Physician-Led Hormone Care for Women & Men
Hormone replacement therapy is not a single treatment. Different hormones may be considered for different diagnoses, symptoms and stages of life. This guide explains the major forms of hormone replacement therapy used in women and men, how they differ, and how treatment is individualized after a comprehensive medical evaluation.
The hormone that may need treatment depends on the underlying diagnosis. Symptoms such as fatigue, sleep changes, low libido, hot flashes, changes in body composition, mood changes or difficulty concentrating can have hormonal and non-hormonal causes. Treatment should begin with determining what is actually contributing to the symptoms rather than assuming that every symptom represents a hormone deficiency.
When hormone therapy is medically appropriate, the choice of hormone, formulation, dose and monitoring plan should be individualized.
Estrogen therapy may be considered for appropriate women experiencing menopausal symptoms such as hot flashes, night sweats and genitourinary symptoms. The route and whether progesterone is also required depend on the patient’s clinical circumstances.
Progesterone or a progestogen may be used with systemic estrogen in women with an intact uterus to protect the endometrium, and may have other specific clinical uses. The need for therapy is determined individually.
Testosterone replacement may be appropriate for men with compatible symptoms and consistently low testosterone levels after appropriate evaluation. Testosterone use in women has narrower evidence-based indications and requires careful assessment.
Thyroid hormone replacement is used to treat hypothyroidism when clinically indicated. Symptoms alone are not enough to diagnose thyroid dysfunction; evaluation and laboratory testing help determine whether replacement is appropriate.
Insulin regulates blood glucose and metabolism. Evaluation focuses on recognized glucose and metabolic disorders; insulin treatment is used for specific medical indications rather than general hormone optimization.
Cortisol is an essential adrenal hormone. Both cortisol deficiency and cortisol excess can represent important endocrine disorders and require diagnosis using established testing rather than symptoms alone.
Growth hormone replacement may be considered for appropriately confirmed growth hormone deficiency. Adult diagnosis often requires formal stimulation testing, and therapy should be individualized and monitored.
The adrenal glands produce cortisol, aldosterone and adrenal androgens. Evaluation depends on the suspected disorder and may require targeted hormone testing and stimulation or suppression testing.
Women’s hormone care may involve evaluation of perimenopause, menopause, surgical menopause, menstrual changes, vasomotor symptoms, sleep disruption, vaginal and urinary symptoms, sexual health and bone health. Depending on the indication, treatment may involve estrogen, progesterone, local vaginal therapy or other approaches.
Men’s hormone evaluation commonly focuses on possible testosterone deficiency, sexual symptoms, energy, body composition, fertility considerations and related medical conditions. A diagnosis of testosterone deficiency should be based on compatible clinical findings and appropriate laboratory confirmation.
Systemic hormone therapy is designed to circulate through the bloodstream so that the hormone can have effects throughout the body. Depending on the specific hormone and the patient’s clinical needs, systemic therapy may be administered as pills, troches, transdermal patches, gels, sprays, or other appropriate formulations. The route, dose, and formulation should be selected according to the hormone being treated, symptoms, medical history, risk factors, response, and available evidence.
Local hormone therapy is intended to deliver treatment primarily to a specific area and often uses lower doses than systemic therapy. For genitourinary symptoms of menopause, local vaginal estrogen may be administered as a vaginal cream, ring, tablet, or insert to treat symptoms such as vaginal dryness, irritation, painful intercourse, and vaginal or vulvovaginal atrophy. Some hormone preparations may also be applied to the skin, including the thighs or arms; however, whether a skin-applied product acts locally or systemically depends on the medication and formulation.
Hormones can be delivered in several ways. The appropriate route depends on the hormone, treatment goal, medical history, whether systemic or local effects are needed, and whether an FDA-approved formulation is available.
Common examples: estrogen, micronized progesterone and some estrogen-progestogen combinations. Thyroid hormone replacement is also commonly taken orally. Oral testosterone is available for specific indications in men, but the appropriate formulation depends on the diagnosis and patient.
Potential benefits: convenient, familiar dosing; oral progesterone and thyroid hormone are established options; systemic oral estrogen can effectively treat hot flashes and other menopausal symptoms.
Considerations & risks: oral estrogen passes through the liver first and is associated with more effect on clotting factors and a higher gallbladder risk than nonoral estrogen. Systemic hormone risks also depend on the hormone, dose, age, medical history and whether endometrial protection is needed.
Troches are compounded preparations that dissolve in the mouth. Depending on the prescription, a compounding pharmacy may prepare combinations such as estradiol and progesterone, sometimes with testosterone.
Potential benefits: may allow an individualized dose or combination when a commercially available product cannot meet a specific clinical need, and can be useful for patients who have difficulty swallowing pills.
Considerations & risks: compounded troches are not FDA-approved finished combination products. Evidence regarding their absorption, safety and effectiveness is more limited, and dose consistency can differ from FDA-approved products. FDA-approved therapy is generally preferred when an appropriate option is available.
Common examples: transdermal estradiol and certain estrogen-progestogen combinations. Patches deliver hormone through the skin into the bloodstream.
Potential benefits: provide relatively steady systemic delivery and avoid first-pass metabolism through the liver. For menopausal estrogen therapy, transdermal routes may have a lower risk of venous blood clots than oral estrogen and may be useful when avoiding oral therapy is desirable.
Considerations & risks: patches can cause skin irritation or adhesion problems. They still provide systemic hormone exposure, so the broader risks and contraindications of the hormone remain relevant.
