Stanford Health

Short answer: pick a clinic that is physician‑led (ideally a board‑certified specialist), follows evidence‑based guidelines (NAMS / Endocrine Society), does proper baseline labs and ongoing monitoring, prefers FDA‑approved products when possible, and uses accredited compounding pharmacies only when necessary. Avoid clinics that push “one‑size‑fits‑all” protocols, saliva testing as the main diagnostic tool, or membership/marketing tactics that upsell high‑dose hormones as a panacea. What to look for (quick checklist) Physician oversight: an MD or DO directly managing care. Board certification in Endocrinology, OB/GYN, Family Medicine or Internal Medicine is a plus. NAMS involvement: clinicians who are NAMS Certified Menopause Practitioners (NCMP) or follow North American Menopause Society guidance. Evidence‑based testing: baseline serum labs (estradiol, FSH as indicated, TSH, lipids, CMP, CBC, pregnancy test if relevant). Avoid clinics that rely primarily on saliva hormone panels. Clear informed consent: discussion of risks/benefits, alternatives (including non‑hormonal options), and written treatment plan. Monitoring plan: scheduled follow‑up and lab monitoring (dose adjustments, safety labs). Product preference: use FDA‑approved hormone products when possible; if compounded bioidentical hormones are needed, they should be made by a state‑licensed/PCAB (or USP) accredited compounding pharmacy and only after a documented medical reason. No pressure sales: beware of membership fees, aggressive marketing, social‑media testimonials promising “anti‑aging” cures or guaranteed results. Red flags (“hormone mill” signs) Quick online quiz → instant prescription without medical record review or labs Reliance on saliva testing as the primary diagnostic tool One dosing protocol for everyone (e.g., “take X mg for all women over 40”) Claims that “bioidentical = safer” as an unqualified blanket statement Regular use of custom compounds when FDA options would work, without explaining why No board‑certified physician, or physician only available by chat Questions to ask any clinic before you commit Are you a physician‑led practice? Who will prescribe and follow me? What board certifications do your prescribing clinicians hold? Do you follow NAMS or Endocrine Society guidelines for hormone therapy? What tests do you run before starting hormones and how often will you monitor me? Do you use saliva testing? If so, why do you prefer it over serum testing? Do you use FDA‑approved hormones or compounded products? If compounded, which pharmacy and what accreditations does it have (PCAB/USP)? What are the risks and alternatives for the regimen you’re proposing? Specific organizations, clinics and services to consider (and why) North American Menopause Society (NAMS) — resource and directory: NAMS sets practice guidelines and certifies menopause practitioners; clinicians affiliated with NAMS are more likely to follow evidence‑based care. Endocrine Society — guideline resource: supports standardized, evidence‑based hormone practice (helpful to ask if your clinician follows these guidelines). Major academic centers’ menopause programs (examples): Mayo Clinic Menopause Clinic, Cleveland Clinic Center for Specialized Women’s Health, Johns Hopkins Menopause Clinic, Northwestern Memorial Menopause Program, Stanford Women’s Health. Why: physician‑led teams, access to specialists (endocrinology/gynecology), less commercial pressure, and adherence to guidelines. Established clinical labs: LabCorp or Quest Diagnostics. Why: widely used, reliable serum hormone testing and routine safety labs. Reputable compounding pharmacies (if compounding is medically necessary): Wedgewood Pharmacy and Fagron (large, well‑known compounding providers). Why: have national reputations and typically maintain PCAB/USP standards — confirm current accreditation before use. FDA‑approved hormone products (examples to ask about): Estradiol patches/creams: Vivelle‑Dot, Climara (stable dosing/regulated manufacturing). Micronized progesterone: Prometrium (oral progesterone that’s FDA‑approved, often preferred over some compounded progesterones). Testosterone gels (for men or when indicated for women off‑label use): AndroGel, Testim (note: female testosterone therapy is often off‑label and requires careful monitoring). Why: FDA‑approved products have manufacturing oversight, known dosing, and documented safety data. If you’re considering telemedicine BHRT Prefer telemedicine from established health systems or NAMS‑certified clinicians who require local lab testing (LabCorp/Quest) and offer follow‑up visits. Be cautious of direct‑to‑consumer services that prescribe based only on a questionnaire or finger‑prick/saliva tests sent to uncertified labs. Next steps Make a short list of local academic/large private clinics and check whether the prescribers are board certified and/or NAMS‑certified. Call and ask the “questions to ask” above; if answers are evasive or they insist on saliva testing/instant prescribing, walk away. Get baseline serum labs at a reputable lab before starting hormones and insist on a documented follow‑up plan. If you’re offered compounded hormones, ask why an FDA product isn’t suitable and verify the pharmacy’s accreditation. If you want, tell me your city or zip code and whether you prefer in‑person or telemedicine, and I can suggest specific clinics or clinicians near you.

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