How to Get Hormone Replacement Therapy: Prescription, Online & Over-The-Counter Options

Thinking About Hormone Replacement Therapy But Not Sure Where to Start?

You’re not alone.

Every day, I talk to women who are frustrated, confused, or overwhelmed when it comes to hormone replacement therapy (HRT). They’ve Googled symptoms, tried a few creams, or herbs and maybe even bought something off Amazon—but nothing seems to work the way they’d hoped.

I remember a patient—let’s call her Samantha. She was in her early 40s, navigating perimenopause with very heavy periods, anxiety, irritability, and crushing fatigue. She was getting thinning hair and some mild vaginal dryness. She had tried everything: Yam cream from the health food store, a handful of herbs from her favorite wellness influencer, and even saw her PCP who told her that she was normal. She ordered some hormones online finally – oral progesterone, an estradiol patch and DHEA. She still had all of her symptoms – nothing got better and her acne and hair loss only got worse. Nothing felt safe. Nothing felt consistent. Nothing worked.

By the time Samanatha found me at Inner Balance, she was exhausted—not just from hormones, but from the hunt for the right hormones.

This blog is what I wish she’d had from the beginning.

If you’re wondering where to get hormone replacement therapy, whether you can buy it over the counter, or how to do it safely online—this is your guide.

Let’s demystify the process and help you take confident, informed steps toward feeling better in your body.

Over-the-Counter (OTC) Hormones 

Why Are Some Hormones Available Over the Counter?

In the U.S., certain hormone-related products can be sold without a prescription because they are classified as dietary supplements or cosmetics, not as regulated medications. This is largely because the dose is well below what is considered a pharmaceutical product. This also means lower effectiveness.

For example, many OTC progesterone creams contain wild yam extract, or natural progesterone. These creams typically contain small doses (often too small to be effective) and lack standardized testing for safety and potency. In addition, yam doesn’t always convert to progesterone in women, or absorb effectively through the skin.

Common OTC Hormone Products

• Progesterone creams (wild yam-based, or micronized)
• Phytoestrogens (plant estrogens in supplements like soy isoflavones or black cohosh)
• DHEA 
• Topical hormone creams sold as cosmetics
• Estriol cream
• Low low low low dose estradiol creams

What to Know About Over-the-Counter (OTC) Estrogen Supplements

These products are often marketed as natural, accessible alternatives to prescription hormone therapy—but how effective and safe are they, really? Most OTC estrogen supplements fall into three main categories: phytoestrogens, herbal remedies and very low dose creams. While these can offer some mild benefits, they also come with limitations that are important to understand.

Phytoestrogens: Plant-Based Estrogen Mimics

Phytoestrogens are compounds naturally found in certain plants that mimic the effects of estrogen in the body—though typically much more weakly than your own hormones or prescription therapies. They do not offer the same protection, disease prevention, or symptom relief.

Common sources include:

• Soy and soy isoflavones: Found in foods and supplements, soy contains isoflavones—plant compounds that bind to estrogen receptors and may offer mild relief from symptoms like hot flashes.
• Flaxseeds: Rich in lignans, flaxseeds have weak estrogenic effects and are often promoted for their hormone-balancing properties.
• Red clover: Another plant high in isoflavones, red clover is frequently used in fertility blends and may offer minimal benefit for symptom relief.

Herbal Supplements: “Natural” Isn’t Always Better

Many OTC menopause products contain herbs marketed for hormonal balance—but few are supported by strong clinical evidence. In addition, our bodies do not make herbs naturally. The most natural thing we can do is replace the hormone that is missing!

• Black cohosh: Historically used for hot flashes and night sweats, but studies show long term they are not effective and do not bind to the estrogen receptor. It mostly just raises serotonin in the brain, which can sometimes provide temporary relief, but doesn’t offer the benefits of estradiol.
• Evening primrose oil: Known for its omega-6 fatty acid content, this supplement is often taken for breast tenderness and mood changes—but data is limited. In addition it doesn’t raise estrogen.
• Dong quai: Used in traditional Chinese medicine for women’s health, but doesnt actually boost or raise estradiol in the body.

