Bioidentical hormone replacement therapy (BHRT) can be prescribed by licensed medical professionals whose scope includes medications – commonly MDs/DOs, nurse practitioners (NPs), physician assistants (PAs), and some OB/GYNs and endocrinologists. In most states, NPs and PAs can prescribe under state-specific rules. Because BHRT requires individualized dosing and monitoring, it’s best to work with a clinician formally trained in hormone therapy – ideally with additional education through IFM or A4M – and experienced in lab interpretation (including advanced urine panels like DUTCH, saliva testing, and genetic testing when clinically appropriate). Seek urgent care for red-flag symptoms such as chest pain, shortness of breath, severe headache/vision change, one-sided weakness, or heavy bleeding.

Key Points

• Who can prescribe: In the U.S., physicians (MD/DO), many nurse practitioners (NPs), and physician assistants (PAs) can prescribe BHRT; rules vary by state and supervising requirements.
• Why training matters: BHRT is individualized; clinicians with hormone-specific training (e.g., IFM, A4M) are better equipped to dose safely, interpret labs, and monitor over time.
• Advanced testing when appropriate: Experienced BHRT clinicians may use urine hormone metabolite testing (e.g., DUTCH), saliva testing, or genetic panels alongside standard blood work to inform care – only when clinically indicated.
• Safety & monitoring: Responsible prescribing includes risk screening, baseline labs, dose titration, and follow-ups to review benefits/side effects.
• If you’re looking for a BHRT prescriber, we offer consultations (with telehealth options) and responsible monitoring.

What It Means

“Who can prescribe BHRT?” really means “Who is qualified – and set up – to prescribe and monitor hormone therapy safely?” Legally, many clinicians can write prescriptions. Practically, the best outcomes tend to come from clinicians who do this work routinely and have additional training in women’s midlife health and hormone metabolism.

Common BHRT prescribers include:

• MD/DO physicians (e.g., family medicine, internal medicine, OB/GYN, integrative and functional medicine).
• Nurse practitioners (NPs) and physician assistants (PAs), depending on state scope and practice agreements.
• Some endocrinologists provide menopausal hormone therapy; others focus on complex endocrine disorders and may refer for midlife symptom care.

Because BHRT is not “one-size-fits-all,” real-world expertise – including how to select route (patch/gel/oral/vaginal), how to combine estrogen and progesterone, how to monitor, and when to adjust – matters as much as the prescription authority itself.

How It Works / What’s Involved In Responsible Prescribing

A well-run BHRT clinic will typically:

1. Screen risks & goals: medical history (including cancer/clotting history), medications, family history, symptom review, life context, and priorities.
2. Order baseline labs (as indicated): e.g., CBC, CMP, lipids, A1C/fasting glucose, thyroid markers when appropriate; sometimes estradiol/progesterone context depending on timing and clinical need.
3. Choose route & dose: For many candidates, transdermal estradiol is favored for safety/tolerability; micronized progesterone supports uterine protection when a uterus is present.
4. Titrate & monitor: reassess in 4–12 weeks; track benefits, side effects, blood pressure, and relevant labs; adjust formulation or dose over time.
5. Use advanced testing selectively: experienced clinicians may add DUTCH urine testing for metabolites, saliva testing (e.g., diurnal cortisol) or genetic testing to clarify nuances – only if it changes care and after discussing pros/cons and limitations.

We practice responsible BHRT informed by testing, with bioidentical, compounded and FDA-approved options, shared decision-making, and routine follow-ups. We also provide telehealth where allowed for convenient check-ins.

Is Anyone Not An Ideal Prescriber?

Be cautious about clinics that:

• Offer “one-size” BHRT without proper intake, testing, risk assessment, or follow-up and dose adjustment.
• Avoid discussing risks/side effects or do not provide clear monitoring plans.
• Promote hormones as a weight-loss cure or make sweeping performance claims.
• Do not explain the difference between FDA-approved and compounded options or when each is appropriate.

Look instead for clinicians who can articulate why a specific route/dose fits your history, explain expected timelines, and outline what to watch for between visits.

Safety, Side Effects & When To Seek Care

Common effects when starting or adjusting therapy can include breast tenderness, bloating/water retention, spotting/irregular bleeding, skin irritation (with patches/gels), headache, or mood shifts. These often improve with dose or route changes.

Contact the clinic for persistent or bothersome effects. Seek urgent care immediately for chest pain, shortness of breath, one-sided weakness/numbness, severe headache/vision changes, calf pain/swelling, or heavy vaginal bleeding.

Next Steps

If you’re exploring BHRT and want guidance from a team trained in hormone therapy and advanced lab interpretation (IFM/A4M-informed), we can help you evaluate fit and outline a safe plan.

• Ready to talk it through? Book a discovery call

Sources:

• North American Menopause Society (NAMS). The 2022 Hormone Therapy Position Statement.
• Endocrine Society. Compounded Bioidentical Hormone Therapy Scientific Statement.
• ACOG. Compounded Bioidentical Menopausal Hormone Therapy (Clinical Consensus, 2023).NIH/NCBI. Menopausal Hormone Therapy—risks and benefits overview.
• NIH/NCBI. Menopausal Hormone Therapy—risks and benefits overview.