Hormone replacement therapy (HRT) means using prescription hormones — most often estrogen, progesterone, or testosterone — to treat symptoms caused by a genuine hormonal deficiency. For women, that usually means the vasomotor symptoms of perimenopause and menopause: hot flashes, night sweats, disrupted sleep, and genitourinary symptoms such as vaginal dryness and painful intercourse. For men, it means treating clinically confirmed hypogonadism, diagnosed with repeat morning testosterone testing rather than symptoms alone.
HRT is a real medical treatment with real benefits and real risks, and the honest version of the conversation includes both. In November 2025 the FDA began a review of menopausal hormone therapy labeling, and on February 12, 2026 it approved the first batch of label changes removing the boxed warnings regarding cardiovascular disease, breast cancer, and probable dementia. That is a meaningful change in how the evidence is being communicated. It is not the same as saying hormone therapy is risk-free. Removing a warning from a label does not remove a risk from a patient, and the underlying risks still need to be weighed individually — which is exactly what a physician evaluation is for.
Most of the modern guidance converges on the same idea, sometimes called the timing hypothesis: the benefit-to-risk balance of systemic hormone therapy is most favorable for women who are under 60 or within about ten years of their final menstrual period, and who have no contraindications. The Menopause Society's hormone therapy position statement, the International Menopause Society recommendations published in late 2025, and the updated NICE menopause guideline all work from that framing. Starting therapy much later, or continuing it without periodic reassessment, changes the calculation.
At Atlanta Medical Institute in Buckhead, hormone therapy is prescribed only after an evaluation and lab work, and only when the results support it. Whether you are a candidate, which hormone, which delivery route, and what dose are all clinical decisions made by one of our physicians with you — not decided from a symptom checklist or a website. If your symptoms turn out to have a different cause, we would rather find that than hand you a prescription.
Program Benefits
- Treats the symptoms that actually respond to hormones — hot flashes, night sweats, sleep disruption, and genitourinary symptoms of menopause are among the best-supported indications for estrogen therapy
- Evaluation before prescribing, including a medical and family history, a physical exam, and laboratory testing appropriate to your situation
- Access to FDA-approved hormone products, with a clear explanation of where a compounded preparation would be used instead and why that distinction matters
- Dosing chosen by a physician and reviewed over time, rather than a fixed protocol applied to everyone
- Screening for the conditions that make hormone therapy inadvisable, so that risk is assessed before treatment rather than after
- Coordination with the rest of your care — thyroid, metabolic health, weight, and bone health are evaluated alongside hormones instead of in isolation
- One Atlanta office on Roswell Road, so follow-up visits and repeat labs stay with the same clinical team
Who Is Likely to Be a Candidate — and Who Is Not
For women, systemic hormone therapy is most clearly indicated for moderate to severe hot flashes and night sweats, and it is generally most favorable when started under age 60 or within roughly a decade of menopause. Low-dose vaginal estrogen is a separate conversation: it is used for vaginal dryness, irritation, and painful intercourse, and because very little is absorbed into the bloodstream it is generally considered to carry a different risk profile than systemic therapy.
For men, testosterone therapy is for diagnosed hypogonadism confirmed by repeat testing, not for fatigue or low motivation on their own. It is worth knowing that FDA-approved testosterone labeling retains a limitation-of-use statement regarding age-related decline in testosterone, meaning these products are not approved simply because levels drift down with age. We will tell you plainly if your numbers and symptoms do not support treatment.
Hormone therapy is not appropriate for everyone. A history of breast cancer or certain other hormone-sensitive cancers, unexplained vaginal bleeding, active or prior blood clots or stroke, active liver disease, or known or suspected pregnancy are among the reasons a physician may advise against it or recommend a non-hormonal path. Men with untreated severe sleep apnea, an elevated hematocrit, or an unevaluated prostate finding may need those addressed first. These are evaluated for every patient before anything is prescribed.
What to Expect at Your First Visit
Your first appointment is a medical visit, not a sales consultation. We take a full history — symptoms and their timeline, menstrual or andropausal history, medications and supplements, cardiovascular and clotting history, cancer history in you and your family — and perform an examination.
Laboratory testing is ordered based on that history. For women, testing may be less central than the clinical picture, because in a woman of typical menopausal age the diagnosis is usually made on symptoms and menstrual history rather than a hormone panel. For men, the standard is a morning total testosterone drawn on two separate occasions, with additional testing as indicated.
If therapy is appropriate, your physician will discuss the options for the hormone involved — including the different delivery routes, since route affects both how a hormone behaves in the body and its risk profile — along with the expected benefits, the risks specific to you, and the alternatives, including non-hormonal options. Dosing is determined by your physician at that visit. We do not publish doses here, because the right starting dose depends on findings that only an evaluation can produce.
Safety, Monitoring, and Follow-Up
Hormone therapy is not a prescription you start and forget. Patients are seen for follow-up so that symptom response, side effects, and relevant laboratory values can be reviewed, and the plan adjusted or stopped as appropriate. Women on systemic estrogen who still have a uterus require a progestogen to protect the uterine lining — this is not optional, and it is one reason self-directed or unsupervised hormone use is genuinely unsafe.
For men on testosterone, monitoring typically includes hematocrit, testosterone levels, and prostate-specific antigen where age-appropriate, along with blood pressure. The FDA issued class-wide labeling changes for testosterone products in February 2025 that added blood pressure warnings and incorporated results from the TRAVERSE cardiovascular safety trial. In that trial, which enrolled more than 5,000 middle-aged and older men with hypogonadism and elevated cardiovascular risk, testosterone therapy did not increase major adverse cardiovascular events compared with placebo over a mean follow-up of about 33 months. That finding was reassuring enough that the FDA removed the cardiovascular language from the boxed warning. It is a population-level result over a defined follow-up period, not a promise about any individual, and blood pressure monitoring remains part of care.