Are OTC Estrogen Supplements Safe?

This is one of the most important questions I get—and the answer is nuanced.

Unlike prescription hormone therapies, OTC estrogen supplements are not regulated which means they don’t undergo the same testing for safety, effectiveness, or purity. The FDA only regulates claims that are made. They don’t regulate what is actually in the product or the effectiveness of it. Unlike prescriptions, which are heavily regulated.

Here’s what that means for you:

• Inconsistent potency: Doses can vary from one product to the next, even within the same brand—leading to unpredictable effects and inconsistent symptom relief.
• Unlisted or contaminated ingredients: Some OTC supplements may include fillers or even undeclared pharmaceutical agents, which can trigger allergic reactions or other adverse effects.
• Unproven claims: Many of these products are marketed with promises that sound great—but aren’t backed by clinical research.
• Potential drug interactions: Just because something is “natural” doesn’t mean it’s risk-free. Herbal and plant-based supplements can affect how your body processes other treatments.

My Take as a Hormone Specialist

I completely understand the appeal of OTC options—especially if you’ve felt dismissed by doctors or overwhelmed by prescription pathways. But here’s the reality: OTC estrogen supplements aren’t true hormone replacement therapy. Most contain hormone-like compounds in amounts too low to create meaningful, lasting change. At best, they may offer a mild placebo effect. If you’re experiencing signs of hormone imbalance—whether it’s hot flashes, brain fog, mood shifts, or vaginal dryness—you deserve more than a generic solution. You deserve clarity, precision, and a treatment plan that’s tailored to you.

A Note on OTC Progesterone and Wild Yam Cream

Many over-the-counter “natural progesterone” creams are made from wild yam extract, leading women to believe they’re supporting their hormone levels naturally. But here’s the truth: your body cannot convert wild yam into progesterone on its own. In fact, the progesterone used in bioidentical prescription therapies is synthesized from wild yam in a lab—not by your body. Even when a cream is labeled “natural,” the amount of active progesterone it contains (if any) is often too low or inconsistent to provide meaningful symptom relief or endometrial protection. Without proper dosing and medical supervision, these creams may give a false sense of security while leaving you vulnerable to the risks of unopposed estrogen. The human body lacks the necessary enzymes and biochemical pathways to convert yam (diosgenin) into progesterone. For real, therapeutic results, bioidentical progesterone must be prescribed in clinically effective doses—and guided by lab work and expert oversight.

Pros and Cons of OTC Hormones

Pros

• Easy to access (no prescription needed)
• Lower cost upfront
• Can offer mild symptom relief for some women from things like anxiety, or vaginal dryness

Cons

• Low and unreliable hormone absorption
• Not FDA-approved for hormone replacement
• Yam doesn’t convert to progesterone
• Many side effects with DHEA such as hair loss, acne and weight gain
• Low effectiveness, low potency
• No regulation – what the label says doesn’t always mean that is what is in the product

My Take

I understand why women turn to OTC options—especially when they feel dismissed or overlooked by traditional healthcare. There is also distrust in pharmaceuticals or medicine in general sometimes. But hormone precursors such as DHEA, or yam or taking skin creams that are low dose is not the same as real, therapeutic hormone replacement.

Over-the-counter products rarely provide therapeutic levels of estradiol or progesterone, and they do not offer protection against the risks that can come with unbalanced hormones (like uterine thickening).

They may help you feel like you’re doing something, but they rarely move the needle long-term.

How Do OTC Hormones Compare to Prescription HRT?

Here’s the difference in a nutshell: OTC hormones are unregulated and inconsistent; prescription HRT is science-backed and clinically supervised.

Prescription HRT uses more effective doses, with clear medical oversight.

Prescription Hormone Replacement Therapy: How and Where to Get It

Who Prescribes It?

