Feeling Lost in the HRT Maze?
If you’ve been researching hormone replacement therapy (HRT), you might feel overwhelmed—like every article leads to more questions than answers. You’re not alone. Many women come to me after sifting through dozens of conflicting opinions, only to realize that what they really need is a provider who truly specializes</i > in hormones, not just thinks they know, or dabbles in them, or thinks birth control is HRT.
I’m Dr. Sarah Daccarett, MD, a longevity and hormone specialist. I am a board certified physician and have been treating hormone deficiencies and imbalances in women for years. At Inner Balance, I’ve helped thousands of women navigate hormonal changes—whether they’re in their 20s and have endometriosis or PCOS, or in their 30s and feeling “off,” entering perimenopause, or years postmenopausal and ready to reclaim their vitality.
If you’re wondering what type of doctor does hormone replacement therapy—or what kind of expertise you should be looking for—this guide is for you. If you want to read more about how to get started on HRT, more information can be found here</a >.
Let’s break it down.
What Is Hormone Replacement Therapy?
Hormone Replacement Therapy (HRT)</a > is a medical treatment that restores optimal levels of sex hormones—primarily estrogen, progesterone, and sometimes testosterone—in women experiencing symptoms</a > related to hormone decline. This includes symptoms like fatigue, brain fog, weight gain, mood swings, brittle bones</a >, low libido, painful periods, and more.
What Should You Expect From a Hormone Replacement Therapy Doctor?
A qualified doctor for hormone replacement therapy</a > should:
- Take a full symptom history—not just rely on labs.
- Understand bioidentical hormone therapy and its long-term safety profile.
- Offer personalized treatment plans, not one-size-fits-all prescriptions.
- Not just use oral, or topical formulations, but consider vaginal</a >.
- Monitor progress through symptoms and your own experience—not just generic reference ranges and expensive lab tests.
Now, let’s explore the most common types of doctors who offer HRT—and how to find the best fit for you.
Types of Doctors Who Prescribe Hormone Replacement Therapy
Anti-Aging or Longevity Physicians
What They Do: Specialize in hormone optimization, preventative aging, peptides and performance. If you want to feel your best while you are aging – these are the docs</a > to see!
Training Focus: Aging biology, regenerative medicine, hormone and peptide therapy.
Typical Approach: Frequently prescribes testosterone, estrogen, and progesterone for energy, cognition, body composition, and anti-aging benefits. These doctors have spent a great deal of time out of residency learning anti-aging and hormone balancing. They know how to address your concerns.
Pros:
- Optimizes for how you feel, not just how you score on a lab
- Often includes cutting-edge approaches
- Personalized approach
- Uses your body’s natural processes to optimize your health long-term
Cons:
- Variable quality across clinics
- Women’s hormones replacement is still years behind men’s
- Very expensive out of pocket and not covered by insurance
Functional or Integrative Medicine Doctors
What They Do: Focus on root cause medicine and whole-body wellness.
Training Focus: Nutrition, gut health & detoxification. Focus on dietary restrictions and supplements.
Typical Approach: Often use lifestyle interventions first and if trained will use bioidentical hormones. Traditional therapies like oral progesterone pills, patches and topical creams are widely used but not optimized. Many integrative physicians try to balance hormones with herbs, supplements, or gut protocols.
Pros:
- Deep experience on gut health, supplements and diet
- Personalized treatment plans
- Often offer telehealth and comprehensive follow-up care
- Focus on wellness and treating the root cause
Cons:
- Not a lot of training in women’s hormones
- May not be covered by insurance – very expensive out of pocket
- Longer wait times and out-of-pocket costs
- Expensive laboratory testing is a must with most integrative clinics
- Women spend years with this approach and often do not feel any better
- Focus on lowering estrogen through diet and supplements, not optimizing all 3 hormones.
OB/GYN (Obstetrician-Gynecologist)
What They Do: OB/GYNs specialize in reproductive health & pregnancy.
Training Focus: Surgical focus to deliver babies, perform c-sections, pap-smears, ultrasounds, cancer screening.
Typical Approach: May prescribe traditional HRT (synthetic or low-dose estradiol vaginal cream). Most prescribe birth control for all women regardless of age, or problem. Got endometriosis, PCOS, or are menopausal – birth control is typically the solution for OB/Gyns.
Pros:
- Insurance typically covers visits and prescriptions
- Comfortable discussing reproductive symptoms.
Cons:
- No training in hormone replacement therapy whatsoever.
- Time-limited appointments
- Unless trained outside of residency, they do not take an anti-aging or integrative approach to wellness and prevention medicine.
- Some have outdated approaches and even believe hormones to be controversial</a >, which has been debunked.
Endocrinologist
What They Do: Endocrinologists specialize in complex endocrine disorders such as tumors, cancer, diabetes, or genetic conditions. They do not have any training in hormone replacement therapy for anti-aging, perimenopause, endometriosis, PCOS, or menopause.
Training Focus: Thyroid, adrenal, pituitary, and congenital (genetic) hormone disorders.
Typical Approach: May address severe conditions caused by tumors, metabolic dysfunction or rare conditions. Tend to focus on disease thresholds rather than wellness optimization. Less likely to treat mild-to-moderate perimenopausal symptoms with HRT unless clinically deficient by lab standards.
Pros:
- Covered by insurance
- Strong understanding of rare diseases such as Addison’s disease, pituitary tumors, or diabetes.
- Ideal for complex or co-occurring endocrine disorders
Cons:
- Often less experienced with bioidentical hormone therapy
- Do not treat unless labs are abnormal and do not specialize in menopause.
- Extremely long wait times (4-6 months). Need referral from PCP.
Should I See a Local Doctor or Use Telehealth?
Both options can work—but the right answer depends on your needs.
Telehealth Pros:
- Easier access to HRT specialists, regardless of geography
- No time wasted commuting, or waiting to see a specialist
- Personalized care from the comfort of home
- Ideal for women in any area, but especially those without access to longevity clinics
Telehealth Cons:
- Some issues require in-office visits
- Insurance sometimes doesn’t cover specialists like anti-aging physicians
- Limited scope of treatment is offered online in a telehealth setting.
What About Insurance & Costs?
- Traditional providers (OB/GYN, endocrinologists) are typically covered by insurance, but offer less flexibility in treatment options. Treatments that are prescribed by traditional doctors are covered by insurance but are birth control or traditional forms that are not custom, or very effective.
- Functional and longevity-focused care is often out-of-pocket but may include more time, support, and customized protocols. Treatments are custom, effective and more modern.
Think of HRT as an investment—not just in symptom relief, but in disease prevention, bone strength, brain health, sexual wellness, and quality of life. Read more here about </b >getting started on HRT.</a >
Long-Term Engagement and Support
HRT is not a one-time prescription. It’s a journey. Your hormone needs will evolve over time, and your doctor should grow with you.
Look for providers who:
- Offer routine or unlimited follow-ups
- Adjust based on how you feel
- Labs are variable and forcing you into a reference interval isn’t personalized medicine. It’s defensive medicine. Find a provider that listens to you over a lab test.
- Understand that optimal is not the same as “normal”
At Inner Balance, we build long-term partnerships with women to help them evolve through every season of life—thriving, not just surviving.
