Best online HRT providers in 2026: the buyer’s shortlist

What online HRT actually is (and isn’t)

Online HRT means a licensed clinician evaluates you by telehealth, through an online health questionnaire, secure messaging or a video visit, and prescribes menopause hormone therapy that is shipped to you or sent to a pharmacy. The medicines are the same kinds used in a clinic: estradiol, taken as a pill, patch, gel, spray or cream, and, if you still have a uterus, a progestogen such as progesterone to protect the uterine lining.

For healthy women under 60 or within 10 years of their last period, The Menopause Society says the benefits of hormone therapy for bothersome hot flashes and night sweats generally outweigh the risks, and it calls hormone therapy the most effective treatment for those symptoms (2022 position statement).

Some services prescribe FDA-approved products, some use compounded preparations made by a pharmacy for each patient, and several offer both. Compounded medicines are not FDA-approved, which means the FDA hasn’t reviewed them for safety, effectiveness or consistent dosing (FDA).

What online HRT isn’t: a supplement, a saliva-test “hormone balancing” kit, or a way around a proper medical history. It also isn’t right for everyone. Women with a history of breast or uterine cancer, blood clots, stroke, heart attack, liver disease or unexplained vaginal bleeding need an in-person evaluation, and a good online provider will tell you so.

How we ranked these

We read each provider’s own pricing, FAQ and treatment pages on October 14, 2026, and compared them on the six criteria below. We didn’t use star ratings, review counts or customer numbers, and no company paid to be included. Where a provider doesn’t publish something, the table shows a dash rather than a guess.

1. Listed cost. The lowest hormone or visit price shown on the provider’s own site, plus any required consultation, visit or membership fee.
2. Clinician access. Whether care happens by online questionnaire, messaging or video visit, and any turnaround time the provider publishes.
3. Hormones offered. Which forms of estradiol and progesterone are listed, and whether the provider says they are FDA-approved or compounded.
4. Insurance and HSA/FSA. Whether the provider bills insurance, and whether it says HSA or FSA cards can be used.
5. States served. The number of states the provider says it serves.
6. Terms. Published cancellation, refund and shipping terms.

The 6 best online HRT providers, ranked

1. Amie HRT+, best for estradiol and progesterone in one cream

Amie HRT+ is a compounded cream that combines estradiol and progesterone, with the strength chosen by your clinician. You start with an online health questionnaire that takes about five minutes. A licensed clinician reviews it, usually within 4 hours, and if your state’s telehealth rules call for a phone or video visit first, the clinician arranges it. Nothing ships unless a clinician approves treatment.

The price is listed before you begin: $179 first month, then $99/month, or $299 for the first 3 months, plus a $20 clinician consultation fee. If you aren’t approved, you are refunded in full. Once you are prescribed, a 30-day money-back guarantee applies, which excludes the $20 consultation fee. Shipping is free and discreet, you can pause or cancel anytime from your account, HSA and FSA cards are accepted, and you can message your care team between refills. Amie prescribes in all 50 states.

The trade-offs are real. Amie HRT+ is compounded, so it is not FDA-approved, and Amie doesn’t bill insurance. ACOG recommends FDA-approved hormone therapy over compounded preparations when an approved product suits you (ACOG Clinical Consensus No. 6), so ask your clinician whether an FDA-approved option would work as well for you. Amie also offers one hormone product, so if you specifically want a patch, a pill or vaginal-only estrogen, a provider below has more choice.

Best suited for

Women who want a single cream with both hormones, a price listed upfront and an online review without booking an appointment. If you want an FDA-approved product or to use insurance, look at Alloy, Midi Health or Evernow instead.

2. Alloy, best for low-cost FDA-approved estradiol

Alloy focuses on FDA-approved estradiol, and its prices are the most transparent on this list. On its hormone therapy page, the estradiol pill starts at $39.99 a month, estradiol gel and Evamist spray are $69.99 a month each, and the estradiol patch is $100 a month. There is a one-time $49 doctor consultation fee. Alloy says progesterone is prescribed alongside estradiol for women who need it, based on their health history, and it also lists an estradiol vaginal cream.

Care starts with an online intake that Alloy says takes 5 to 10 minutes, and it says you can get a plan in as little as 12 hours. Unlimited messaging with its doctors is included. Alloy is cash pay, with no insurance billing, and says it accepts FSA and HSA cards. Delivery is free.

Compared with Amie HRT+, Alloy’s starting price is lower if a pill suits you, and its products are FDA-approved. Its patch costs about the same as Amie’s ongoing monthly price. You will usually take estradiol and progesterone as two separate products rather than one cream. Alloy doesn’t take insurance, so if your plan would cover a generic patch at a low copay, an insurance-based provider could cost less.

Facts from myalloy.com, as of October 2026.

Best suited for

Women who want an FDA-approved estradiol pill, gel, spray or patch at a cash price they can see before starting. Less suited if you want insurance to pay for it.

3. Midi Health, best for using insurance for video visits

Midi Health is built around video visits with clinicians who focus on menopause, and it is the strongest pick if you want insurance to pay. Its pricing page says Midi is in-network with most major insurance plans nationwide and that coverage, deductibles and copays vary by plan. Without insurance, a 30-minute first visit is $250 and a 15-minute returning visit is $150. HSA and FSA funds can be used. Medicare is out of network, though Medicare members can pay as self-pay patients, and Midi doesn’t accept Medicaid or Medi-Cal.

