How do I pick a legitimate BHRT clinic and avoid the hormone mills?

Short answer: choose a clinic run by board‑certified physicians who practice evidence‑based hormone medicine, require baseline labs and routine safety monitoring, prefer FDA‑approved preparations when appropriate, and will document individualized goals and follow‑up. Avoid clinics that push treatment after an online quiz, rely on saliva tests alone, or sell “one‑size‑fits‑all” compounded creams without lab follow‑up.

Concrete checklist to vet a BHRT clinic

• Clinician credentials
  • Are the prescribers board‑certified in endocrinology, gynecology, family medicine or internal medicine? Bonus if they are a NAMS Certified Menopause Practitioner (NCMP) or REI/endocrinology fellowship trained.
  • Verify on the state medical board or American Board of Medical Specialties.
• Evaluation process
  • Do they take a full history and physical exam (or video visit) rather than only an online quiz?
  • Do they order baseline labs and imaging as indicated (notably labs appropriate to your sex/age and symptom set)?
• Testing standards
  • They should use reputable labs (Quest, LabCorp, hospital labs). Be cautious if the clinic relies primarily on saliva testing or an online questionnaire as the basis for long‑term prescriptions.
• Treatment approach
  • Prefer FDA‑approved hormone formulations when available (patches, pills, gels, injections) unless there is a clear reason to use a compound.
  • If compounding is necessary, the pharmacy should follow USP standards (sterile/nonsterile compounding per USP) and be willing to provide Certificates of Analysis (CoA) or evidence of accreditation.
• Safety monitoring and follow‑up
  • Ask how often they re‑check labs and adjust doses, and how they monitor risks (mammography, bone density, hematocrit/PSA for men on testosterone, liver function, lipid panel, etc.).
  • There should be a written plan for stopping or tapering treatment and for managing side effects.
• Cost transparency and prescribing practices
  • Clear pricing, explanation of what is compounded vs FDA‑approved, and no high‑pressure auto‑refill/subscription upsells.
• Red flags
  • No baseline labs or follow‑up, prescribing after a short online quiz only, strong anti‑medicine buzzwords (“detox,” “optimum level for everyone,” “age reversal”), aggressive promotion of unvalidated tests, secret proprietary “hormone optimization” ranges, refusal to discuss risks.

Typical tests you should expect (general, not medical advice — will vary by sex/age/symptoms)

• For women: estradiol, FSH, LH (if relevant), progesterone (when indicated), thyroid tests (TSH ± free T4), CBC, CMP (liver/kidney), lipid panel, and age‑appropriate mammography/bone density screening.
• For men: total testosterone (morning sample), free testosterone or calculated free when indicated, SHBG, CBC (hematocrit), PSA (when appropriate), CMP, lipid panel.
• Some clinicians may add cortisol, DHEA, or urinary steroid profiles (DUTCH) in specific situations; these have niche uses and should not replace serum testing unless the clinician explains why.

Organizations and reputable places to consider

• Professional societies for vetting providers: North American Menopause Society (NAMS) — “Find a Menopause Practitioner,” Endocrine Society, American College of Obstetricians and Gynecologists (ACOG).
• Large academic centers with menopause/endocrine expertise: Mayo Clinic, Cleveland Clinic, Johns Hopkins, UCSF — these centers have multidisciplinary menopause and endocrine clinics and follow evidence‑based protocols.
• Reputable labs: Quest Diagnostics, LabCorp, major hospital labs.
• Compounding pharmacy standard to ask for: compliance with USP 795/797/800 standards and willingness to provide a Certificate of Analysis for compounded products.

Names to look for (examples)

• Clinics: Mayo Clinic Menopause Clinic, Cleveland Clinic Women’s Health — good choices if you want conservative, evidence‑based care from academic centers.
• Directories: Search NAMS “Find a Practitioner” or check state medical board listings for board‑certified endocrinologists/gynecologists. (If you’d like telemedicine, I can help find telehealth clinicians affiliated with academic centers or vetted practitioners in your state—telehealth companies vary widely in quality.)

What to say when you contact a clinic (quick script)

• “Are your prescribers board‑certified? Do you require baseline labs before prescribing hormones, and which labs? How do you monitor safety and how often do you follow up? Do you use FDA‑approved hormones or compounded products, and which compounding pharmacies do you use? Can you provide your credentialing and references?”

If you want, tell me:

• whether this is for male or female hormones, your age range, and whether you prefer in‑person or telemedicine care, and I’ll recommend clinics or providers in your area or reputable programs you can contact.