Hormone Therapy: What Is It and How Does It Work?

Jenna Hilton
June 26, 2024

Hormonal imbalances can lead to a range of health issues and long-term medical conditions. Hormone therapy is a highly versatile solution that can effectively alleviate the symptoms and reduce or stop unwanted hormonal changes.

‌This article explains what hormone therapy is and how different treatments restore optimal hormonal values for a healthier life.

Hormone Therapy: What Is It and How Does It Work?

What Is Hormone Therapy?

‌Hormone therapy, or hormone replacement therapy (HRT), involves the use of medication to replace deficient hormones such as estrogen, progesterone, and testosterone.

HRT addresses hormonal imbalances and can lessen menopausal symptoms, alleviate discomfort associated with low testosterone, relieve symptoms of hormone-related cancers, treat adrenal insufficiency, and help transgender individuals during their medical transition process.

A healthcare provider will carefully evaluate individual suitability for hormone therapy to determine if the benefits outweigh the potential risks. Depending on the treatment goals and patient’s preferences, hormone therapy can be administered orally or through gels, patches, creams, and injections.

Types of Hormone Therapy

‌Based on the desired effect, administration method, and recommended dosing, we can distinguish two types of hormone therapy:

  1. Systemic hormone therapy – The treatment involves a higher-dose medication that enters the bloodstream to affect the entire body. It may be applied in pills, skin patches, rings, gel, cream, or spray. It effectively treats various systemic conditions and alleviates severe menopausal symptoms. However, it may cause more side effects, requiring close medical supervision.
  2. Local (non-systemic) hormone therapy – Localized treatment involves the use of lower hormonal doses that target specific body areas, such as the vaginal area. Low-dose vaginal estrogen comes in the form of creams, tablets, or rings. It reduces the risk of broader side effects associated with systemic estrogen and is typically prescribed to patients with mild vaginal or urinary menopausal symptoms.

Hormone therapy can be subcategorized based on the type of hormone it replaces. Read the list below to learn about the most common hormone replacement therapies, their benefits, and risks.

Bioidentical Hormone Replacement Therapy (BHRT)

Bioidentical hormone replacement therapy (BHRT) treats hormonal deficiencies using hormones whose chemical structure is identical to naturally occurring human hormones. BHRT may contain estrogen, progesterone, and smaller amounts of testosterone. Depending on the type of hormones, it can also be classified as estrogen therapy (ET) or combined estrogen-progesterone therapy (EPT).

BHRT is most often used to address perimenopausal and menopausal hormonal imbalances and alleviate symptoms such as sweating, vaginal discomfort, low sex drive, brain fog, and mood swings.

Note: Learn the differences between perimenopause and menopause.

Testosterone Replacement Therapy (TRT)

Testosterone therapy is designed to mitigate symptoms of male hypogonadism and testosterone deficiency associated with a medical condition. It is not FDA-approved for restoring low testosterone levels caused by aging in otherwise healthy adults.

TRT has numerous benefits and helps manage symptoms such as weight fluctuations, reduced sex drive, poor sleep, or fatigue caused by low testosterone levels.

TRT for women is an off-label treatment that may help alleviate menopausal symptoms.

Note: Read about how testosterone increases energy.

Hormone Treatment for Infertility

Couples struggling to conceive frequently undergo hormonal treatments under medical supervision. The treatment includes various medications and interventions that stimulate reproductive hormones and increase the chance of conception.

Female fertility hormone treatment typically includes:

  • Oral medication with follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
  • Drugs that block estrogen and stimulate gonadotropin-releasing hormone (GnRH), FSH, and LH to trigger ovulation.
  • HCG injections (human chorionic gonadotropin) for the growth and release of a mature egg.
  • Progesterone vaginal tablets and supplements to prepare the uterine lining for fertilization.
  • Estrogen therapy in the form of oral tablets, patches, and gel to regulate the menstrual cycle and support the development of the uterine lining.
  • Metformin treatment for women diagnosed with insulin resistance and polycystic ovary syndrome (PCOS).