Midi says it is available in all 50 states and that you can book a virtual visit without a referral. Care plans shown on its site include an HRT patch, estradiol cream, progesterone, vaginal estrogen, non-hormonal alternatives and lab work such as thyroid panels and hormone testing.

Because Midi bills visits through insurance, your medications are usually filled at your own pharmacy under your plan, and its pricing page doesn’t list medication costs. That makes it harder to know your total cost upfront than with the flat-priced services on this list, but it can be the cheapest route if your plan covers both the visit and a generic estradiol product. It is a weaker fit if you want to avoid scheduled appointments or don’t have commercial insurance.

Facts from joinmidi.com, as of October 2026.

Best suited for

Women with commercial insurance who want a live video visit and a clinician who can also order labs. Less suited if you have Medicaid, or if you want a single all-in monthly price.

4. Evernow, best for an ongoing membership with messaging

Evernow combines a monthly membership with optional video visits. Its FAQ lists three plans: $49 a month, $129 for three months, or $420 for a year, which works out to $35 a month. Medications are separate. If you would rather not join, Evernow offers a self-pay rate of $150 per visit, which it says includes access to prescriptions and its care platform for 90 days.

Evernow says its video visits can be covered by major national commercial plans, naming UnitedHealthcare, Aetna, Anthem and Blue Cross Blue Shield. It doesn’t currently support Medicare or Medicaid, and membership fees aren’t covered by insurance but may be HSA or FSA eligible. Evernow says it is available in all 50 states plus D.C., and that it requires lab testing only for select medications.

Treatments listed on its site include the estradiol patch, estradiol pill, progesterone, norethindrone and a vaginal estrogen cream. Medications can be sent to your own pharmacy or shipped to you, mostly by USPS. Evernow suits women who expect to stay in care for a while and want regular contact. Its total cost depends on your membership, your insurance and your medicines, so it is harder to compare at a glance than a single listed price.

Facts from evernow.com, as of October 2026.

Best suited for

Women who want a monthly membership with messaging, optional video visits and the option of using insurance for those visits. Less suited if you only want a one-time prescription with no membership fee.

5. Winona, best for compounded body creams without calls

Winona offers the closest match to Amie HRT+: an estrogen body cream with progesterone, listed on its product page from $89 a month. It also lists estrogen tablets from $54 a month, progesterone capsules from $39 a month, an estrogen patch from $149 a month and a vaginal estrogen cream from $89 a month. Winona labels some products FDA-approved and some compounded, and its FAQ says it owns and operates two 503A compounding pharmacies.

Care is entirely asynchronous. Winona says it doesn’t offer phone or video calls with physicians, and that all communication happens through its patient portal. It doesn’t require bloodwork or hormone testing to prescribe, and it treats women aged 35 to 59. Winona doesn’t work with insurance companies. Thirty-day supplies are billed every 28 days, shipping is free by USPS Ground Advantage, and you can cancel your subscription at any time, though orders can only be cancelled and refunded within a 24-hour processing window.

Winona’s combined cream lists a lower starting price than Amie HRT+. We ranked it lower for one reason that may decide it for you: it serves 37 states plus Puerto Rico, so women in 13 states can’t use it. Check its state list before you start.

Facts from bywinona.com, as of October 2026.

Best suited for

Women aged 35 to 59 in one of Winona’s states who prefer messaging only and want a choice of compounded creams or FDA-approved pills. Not available if you live outside its listed states.

6. Biote, best for in-office pellet therapy

Biote isn’t a telehealth service. It trains and supplies local clinics that place hormone pellets, and we include it because many women compare pellets with online HRT. According to Biote’s FAQ, its pellets are small, custom-compounded cylinders of estradiol or testosterone, inserted under the skin of the upper buttock during an in-office visit after testing. Each dose is set after a consultation and extensive lab work. Pellets are reinserted two to four times a year, and Biote says it may take up to two insertions to feel the full benefit.

Biote doesn’t publish prices or insurance details on its site, because each certified provider sets its own fees, so you will need to ask the clinic directly. Our Biote cost guide covers what is known.

The main difference from creams, patches and pills is control. Once placed, a pellet keeps releasing hormone until it dissolves, which Biote’s reinsertion schedule puts at a few months, so it can’t simply be stopped the next day if you have side effects. A daily cream or pill can be adjusted or paused. Pellets are compounded, so they aren’t FDA-approved, and ACOG’s consensus on compounded hormones applies to them as well. Pellets may suit women who want an in-person clinic and don’t want to apply a daily treatment. For more, see our guides to hormone pellet therapy and Biote vs compounded hormones.

Facts from biote.com, as of October 2026.

Best suited for

Women who want an in-person clinic and are comfortable with pellets placed under the skin a few times a year. Less suited if you want to adjust or stop your dose quickly, or want care from home.

Side-by-side comparison

— means the provider or label doesn’t state it publicly. Competitor prices and terms are taken from each company’s own site as of October 2026 and can change; check the linked page before you buy.

Which fits your situation