Compounded HRT: Is It Legal, Safe, and What Does It Cost?

Where can you get compounded HRT online, and what does it cost?

Most big HRT telehealth brands built their programs around FDA-approved patches, pills and gels. Few publish a price for a compounded product. These three do.

Winona: a compounded cream from a mostly FDA-approved lineup

Winona sells an estrogen and progesterone cream for about $90 a month, with no visit fee. It is made at one of the two 503A pharmacies Winona owns, so it is compounded and not FDA-approved. Winona's vaginal estrogen cream is made the same way.

Winona's patch, estrogen tablets and progesterone capsules are FDA-approved products. That lets you compare both kinds at the same company. On Trustpilot, Winona scores 4.6 out of 5 from about 8,600 reviews.

• Pros: no visit fee; the lowest compounded price we found; FDA-approved options at the same brand
• Cons: only the creams are compounded; cash only, no insurance
• Best for: women who want a compounded cream at a low price

Henry Meds: one flat price, cream or patch

Henry Meds runs a women's hormone therapy program for about $150 a month. Visits, medicine and shipping are included. Options include compounded estrogen creams, FDA-approved estradiol patches or tablets, and progesterone.

Testosterone cream costs about $100 more if prescribed. Women aged 35 to 59 can apply. Henry is a platform, and independent clinicians do the prescribing. On Trustpilot, Henry scores 4.4 from about 12,500 reviews, mostly from its weight-loss patients.

• Pros: one price for care and medicine; you can switch to an FDA-approved patch at the same price
• Cons: costs more than Winona's cream; age limits
• Best for: women who want care and medicine in one bill

Inner Balance: one cream, priced in two phases

Inner Balance sells one product, Oestra. It is a compounded cream with estradiol and progesterone. You apply it to the vaginal tissue, and the hormones act on the whole body. Inner Balance says it replaces a patch, a pill and a separate vaginal cream.

It costs about $200 a month for the first six months, then about $100 a month. Visits are included, and labs are optional. The concerns are trust and fine print. Trustpilot shows 2.2 out of 5 from 38 reviews, and the money-back guarantee has two deadlines that are easy to miss.

• Pros: one cream instead of several products; the price halves after month six
• Cons: the first six months cost twice the later rate; few reviews, and weak ones; cash only
• Best for: women who want a single all-in-one cream and will read the refund terms first

Other services prescribe compounded hormones without a public price. Midi Health sells its own compounded estradiol cream, estradiol gel and progesterone, but uses FDA-approved hormones by default. Evernow says it prescribes compounded formulas when needed. Ask for the price and the pharmacy name before you start.

What this costs over a year

Winona's cream costs about $1,070 a year. Henry Meds costs about $1,790 a year, care included. Inner Balance costs about $1,790 in the first year, then about $1,190 a year after that.

Compounding doesn't reliably save money. At Alloy, an FDA-approved estradiol pill plus progesterone costs about $65 a month, after a one-time $49 visit. Our HRT cost guide compares every format.

What is compounded HRT, exactly?

Compounding is a way of making a drug. A pharmacist mixes a hormone product for one named patient, from one prescriber's order. A drug company, by contrast, makes millions of identical, tested doses.

"Bioidentical" is a different idea. It means the hormone has the same structure as the one your ovaries made: estradiol, progesterone or testosterone. Many FDA-approved products are bioidentical too, such as estradiol patches and tablets. A product can be compounded, bioidentical, both or neither.

Compounded status belongs to the product, not the company. Winona, for example, sells both compounded creams and FDA-approved patches. So ask whether a specific product is compounded, not whether the brand is.

• Creams and gels applied to the skin, often the first compounded prescription
• Vaginal creams and suppositories, for local symptoms
• Troches and lozenges that dissolve in the mouth
• Capsules, for a strength or mix that isn't sold commercially
• Pellets placed under the skin, covered on their own below

Is compounded HRT legal?

Yes. Compounding is ordinary pharmacy work. In 2012, a fungal meningitis outbreak traced to a Massachusetts compounder killed dozens of people. Congress then passed the Drug Quality and Security Act of 2013, which set up today's two tracks.

• 503A pharmacy: mixes drugs for one named patient with a prescription. The state board of pharmacy is the main regulator.
• 503B outsourcing facility: makes larger batches without patient-specific prescriptions. It registers with the FDA and follows drug-factory quality rules.
• The providers above: all use 503A pharmacies.

Legal is not the same as FDA-approved. The FDA never reviews a compounded cream or capsule before it reaches you. The FDA says plainly that products sold as bioidentical hormones are often compounded, and compounded drugs are not FDA-approved.

Is compounded HRT safe? What the FDA and ACOG say

The FDA says it has no evidence that compounded bioidentical hormones are safe and effective, or safer than approved hormone therapy. The safety data most people assume exists hasn't been produced for these products.

ACOG, the US college of obstetricians and gynecologists, went further in its 2023 clinical consensus. Compounded hormone therapy should not be prescribed routinely when an FDA-approved product exists. Evidence for claims of better safety or results is lacking.

ACOG doesn't say never. If a patient asks for a compounded product, her clinician should explain the lack of FDA approval and the risks of compounding.

One risk is the dose itself. Approved drugs are batch-tested, so each jar or capsule matches the label. A compounded product gets no such outside check, unless the pharmacy chooses to test it.

Are hormone pellets different?

Yes. A pellet goes under the skin, usually in the hip, and releases hormone for about three to four months. Once it's in, it can't be taken out. If the dose is too high or side effects appear, you wait it out.

A cream, patch or pill can be stopped tomorrow. ACOG's 2023 consensus advises against testosterone pellets, citing missing safety data and the fact that they can't be removed. Pellets can also push hormone levels above the body's normal range.

In April 2025, the FDA sent a warning letter to Empower, a large compounding facility. Inspectors found serious deficiencies in how it made sterile products. Among them, it hadn't completed cleaning checks on equipment used to make testosterone and estradiol pellets.

• Red flags at a pellet clinic: no labs before or after insertion, levels sold as "optimization," a supplement bundle in the same visit, no pharmacy named
• A careful program: orders labs, names its pharmacy, and says plainly that the dose can't be changed once placed

For pellet prices and how they compare with approved options, see our HRT pellets guide.

How to tell if a compounding pharmacy is legitimate

With no FDA review of the product, the pharmacy itself is what you check.

• PCAB accreditation: a voluntary audit of compounding pharmacies against USP standards. A pharmacy that has it chose a higher bar than the law requires.
• USP 795 and 797: the standards for non-sterile products like creams and capsules, and sterile ones like injections and pellets. Ask whether the pharmacy follows them.
• A named pharmacy: a real provider tells you which 503A pharmacy fills your order. Refusing to say is a red flag.
• State license: most state boards of pharmacy have a free online lookup.
• Labs: a program that prescribes hormones, especially pellets, without ever ordering bloodwork is focused on the sale.

Compounded or FDA-approved: which should you choose?

Compounding earns its place for one reason: flexibility. It helps if you're allergic to an ingredient in an approved product, or need a strength or mix that isn't sold. It doesn't reliably buy a lower price or a safer product.

Approved hormone therapy has also had a recent review. In February 2026, the FDA began removing the heart, breast cancer and dementia warnings from the boxed warning of approved HRT products. Compounded products were never part of that review.

For most women without a special need, an FDA-approved product is the safer first step. It is reviewed and batch-tested, with a label the FDA has read. Compounded HRT is a reasonable second step when approved options truly don't fit.