Prescription HRT must be managed by a licensed provider. This could include:

• Hormone specialists
• Anit-aging specialists
• Functional medicine doctors
• Naturopathic doctors (in some states)
• Telehealth providers (like Inner Balance)
• Some primary care providers

Learn more about choosing a provider →

What’s Involved?

A legitimate prescription HRT plan should always include:

• A detailed health history and symptom review
• Discussion of risks and benefits
• A customized hormone plan (not one-size-fits-all)
• Regular follow-up visits for dosage adjustment and symptom tracking

Questions to Ask Your Provider

• Do you prescribe bioidentical hormones?
• How do you determine the right dose for me?
• Will I receive lab testing before and during treatment? If not, why not?
• Can you support my whole body needs and not just a few symptoms?
• How often will we follow up?

The right provider should educate, empower, and support—not just hand you a prescription and send you on your way.

Benefits of Prescription Therapies

One of the most powerful advantages of prescription hormone replacement therapy (HRT) is its ability to be fully personalized to meet your body’s exact needs. No two women experience their aging journey the same way. That’s why, at Inner Balance, we don’t believe in a one-size-fits-all approach. Prescription HRT allows us to tailor your treatment based on your unique hormonal profile, symptoms, medical history, and long-term goals.

Unlike over-the-counter products—which are created for broad use and often deliver minimal results—prescription therapies are grounded in data. We start with comprehensive symptom assessments. This allows us to build a plan that’s not just about symptom relief—but about true hormone optimization.

Another key benefit? Flexibility.

As your body changes throughout your life – perimenopause, menopause, and beyond, your hormone needs will shift. Prescription therapies give us the ability to adjust your dose, delivery method, or hormone blend over time. This ensures you always get the right support for where you are right now—not where you were six months ago.

And because your treatment is overseen by a licensed provider, you’ll also benefit from ongoing monitoring to make sure it’s working safely and effectively. If anything isn’t quite right—whether it’s a lingering symptom or a dosage that needs tweaking—we catch it early and adjust accordingly. It’s not just about replacing hormones – it’s about restoring vitality, protecting long-term health, and helping you feel truly balanced again.

Getting Hormone Replacement Therapy Online

Yes, You Can Get HRT Online—But Not All HRT or Services Are Equal

Telehealth has made high-quality HRT more accessible than ever. At Inner Balance, we’ve designed our online care to provide the same personalization and safety as an in-person visit—with added convenience.

Benefits of Online HRT with Inner Balance

• Personalized plans using that balance estradiol & progesterone 
• Effective symptom management and balancing of testosterone as well
• Access to bioidentical and compounded hormones
• Flexible scheduling and secure follow-ups
• Women’s hormone experts

Can You Get HRT Without a Prescription?

Technically, you can buy certain hormone-like products over the counter. But true hormone replacement therapy—especially with estradiol and progesterone—requires a prescription to ensure proper dosing, safety, and effectiveness.

If a website claims you don’t need a prescription for “real” HRT, it’s a cause for concern..

What Should I Watch Out for From Online Providers?

• Lack of personalized assessment
• Lack of progesterone if you’re on estradiol
• No follow-up plan
• Transactional approach – where they just sell you a product with no followup.

A good HRT provider, whether online or in person, will treat you as a whole person, not just a list of symptoms.

Should I Choose In-Person or Online HRT?

Both can work beautifully—it depends on your needs.

Choose in-person if:

• You already have a trusted local provider that is willing to work with you and give you effective treatment.

Choose online if:

• You want convenience and flexibility
• You live in a rural area or don’t have access to HRT specialists
• You prefer an all-women’s hormone care team
• Your current regimen from your in-person doctor isn’t working and you want try a different approach

At Inner Balance, we bring the best of both worlds: medical-grade HRT with compassionate, personalized care—from the comfort of your home.

Ready to Get Started?

If you’re wondering where to buy hormone replacement therapy, or if you’ve tried to go it alone and you’re ready for real support—you’re in the right place. You don’t have to guess anymore. We’re here to walk with you—every step of the way.