Male fertility hormone treatment includes the following:

  • HCG injections (human chorionic gonadotropin) to increase sperm count.
  • Follicle-stimulating hormone (FSH) injections to directly stimulate the testes to produce sperm.
  • Gonadotropin-releasing hormone (GnHR) administered via injection, nasal spray, or subcutaneous pump, helps to stimulate the release of LH and FSH, which encourage the testes to produce testosterone and sperm.
  • Testosterone replacement may be used in certain cases (hypogonadism) but is generally during avoided fertility treatment because it can decrease sperm count.

Therapies for Hormone-Related Cancer

Hormone therapies can also help relieve symptoms of hormone-related cancers by altering hormonal values that fuel cancer cells. These therapies block, alter, or slow hormonal activities responsible for cancer cell proliferation and are typically prescribed to prostate or breast cancer patients because both conditions depend on sex hormones to grow.

This type of therapy is considered a systemic hormonal treatment as it targets hormones that circulate throughout the entire body. In severe cases, it may include surgery to remove hormone-producing organs.

Hormone Treatments for Transgender Individuals

Hormone therapies help gender-nonconforming individuals align their physical characteristics to their gender identity by changing hormonal values. They work by inducing the desired secondary sex characteristics and suppressing undesired ones.

There are two types of gender-affirming hormone therapies:

  1. Feminizing hormone therapy – It triggers the development of female secondary sex characteristics by supplying estrogen and progestin and using anti-androgens to suppress testosterone production.
  2. Masculinizing hormone therapy – This testosterone treatment spurs the development of masculine features such as facial hair, increased muscle mass, and a deeper voice.

Thyroid Hormone Replacement Therapy

Thyroid hormone replacement therapy involves the use of a medicine called levothyroxine to alleviate symptoms of hypothyroidism (underactive thyroid) and treat other thyroid-related medical conditions.

This medicine is used to treat the following conditions:

  • Hypothyroidism
  • Thyroid nodules
  • Goiter (enlarged thyroid gland)
  • Thyroid gland removal
  • Radioactive iodine ablation for hyperthyroidism

Corticosteroid Replacement Therapy (CRT)

Corticosteroid replacement therapy is suitable for individuals who have stopped producing hormones such as cortisol or aldosterone due to malfunctioning adrenal glands. CRT helps maintain normal physiological functions by replacing these two hormones responsible for stress response, immune function, and inflammatory response.

CRT can treat medical conditions related to adrenal insufficiency, such as the following:

  • Addison’s disease
  • Adrenoleukodystrophy (ALD)
  • Congenital adrenal hyperplasia (CAH)
  • Hypopituitarism
  • Adrenalectomy

Note: Learn about adrenal fatigue and ways to improve adrenal function.  

Growth Hormone Replacement Therapy

Growth hormone replacement therapy (GHRT) involves administrating somatropin injections to treat growth hormone deficiencies (GHD) in children and adults. By replacing the naturally-occurring growth hormone (somatotropin) with its synthetic form (somatropin), GHRT improves growth, metabolism, and overall physical development.

Growth hormone treatment helps children diagnosed with GHD increase their height and reach full bone maturity. It can also be prescribed to patients whose medical conditions affect growth and development (e.g., Turner syndrome, chronic kidney disease).

This type of treatment is a long-term commitment that typically lasts for months or even years, depending on the desired outcome.

Benefits of Hormone Therapy

HRT supports vital physiological processes and bodily functions, improving overall physical condition and emotional well-being.

Below is the list of numerous health benefits HRT offers by restoring optimal hormonal levels.

Note: Learn how HRT may help you lose weight.

When Is Hormone Therapy Commonly Used?

Hormone therapy is used to restore hormonal balance, modify hormonal activity to suppress the development of severe medical conditions, and alleviate symptoms associated with:

  • Menopause
  • Post-menopause
  • Infertility
  • Declining testosterone
  • Thyroid issues
  • Cancer growth
  • Medical gender transition
  • Growth stall  
  • Adrenal malfunction

HRT is prescribed to individuals across different age groups and medical backgrounds.

How Can You Take Hormone Therapy?

Hormone therapy is administered in various forms, depending on the treatment type, medical condition, and severity of symptoms. Some methods provide a localized treatment, while others offer a more systemic approach.

