adjusted, as well as reviewing hormone metabolism, methylation, and detoxification pathways.

Progesterone-Related Risks

Potential side effects include:

• Sedation or drowsiness (more common with oral micronized progesterone) - dose can be adjusted if this occurs. 

• Mood changes - if you are under high stress, supplementing with progesterone can sometimes make anxiety or stress worse. It is best to work with your medical provider to help reduce stress before or during your HRT. 

• There is a small risk of paradoxical reaction to progesterone supplementation which may worsen anxiety, stimulation, sleep. If this occurs, notify your provider right away.

• Bloating

  • It can occur in 10-15% of people but can be dependent on dosing, timing, and frequency of dose. A continuous low dose is started (100mg nightly). The bloating can be due to slower motility transit, so if you are not already taking magnesium I would add magnesium glycinate (200-300mg) to your nightly routine. In rare cases, it can cause fluid shifts, but the body typically adjusts. 

• Breast tenderness

• Irregular or breakthrough bleeding

Inadequate progesterone exposure increases the risk of endometrial hyperplasia and cancer. (This likely will not happen with oral progesterone, however, it is recommended to complete a DUTCH hormone metabolite panel 3-6 months after starting treatment to look at absorption). 

Testosterone-Related Risks

Potential risks and side effects of testosterone therapy include:

• Acne and oily skin

• Unwanted facial or body hair growth

• Scalp hair thinning

• Voice deepening (may be irreversible)

• Clitoral enlargement (rare with physiologic dosing)

• Mood changes

It is recommended to complete a DUTCH hormone metabolite panel to evaluate your testosterone metabolism pathways. If you favor the DHT pathway genetically, this can cause the above symptoms. We can test this prior to starting testosterone therapy as well as 6 months after. There are DHT pathway blocking medications such as spironolactone (under 50 years) or dutasteride (over 50 years). 

Long-term safety data for testosterone use in women are more limited than for estrogen therapy. Therapy requires careful dosing and monitoring.

Updated Evidence and Regulatory Considerations

Recent regulatory updates have clarified that menopausal hormone therapy should be evaluated based on formulation, dose, route of administration, and patient-specific risk factors rather than generalized class warnings. However, systemic estrogen therapy retains warnings related to endometrial cancer risk when used without progesterone in patients with a uterus.

These updates do not eliminate risk and do not apply uniformly to all individuals.

Individuals Who Should Use Caution

Menopausal hormone therapy should be used cautiously and individualized in patients with:

• Prior blood clots or known clotting disorders

• Migraine with aura

• High cardiovascular risk

• Uncontrolled hypertension or diabetes with vascular disease

• High breast cancer risk

• Liver disease

• Unexplained vaginal bleeding
  

Testosterone therapy requires additional caution in individuals with cardiovascular risk factors, lipid abnormalities, or a history of hormone-sensitive conditions.

Contraindications

Systemic estrogen therapy is generally contraindicated in individuals with:

• Known or suspected breast cancer

• Estrogen-dependent malignancy

• Undiagnosed abnormal genital bleeding

• Active or prior venous blood clot or arterial thrombotic disease

• Severe liver disease

• Pregnancy

Testosterone therapy is contraindicated in:

• Pregnancy or breastfeeding

• Known androgen-sensitive malignancies without specialist involvement

• Use of supraphysiologic dosing

• Hypersensitivity to formulation components

Monitoring and Follow-Up

Ongoing monitoring is required and may include:

• Regular assessment of symptom response (every 6 months at a minimum) and side effects

• Blood pressure and cardiovascular risk evaluation, this is self-reported during evaluation

• Breast cancer screening per guidelines, patients must continue their annual mammograms with primary care or OBGYN provider

• Prompt evaluation of any abnormal vaginal bleeding

• For testosterone therapy, periodic monitoring of testosterone levels and assessment for androgenic side effects
  

Therapy may be adjusted or discontinued based on benefit, risk, and patient preference.

