Short answer: treat “BHRT” like any medical specialty — choose a board-certified clinician who uses evidence-based testing and follow-up, favors FDA‑approved products when possible, and only uses compounded preparations from an accredited compounding pharmacy when necessary. Avoid clinics that rely on questionnaires/saliva tests, push “one-size-fits-all” creams, or sell expensive proprietary mixtures with no lab follow-up. How to pick a legitimate BHRT clinic — quick checklist Provider credentials: must be a board‑certified physician (endocrinologist, gynecologist with menopause training, reproductive endocrinologist, urologist for men, or internist with experience). Verify board certification on the state medical board or certifying board site (ABIM, ABOG, ABU, etc.). Evidence-based testing: wants baseline serum labs (for women: estradiol, FSH/LH as indicated, progesterone if used, TSH, CBC, LFTs, lipids, DEXA when appropriate; for men: total and free testosterone, PSA, hemoglobin/hematocrit, LFTs). Avoid clinics that rely on saliva or unvalidated urine “hormone panel” for systemic therapy decisions. Individualized plan and informed consent: provides a written treatment plan, documents risks/benefits, explains alternatives, and schedules follow-up visits with repeat labs and dose adjustments. Uses FDA‑approved formulations when appropriate (e.g., estradiol patches/creams, micronized progesterone [Prometrium] when indicated); compounds only when necessary and from an accredited pharmacy. Pharmacy safety: if using compounded hormones, make sure the pharmacy is accredited (PCAB) and has lot testing and sterility/quality documentation. Ask where they get potency testing and for certificates of analysis. Follow-up and monitoring: clear schedule for symptoms review and lab monitoring (e.g., labs at 3 months, 6 months, then annually or as indicated). No pressure sales: avoids upselling supplements, expensive proprietary “longevity” mixes, or lifetime cash memberships without clinical rationale. Transparent costs and insurance policies. Red flags — avoid clinics that: Prescribe solely from an online form without an exam or labs. Use saliva testing to dose systemic therapy. Push very high doses or “anti‑aging” claims without discussing risks. Will not identify the physician signing prescriptions, their board certification, or the compounding pharmacy used. Require membership fees to access care and limit follow-up. Questions to ask a clinic before you commit What are the prescribing provider’s board certifications and where can I verify them? What baseline labs do you order? Do you use serum testing or saliva/urine? Do you use FDA‑approved hormone products first? When would you compound? Which compounding pharmacy do you use? Is it PCAB‑accredited? Can I see their certificate of analysis process? How often will I be monitored and what labs will you repeat? What are the potential risks and side effects you will discuss with me in writing? Do you have published protocols or follow guidelines (e.g., North American Menopause Society, Endocrine Society)? Reputable types of places and examples (to consider) Academic medical centers/menopause clinics (best for complex cases and evidence‑based care): Mayo Clinic Menopause Clinic, Cleveland Clinic Menopause Center, Johns Hopkins Menopause Program. Why: multidisciplinary teams, guideline‑driven care, standard quality controls. Board‑certified specialists in your area: look for local endocrinologists, gynecologists with menopause subspecialty training, or urologists for male hormone care. Why: they manage complex endocrine issues and are audited by certifying boards. Telemedicine companies with board‑certified clinicians (use caution — vet credentials and follow‑up plans): Defy Medical is one telemedicine provider known for hormone therapy and for listing physician credentials and lab monitoring protocols. Why: convenient, but verify an in‑person exam/appropriate labs and monitoring. Compounding pharmacies: prefer PCAB‑accredited labs. Examples commonly used in clinical practice include Wedgewood Pharmacy Laboratories and Fagron (check current accreditation and state licensing). Why: PCAB accreditation and third‑party testing reduce but do not eliminate risk. Guidelines and resources to reference North American Menopause Society (NAMS) position statements on hormone therapy Endocrine Society and American College of Obstetricians and Gynecologists (ACOG) guidance on hormone therapy Pharmacy Compounding Accreditation Board (PCAB) directory for accredited compounding pharmacies Your state medical board to verify provider standing If you already have a clinic in mind Verify the physician’s board certification. Ask for copies of initial lab orders and a sample written treatment plan/consent form before starting. Request the name and accreditation status of the compounding pharmacy. Insist on a defined monitoring schedule (labs and symptom check) and don’t accept “lifetime membership” sales pressure. If you’d like, tell me where you live (city/state) and whether you’re seeking care for male or female hormones; I can look up local board‑certified specialists and reputable academic clinics or telemedicine options to consider.
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