How can you take hormone therapy


Most HRT patients are prescribed tablets or capsules taken by mouth once or twice daily. Oral medication includes buccal tablets and sublingual drops that may be combined with hormone-balancing supplements such as Osmosis MD Hormone Relief Elixir.


Doctors may suggest the use of transdermal estrogen or testosterone patches that are applied directly to the skin and changed every few days. They help manage menopausal symptoms and restore hormonal balance by ensuring a steady full-body absorption.

Nasal Sprays

This type of medication contains synthetic hormones that are sprayed into nostrils to be absorbed through the nasal mucosa. For example, Nafarelin (Synarel spray) is used to treat endometriosis and precocious puberty by lowering the amount of testosterone or estrogen in the body.

Topical Gels and Creams

Hormone treatment may include testosterone gel or estrogen creams applied directly to the skin to be absorbed into the bloodstream. It is typically applied once a day to a clean and dry skin area as the doctor prescribes.

Vaginal Application

The most common hormone therapy applied vaginally comes in the form of creams, tablets, and rings. The medicine is inserted directly into the vagina with an applicator. This localized hormone treatment reduces symptoms such as vaginal irritation, dryness, and atrophy.


Implants are a long-acting form of testosterone therapy consisting of small pellets inserted under the skin of the upper hips or buttocks. They contain crystalline testosterone and measure 3 mm by 9 mm. The most common brand is Testopel, designed to provide a steady dose of testosterone for four months.


Hormone injections are highly effective because they deliver hormones directly into the bloodstream, bypassing the liver and ensuring faster absorption. They can be administered subcutaneously or intramuscularly. The most common examples include estrogen, testosterone, insulin, HCG, and HGH injections.

Intravenous (IV) Infusions

Intravenous hormone therapy consists of delivering hormone-based medication with essential vitamins and minerals through an IV drip. This method ensures immediate absorption, higher efficacy, and a more controlled delivery of hormones. Depending on the type, IV therapy may also boost immunity, reduce inflammation, address nutrient deficiencies, and provide numerous other health benefits.

Examples of hormone-based IV treatments include intravenous steroid infusions, levothyroxine IV infusions, and insulin pump infusions.

Rectal Suppositories

This is a solid form of hormone medication inserted into the rectum. It is an alternative to oral medication and is ideal for individuals with swallowing difficulties or patients with digestive issues as they bypass the GI tract. They also provide a more stable and consistent release of hormones compared to oral pills. The most common examples include estrogen, progesterone, and corticosteroid suppositories.

What Age to Start Hormone Replacement Therapy?

The appropriate age to start HRT depends on the type of therapy, individual health status, and condition. Your healthcare provider will determine if you are a suitable candidate for early hormone therapy based on your medical record and condition.

Men and women can start HRT as early as thirty to delay or prevent age-related medical issues, such as premature menopause, primary ovarian insufficiency (POI), cardiovascular diseases, or hypogonadism. That said, most female patients start the therapy within ten years of menopause. Women who begin HRT at age sixty or older are more likely to develop age-related health issues such as osteoporosis.

When should you start hormone therapy?

How Often Will You Take Hormone Therapy?

Hormone medication can be taken at varying frequency:

  • Daily – Oral tablets, topical gels and creams, transdermal patches, vaginal tablets and creams, and subcutaneous injections.
  • Twice weekly or weekly – Transdermal patches and subcutaneous injections.
  • Once a week or every two weeks – Intramuscular injections.
  • Every three to six months – Vaginal rings and implantable pellets.

The frequency may change over time, depending on the hormone therapy type, formulation, dosage, and the individual’s treatment plant.

How Long Do You Stay on Hormone Therapy?

The duration varies depending on your age, symptoms, and risk factors. The healthcare provider will schedule regular check-ups to evaluate your hormonal status and decide on the next step (e.g., adjusting the dose, adding new supplements).

Testosterone replacement therapy and thyroid hormone therapy for hypothyroidism are life-long treatments, while menopausal symptoms such as hot flashes and night sweats typically require two to five years of BHRT.

Regular reassessment of benefits and risks is necessary to adjust the duration of each hormone therapy.

Hormone Therapy Side Effects

Hormone therapy can produce mild to moderate and severe adverse effects, depending on the hormones used, dosage, duration, and patient’s response.

