Last reviewed May 8, 2026
Quick answer: As of May 2026, the menopause telehealth services that actually prescribe compounded HRT are ClearedRx, Defy Medical, Joi Women's Wellness, and Winona. Evernow and Midi Health prescribe a mix — primarily FDA-approved with limited compounding. Hers and Alloy prescribe FDA-approved HRT only. ClearedRx's compounded estradiol vaginal cream is $89/month flat through state-licensed 503A pharmacies. The 2022 NAMS Position Statement does not endorse compounded as first-line but acknowledges legitimate uses; ACOG Committee Opinion 532 recommends FDA-approved when both meet patient needs, with explicit additional caution about pellet HRT.
60-second TL;DR
Side-by-side: 8 services in one table
| Service | Prescribes compounded? | Compounded vaginal cream? | Pellets? | Pricing (typical) | Best fit if… |
|---|---|---|---|---|---|
| ClearedRx | Yes | Yes — flat $89/mo | No | $89/mo bundled (compounded vaginal); FDA-approved options also offered | You want compounded vaginal estrogen at a transparent price; you want FDA-approved as an option too |
| Defy Medical | Yes | Yes | Yes | $199 initial visit + meds; $400–$700+/mo with full panel | You want comprehensive testing, including testosterone, and don't mind the higher price |
| Joi Women's Wellness | Yes | Yes | Yes | Membership ~$150/mo + meds; full protocol $300–$500+/mo | You want a longitudinal coaching/lab membership model with compounded options |
| Winona | Yes (compounded-first) | Yes | Yes | ~$28/mo membership + meds; bundles run $80–$200+/mo | You specifically want compounded HRT including pellets and you accept the ACOG/NAMS pellet caution |
| Evernow | Limited | FDA-approved primary; some compounded | No | $59/mo annual plan + meds (FDA-approved usually covered by insurance) | You want a clinician-led FDA-approved-default service with selective compounded availability |
| Midi Health | Limited | FDA-approved primary; case-by-case compounded | No | Insurance-billed (most commercial plans, Medicare); cash $25/visit + meds | You have insurance you want to use and want NAMS-certified clinicians; FDA-approved default |
| Hers | No | No | No | $25–$45/mo + meds; FDA-approved generics | You want low-cost FDA-approved HRT and prefer the FDA-only model |
| Alloy | No | No | No | $49 first month + ~$49–$79/mo meds | You want a NAMS-aligned FDA-approved-only service and like the consultation-led intake |
Service offerings change. Always verify directly with the provider before assuming a current product mix or price.
"Half the menopause telehealth market is FDA-only. Half is compounded-friendly. The right pick depends on whether you specifically need compounded — not whether you've heard the word." — ClearedRx Medical Network
A closer look at each service
ClearedRx
ClearedRx prescribes compounded estradiol vaginal cream at a flat $89/month — bundle includes the prescriber review, prescription, compounded preparation from a state-licensed 503A pharmacy, and discreet shipping. ClearedRx also prescribes FDA-approved options (Estrace generic, Estring, Vagifem, Imvexxy) and systemic HRT (estradiol patches, micronized progesterone). The compounded option is most useful when an allergen or cost issue rules out FDA-approved Estrace. ClearedRx does not prescribe compounded pellet implants, in alignment with ACOG and NAMS pellet caution.
Defy Medical
Defy Medical is a longstanding hormone clinic — originally focused on men's hormone optimization, now serving women too. They prescribe a wide range of compounded options including creams, troches, oral capsules, and pellet implants, alongside FDA-approved products. Pricing reflects a comprehensive testing-first model: $199 initial visit, lab panels, follow-up cycles, plus medications. Realistic monthly cost runs $400 to $700 once you include labs.
Joi Women's Wellness
Joi is the women-focused brand from the same group behind Joi Men's Health. They run a membership-driven coaching model with regular labs and access to compounded preparations including biest, compounded testosterone, and pellet options. Membership is ~$150/month plus medications; full protocol cost typically lands in the $300 to $500+ range once you include labs and the pharmacy.
Winona
Winona built its brand around compounded HRT. They prescribe compounded estradiol creams, compounded progesterone, and pellet implants. The pricing model is leaner than Defy or Joi — roughly $28/month membership plus medications, total typically $80–$200/month depending on the formulation. The pellet offering is the main reason ACOG-aligned clinicians flag Winona; if you specifically don't want pellets, you can stick to creams. See our ClearedRx vs Winona comparison for a deeper side-by-side.