Acknowledgment

I acknowledge that I have been informed of the benefits, risks, alternatives, and uncertainties associated with menopausal hormone therapy and testosterone therapy. I understand that no therapy is without risk and that treatment decisions are individualized. I consent to treatment as outlined above and agree to appropriate monitoring and follow-up.

Summary of Recent Reviews of the Women’s Health Initiative (WHI) Data (2024–2025)

Recent reviews and reinterpretations of the Women’s Health Initiative (WHI) data—now approximately 30 years from study initiation—have led to a significant shift in how menopausal hormone therapy (HT) is understood and applied in clinical care.

Original Purpose and Core Findings

The WHI was designed to evaluate whether hormone therapy could prevent chronic diseases such as heart disease, stroke, dementia, and cancer in postmenopausal women. The original conclusions remain valid: hormone therapy is not recommended for the primary prevention of chronic disease, particularly in older postmenopausal women.

However, newer analyses emphasize that this was never the appropriate population or goal for evaluating hormone therapy’s role in treating menopausal symptoms.

Importance of Age and Timing

A key insight from recent WHI reviews is the importance of age at initiation and time since menopause:

• The average age of women enrolled in the WHI was in the mid-60s, well beyond the typical age at which hormone therapy is initiated for menopausal symptoms.

• When WHI data are reanalyzed by age and timing, women under age 60 or within 10 years of menopause onset show lower risks and more favorable benefit–risk profiles compared with older participants.

• These findings support the concept that hormone therapy is safer and more effective when started earlier in menopause, particularly for symptom relief.
  

Hormone Therapy for Menopausal Symptoms

The WHI data continue to confirm that hormone therapy is the most effective treatment for vasomotor symptoms, such as hot flashes and night sweats.

• For many symptomatic women under age 60 in early menopause, the benefits of hormone therapy outweigh the risks when appropriately selected and monitored.

• Estrogen-alone therapy (used in women without a uterus) showed particularly favorable outcomes in symptom relief.
  

Cardiovascular Risk Reassessment

Earlier concerns about cardiovascular risk have been refined:

• Newer analyses suggest that women in their 50s who initiate hormone therapy do not experience increased risk of heart disease, stroke, or heart attack.

• Some analyses suggest a potential cardiovascular benefit when therapy is started early, though hormone therapy is still not prescribed for cardiovascular prevention.
  

Breast Cancer Findings

Breast cancer outcomes vary by regimen:

• The combined estrogen–progestin arm of the WHI showed a small increase in breast cancer risk, but the absolute risk increase was low, and breast cancer mortality was not increased.

• In contrast, the estrogen-only arm showed a reduced risk of breast cancer.

• These findings underscore the importance of hormone formulation, duration of use, and individual risk factors.
  

Duration and Discontinuation

Long-term follow-up data suggest that:

• The benefits of hormone therapy diminish after discontinuation.

• This supports the current approach of using the lowest effective dose for the shortest duration needed to manage symptoms, particularly when initiated earlier in menopause.
  

Calcium and Vitamin D

WHI findings also clarified that:

• Calcium and vitamin D supplementation are not effective as universal fracture-prevention strategies in all postmenopausal women.

• Supplements are best used to address dietary deficiencies, rather than as blanket recommendations.
  

Overall Updated Interpretation

The WHI provided essential foundational data, but modern reinterpretation emphasizes that its findings were misapplied too broadly in the past. Current understanding recognizes that:

• Hormone therapy is not a preventive treatment for chronic disease.

• For many women in early menopause, particularly those under age 60 with bothersome symptoms, hormone therapy offers meaningful benefit with acceptable risk.

• Treatment decisions should be individualized, taking into account age, time since menopause, symptom severity, health history, and patient preferences.

• Shared decision-making between patient and clinician is essential.
  

Bottom Line

Recent WHI reviews represent a major shift away from earlier blanket warnings and toward personalized, evidence-based care, acknowledging that for appropriately selected women in early menopause, hormone therapy remains a safe and effective option for symptom relief.