Regularly monitoring patients and adjusting doses minimizes or prevents potential risks and complications, such as the following:

  • Hot flashes
  • Night sweats
  • Headache
  • Weight gain
  • Vaginal dryness
  • Menstrual changes
  • Cramps
  • Unusual bleeding or spotting
  • Acne
  • Increased body hair
  • Rash
  • Reduced sex drive
  • Erectile dysfunction
  • Nausea
  • Fatigue
  • Mood changes
  • Hair loss
  • Increased appetite
  • Diarrhea
  • Insomnia
  • Memory problems
  • Breast swelling and tenderness
  • Bone thinning
  • Joint and muscle pain
  • Muscle atrophy
  • Swelling (fluid retention)
  • Stroke
  • Heart disease
  • Blood clots
  • Breast cancer

Should Anyone Avoid Hormone Therapy?

Hormone therapy is not suitable for individuals who belong to one of the following categories:

  • Patients with severe hormone-sensitive health conditions, such as breast or prostate cancer.
  • Patients previously diagnosed with a cardiovascular or liver disease.
  • Patients prone to blood clotting or diagnosed with a thromboembolic disorder.
  • Patients with unexplained vaginal bleeding or spotting.
  • People who are pregnant or planning pregnancy.
  • Patients allergic to hormone therapy ingredients.

Consult your healthcare provider to discuss the best course of action and determine the most suitable medical alternative if you belong to the high-risk population.

How Much Does Hormone Therapy Cost?

The cost range varies widely depending on the hormone therapy type, location, and package that may include a consultation, lab tests, a personalized treatment plan, follow-up visits, and medication.

  • Oral hormone replacement therapy - Costs around 120$ to $240 per month without insurance, or 30$ if the patient has an insurance plan.
  • Creams, patches, and gels - Cost $60 to $360 with insurance and $120 to $1,020 without a plan.
  • Pellet therapy - Costs between $1,050 to $1,400 for female and $1,400 to $2,100 for male patients. Even though it is typically not covered by insurance, this method may be cost-effective because it requires fewer visits to the doctor.
  • Injectable HRT - Requires 52 to 156 injections per year. The cost ranges between $288-$1,440 with insurance and $480-$4,800 for an uninsured person.

Is Hormone Therapy Covered by Insurance?

Insurance plans may cover the full or partial cost of BHRT. Most packages cover estrogen products, but the patient may have to co-pay additional fees and services included in the hormone therapy.

Keep in mind that insurance is only valid with a doctor’s prescription and that seeking medical assistance outside of your insurance network may entail out-of-pocket costs. Check if you are eligible for savings through manufacturer discounts and patient assistance programs.


By providing benefits across a range of conditions, hormone therapy has the potential to transform your life. It not only improves physical health but also enhances emotional well-being. With various methods and approaches, it helps patients live more comfortably, alleviating a wide variety of conditions and improving overall quality of life.

Discuss your options with a doctor specializing in hormonal treatments to learn more about potential benefits and health risks.

Jenna Hilton
Jenna Hilton has been a practicing PA since 2009, specializing in Family, Internal Medicine and Medical Aesthetics. She attended Arizona State University where she received her Bachelor's Degree and graduated magna cum laude. She received her Master of Science degree in Physician Assistant Studies from A.T. Still University.

Jenna has been injecting neurotoxin and dermal filler since 2013. She received certification as a Master Injector in 2017 through Empire Medical in Los Angeles, California. She is currently working on a Fellowship Program in Anti-Aging and Regenerative Medicine through the American Academy of Anti-Aging Medicine. Her special interests include use of PLLA, Ablative/Non ablative skin resurfacing, PDO threads, hormone therapy and nutritional therapies to improve cellular regeneration and medically supervised weight loss.

Jenna Hilton believes in a multi-factorial approach, considering internal factors that accelerate aging and disease development. She always enjoys teaching. She co-founded Vibrant EDU courses at Vibrant Skin Bar and regularly performs one-on-one training with fellow injectors. She teaches Aesthetic and Advanced Injectable Courses at National Laser Institute. She has been named Preceptor of the Year and is an Adjunct Faculty Member at Midwestern University. She was born in Iowa, and lives with her husband and three children in Phoenix, AZ.

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