Evernow
Evernow's clinical model is closer to a NAMS-aligned online clinic. The default prescription mix is FDA-approved estradiol patches, gels, oral micronized progesterone, and FDA-approved vaginal estrogen products. Compounded is available in selected cases. Annual plan is ~$59/month; FDA-approved medications often filled through patient's insurance pharmacy. ClearedRx vs Evernow comparison.
Midi Health
Midi accepts most major commercial insurance plans and Medicare for the visit, which is unusual in this category. NAMS-certified clinicians lead the visits. The default prescription mix is FDA-approved; selective compounding is available case-by-case. Best fit for patients who want to use insurance and prefer the NAMS-aligned model. ClearedRx vs Midi comparison.
Hers
Hers, the women's brand of Hims, prescribes FDA-approved HRT through a low-cost DTC pharmacy bundle. They do not prescribe compounded HRT. Best fit for patients who want low cash prices on FDA-approved options and don't need compounded. ClearedRx vs Hers/Hims comparison.
Alloy
Alloy prescribes FDA-approved HRT only, in alignment with NAMS and ACOG first-line recommendations. Strong patient education and a NAMS-aligned clinical board. Best fit for patients who specifically want a FDA-approved-only model with a female-led intake experience. ClearedRx vs Alloy comparison.
When compounded telehealth HRT is the right pick
Compounded HRT through telehealth is most clearly the right fit when one of these is true:
- Allergen sensitivity to inactive ingredients in FDA-approved options.
- Custom strength or base needed — for example, vulvar-only higher-concentration cream, or a hypoallergenic preservative-free preparation.
- Biest preference — clinician-prescribed estradiol-plus-estriol when that aligns with patient goals.
- Cost-driven necessity — when uninsured/underinsured and the FDA-approved branded product is genuinely out of reach. ClearedRx's $89/month vs $300 to $550 cash for Estrace is a meaningful access difference.
- Documented intolerance of FDA-approved options during prior trial.
When FDA-approved-only telehealth is the cleaner choice
If you have insurance that covers FDA-approved estradiol cream or generic estradiol patches, no allergen issue with the inactive ingredients, and standard dosing that meets your needs — the FDA-approved-only services (Hers, Alloy, Midi, Evernow) are usually the simpler choice. The medication has the most robust dosing labels, the longest post-market safety record, and the cleanest insurance and pharmacy logistics.
The bottom line
Frequently asked questions
Which telehealth services actually prescribe compounded HRT?
ClearedRx, Defy Medical, Joi Women's Wellness, and Winona prescribe compounded HRT routinely. Evernow and Midi Health offer a mix that's primarily FDA-approved with limited compounding. Hers and Alloy are FDA-approved only.
Is compounded HRT legal to prescribe via telehealth?
Yes — when prescribed by a state-licensed clinician for an individual patient and dispensed through a state-licensed 503A or FDA-registered 503B pharmacy, with USP 795/797 compliance.
What's different about ClearedRx vs Winona?
Both prescribe compounded estradiol cream and progesterone. ClearedRx focuses on creams and oral compounding through 503A pharmacies and does not prescribe pellets. Winona offers all three including pellets. ACOG and NAMS apply more caution to pellets than to creams or oral compounding.
Why don't Hers and Alloy prescribe compounded?
Both follow FDA-approved-only policies aligned with ACOG Committee Opinion 532. Defensible clinical position; trade-off is that allergen sensitivities, custom-strength needs, biest, and cost barriers are not addressed.
How much does compounded HRT through telehealth cost?
$79 to $250/month typical. ClearedRx flat $89/month for compounded vaginal estrogen cream is the most transparent and lowest. Defy, Joi run higher because they include broader testing protocols.
Do any of these services accept insurance for compounded HRT?
Insurance coverage of compounded HRT is rare across all services. HSA/FSA payment is widely accepted with itemized receipts.
Which is best for vaginal estrogen specifically?
For compounded vaginal estradiol cream specifically, ClearedRx's flat $89/month is the most transparent. Midi and Evernow prescribe FDA-approved options. Winona offers compounded vaginal preparations at a similar price tier.
How do I tell if a service uses a reputable compounding pharmacy?
Confirm 503A or 503B licensing, USP 795/797 compliance, and PCAB accreditation. Reputable services answer yes to all three.
See where ClearedRx fits.
Tell a prescriber your symptoms, history, and preferences in writing. ClearedRx will recommend FDA-approved or compounded based on what fits. Discreet shipping in 50 states. Flat $89/month for compounded vaginal estrogen cream.
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