Wedgewood

Short answer: look for a board‑certified specialist (gynecologist, endocrinologist, or internist with menopause training) who follows evidence‑based protocols, uses validated lab testing and documented informed consent, prescribes FDA‑approved hormones when appropriate, and partners with accredited compounding pharmacies only when a true need for compounded product exists. Avoid clinics that sell “one‑size‑fits‑all” pellet programs, rely on saliva testing, push big membership fees or proprietary supplements, or promise anti‑aging miracles. Concrete steps and resources 1) Start with reputable clinics and organizations Academic medical centers (examples): Mayo Clinic Menopause Clinic, Cleveland Clinic Women’s Health, Johns Hopkins Menopause Clinic, Brigham and Women’s Hospital — these centers have board‑certified specialists and follow established guidelines. Professional societies to consult or use for finding clinicians: North American Menopause Society (NAMS) — physician directory and position statements; The Endocrine Society — clinical practice guidelines. Why: academic centers and these societies emphasize peer‑reviewed evidence, standardized monitoring, and risk counseling. 2) Check clinician credentials Look for board certification in OB/GYN or Endocrinology (American Board of Obstetrics & Gynecology; American Board of Internal Medicine – Endocrinology). Prefer clinicians with additional menopause or sexual medicine credentials (NAMS certified or fellowship training). Verify via state medical board and the certifying board websites. 3) Ask these specific questions before you sign up Who will evaluate me (name and specialty)? Will I see a physician? Do you order baseline labs before prescribing? Which labs (see below)? How do you dose and monitor therapy? How often are follow‑ups and labs? Do you use saliva testing for hormones? (Red flag — saliva tests are unreliable for routine BHRT.) Will you use FDA‑approved hormones when possible? If compounded hormones are recommended, which compounding pharmacy do you use and is it accredited? What are the risks and benefits for my personal medical history? Is there written informed consent? 4) Reasonable baseline labs and monitoring you should expect For women: FSH (if menopausal status unclear), estradiol (serum), progesterone (if cycling), testosterone (total ± free if indicated), SHBG if interpreting testosterone, TSH, fasting lipid panel, glucose/A1c, LFTs, CBC. Mammogram and DEXA where indicated. Repeat labs after initiation and dose changes (commonly 6–12 weeks and then every 6–12 months depending on therapy and risk). 5) Compounded hormones and pharmacies Prefer FDA‑approved products when available (e.g., estradiol patches/gels, oral estradiol, micronized progesterone — Prometrium). If a compounded product is necessary (allergies, unavailable dose/formulation), use a PCAB‑accredited compounding pharmacy or one that follows USP standards. Check PCAB’s directory. Examples of large compounding suppliers (for checking accreditation): Wedgewood, Fagron — but always verify current accreditation before using. 6) Clear red flags — avoid clinics that: Rely primarily on saliva tests to dose hormones. Automatically put all patients on pellet therapy or a single product without individualized evaluation. Require large upfront “membership” fees for unlimited prescriptions/visits. Push proprietary “hormone blends” or unproven supplements as part of therapy. Don’t provide written consent or a discussion of risks (VTE, stroke, breast cancer risk profile, etc.) and alternative options. Offer minimal follow‑up (no scheduled labs or visits after starting therapy). 7) Telehealth options Telehealth can be fine if the clinician is board‑certified and follows the same standards (baseline labs ordered through Quest/LabCorp, documented informed consent, regular follow‑up). Consider large health systems’ telemedicine services (Mayo Clinic Online, Cleveland Clinic Express Care Online) or telemedicine clinicians affiliated with credible practices rather than direct‑to‑consumer “one‑click” hormone mills. 8) If in doubt, get a second opinion Ask for records and labs and get a second opinion from a board‑certified gynecologist or endocrinologist (preferably at a major medical center). If you want, tell me your city or ZIP and I can suggest specific clinicians or clinics nearby (or check the NAMS directory for certified menopause specialists in your area).

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