Common examples: systemic estradiol gels and testosterone gels. These are applied to designated skin sites and absorbed transdermally.
Potential benefits: avoid first-pass liver metabolism and provide a nonoral systemic option. Estrogen gels can treat systemic menopausal symptoms, while testosterone gels can provide adjustable replacement for appropriately diagnosed testosterone deficiency.
Considerations & risks: application-site reactions can occur. Absorption can vary, and some products require precautions to prevent skin-to-skin transfer to another person. Systemic hormone-specific risks still apply.
Common example: transdermal estradiol spray for menopausal symptoms. The medication is applied to the skin and absorbed systemically.
Potential benefits: convenient nonoral delivery that avoids first-pass liver metabolism and can effectively treat systemic menopausal symptoms.
Considerations & risks: application must follow product-specific instructions, including allowing the area to dry and reducing unintended transfer. It remains systemic estrogen therapy, so patient-specific estrogen risks and contraindications still need to be considered.
Common examples: low-dose vaginal estradiol tablets or inserts, vaginal estradiol rings and vaginal estrogen creams used primarily for genitourinary symptoms of menopause, including vaginal dryness, irritation, painful intercourse and atrophy.
Potential benefits: delivers a low dose directly to vaginal tissues, is effective for local genitourinary symptoms, and generally produces much less systemic exposure than conventional systemic estrogen therapy. Tablets/inserts and rings can also be less messy than creams.
Considerations & risks: local irritation, discharge or spotting can occur. Product selection matters because some vaginal rings are designed to provide systemic estrogen rather than low-dose local therapy. Patients with certain hormone-sensitive conditions should discuss the appropriate option with their clinician.
Common examples: testosterone is available as intramuscular or subcutaneous injectable formulations for appropriately diagnosed testosterone deficiency. Growth hormone replacement is given by subcutaneous injection for confirmed growth hormone deficiency. Insulin is also administered by injection when medically indicated for diabetes and related conditions.
Potential benefits: injections can provide reliable systemic delivery and avoid gastrointestinal absorption and first-pass liver metabolism. Depending on the medication, dosing may range from daily to weekly or at longer intervals. Injectable therapy can be particularly useful when a hormone is not effectively delivered orally or when rapid treatment is required in an emergency.
Considerations & risks: injections can cause pain, bruising, bleeding or local reactions and require correct technique and safe needle handling. Risks also depend on the hormone: testosterone can cause erythrocytosis and suppress fertility; growth hormone can cause fluid retention, joint symptoms and changes in glucose metabolism; insulin can cause hypoglycemia and weight gain; and glucocorticoid dosing that is excessive or prolonged can produce important metabolic and other adverse effects. The indication, formulation, dose and monitoring should therefore be individualized.
The term bioidentical describes hormones that are chemically identical to hormones produced by the human body. Some bioidentical hormone products are FDA-approved; others are prepared by compounding pharmacies. “Bioidentical” does not by itself mean that a treatment is safer or more effective. FDA-approved formulations are generally preferred when an appropriate approved product is available, while compounded therapy may have a role in selected circumstances when an individualized formulation is medically necessary.
Hormone treatment decisions should account for symptoms, medical and family history, medications, fertility goals, cardiovascular and thrombotic risk, cancer history, bone health, metabolic health and the specific hormone being considered. Testing is targeted to the clinical question rather than using the same fixed panel for every patient.
When treatment is appropriate, potential benefits, limitations, alternatives and risks are discussed before therapy begins. Follow-up may include symptom review, laboratory testing, screening appropriate to the patient’s risk profile, assessment for adverse effects and adjustment or discontinuation when appropriate.
Review symptoms, health history, medications, prior treatment and goals, followed by clinically appropriate testing when needed.
Choose therapy only when appropriate, then reassess symptoms, safety, laboratory findings, adverse effects and whether treatment remains beneficial.
Written by: David Nazarian, M.D.
Medically reviewed by: David Nazarian, M.D.
Medical review date: September 21, 2026
David Nazarian, M.D., is Board-Certified in Internal Medicine with extensive experience evaluating and treating women and men with hormonal concerns. His approach emphasizes comprehensive assessment, evidence-informed decision-making, individualized treatment, patient education, safety and ongoing follow-up.
No. The indication, hormone, dose, formulation and monitoring differ according to the diagnosis and individual patient.
No. Many symptoms associated with hormonal change can also occur with sleep disorders, thyroid disease, medication effects, nutritional deficiencies, metabolic conditions and other medical problems.
The term bioidentical does not establish superior safety or effectiveness. Some FDA-approved hormones are also bioidentical.
Monitoring is individualized and may include symptom review, examination, laboratory testing, appropriate screening and assessment for adverse effects.
If you are experiencing symptoms that may be related to hormonal change, a comprehensive evaluation can help determine whether hormone therapy—or another treatment approach—is appropriate.
David Nazarian, M.D., is Board-Certified in Internal Medicine and provides physician-led hormone evaluation and individualized care for women and men. His approach emphasizes comprehensive assessment, patient education, individualized treatment, safety, and ongoing follow-up. Dr. Nazarian specializes in bio-identical hormone replacement therapy in men & women. He has extensive training and knowledge in treating andropause and testosterone replacement therapy in men and menopause and estrogen replacement therapy in women. Supported by his experienced medical team, Dr. Nazarian treats men and women with hormone deficiencies and imbalances and enjoys the one-on-one relationship between patient and doctor.
HRT LA provides physician-led hormone evaluation and individualized care in Beverly Hills and Los Angeles with David Nazarian, M.D.
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