Routine screening — mammography, bone density, lipids, and the rest of your preventive care — continues on schedule while you are on hormone therapy. We coordinate with your primary care physician or gynecologist when you have one.
FDA-Approved Hormones Versus Compounded Preparations
This distinction gets blurred constantly in hormone marketing, so it is worth stating clearly. FDA-approved hormone products have been reviewed for safety, effectiveness, and manufacturing consistency, and they carry an FDA-approved label. Compounded preparations — custom-mixed by a compounding pharmacy — have not been through that review, even when they contain the same molecules.
Some bioidentical hormones are available as FDA-approved products, including estradiol and micronized progesterone. Other preparations, particularly custom-compounded creams and implanted pellets, are not FDA-approved. A National Academies of Sciences, Engineering, and Medicine review commissioned by the FDA concluded that the evidence supporting compounded bioidentical hormone therapy was largely low quality. ACOG has specifically advised against pellets for testosterone delivery, citing variable and sometimes supraphysiologic hormone levels and the fact that a pellet cannot be removed once implanted if a problem develops.
There are legitimate clinical reasons to use a compounded preparation — a documented allergy to an ingredient in the commercial product, or a dose or formulation that is not commercially available. Our position is that when an FDA-approved option will do the job, that is the reasonable starting point, and if a compounded preparation is being recommended to you anywhere, you are entitled to hear specifically why.
Setting Realistic Expectations
Hormone therapy reliably helps some things and is much less predictable for others. Hot flashes, night sweats, and genitourinary symptoms respond well for many patients. Sleep often improves when night sweats improve. Mood, energy, concentration, libido, and body composition are more variable — some patients notice real change, others notice little, and some of those symptoms have causes that hormones will not touch, including thyroid disease, depression, sleep apnea, anemia, medication side effects, and iron or B12 deficiency.
Hormone therapy is not an anti-aging treatment, a weight-loss treatment, or a way to restore the hormone levels of your twenties. It is a treatment for specific symptoms of a specific deficiency. Anyone promising more than that is overselling it. Timelines also vary: some patients feel a difference within a few weeks, others take longer, and some need a change of route or dose — or a different diagnosis entirely.
How Hormone Therapy Fits With Our Other Services
Hormone concerns rarely arrive alone, and AMI is a single Atlanta practice where these evaluations can be coordinated rather than scattered across offices. If your primary concern is menopausal symptoms, our menopause and hot flashes pages go into more detail on the full range of options, including non-hormonal ones. If your concern is low testosterone, that program page covers diagnosis and treatment specifically for men. If weight is a major part of the picture, our medical weight-loss programs are evaluated separately, because weight gain around midlife has causes beyond hormones and is often better addressed directly.
A note on erectile dysfunction, since it comes up in hormone consultations: low testosterone is one possible contributor, but it is usually not the whole story, and ED is frequently an early marker of vascular disease that deserves a proper workup. We also offer acoustic wave therapy, marketed under the GAINSWave name. We want to be straightforward about it — acoustic wave therapy is not FDA-approved for erectile dysfunction, the published studies vary considerably in quality, size, and design, and it should be presented as an option under investigation rather than an established treatment. We will tell you that in person too.
- Menopause Treatment — /services/menopause-treatment
- Hot Flashes Treatment — /services/hot-flashes-treatment
- Bioidentical Hormone Replacement Therapy — /services/bioidentical-hormone-replacement-therapy
- Low Testosterone Treatments — /services/low-testosterone-treatments
- Anti-Aging Treatments — /services/anti-aging-treatments
- Medical Weight Loss in Atlanta — /services/weight-loss-atlanta-ga
- Erectile Enhancement (ED) — /services/erectile-enhancement-ed
- Acoustic Sound Wave Therapy — /services/acoustic-sound-wave-therapy
- Meet our physicians — /about/dr-elbridge-bills, /about/dr-jeff-semel, /about/dr-leslye-pace
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Frequently Asked Questions
Did the FDA decide hormone therapy is safe now?+
Not quite. The FDA began a labeling review in November 2025 and, on February 12, 2026, approved the first label changes removing the boxed warnings about cardiovascular disease, breast cancer, and probable dementia from menopausal hormone therapy products. That reflects a reassessment of how the risks were being communicated, and many clinicians welcomed it. It does not mean the risks are gone or that hormone therapy is right for everyone. Your individual risk still depends on your age, your time since menopause, your personal and family history, and which product and route you use — which is why the evaluation matters.
What is the difference between HRT and BHRT?+
Bioidentical hormones are hormones structurally identical to the ones your body makes, such as estradiol and micronized progesterone. Some bioidentical hormones are available as FDA-approved products; others are custom-compounded, and those have not been reviewed by the FDA for safety, effectiveness, or manufacturing consistency. So bioidentical is a statement about molecular structure, not automatically a statement about safety or FDA status. Our BHRT page covers this in more depth, and your physician will tell you which category any product they recommend falls into.
How do you decide my dose?+
Your physician decides it during your visit, based on your symptoms, your history, your lab results, the specific product, and the delivery route. We deliberately do not publish dosing guidance, because a dose taken from a website is a dose chosen without knowing anything about you. Doses are also reviewed and adjusted at follow-up rather than set once.
Do I need lab work before starting?+
Almost always, though what gets tested depends on the situation. For men, diagnosing hypogonadism requires morning testosterone measured on more than one occasion, plus additional testing as indicated. For women of typical menopausal age, the diagnosis often rests more on symptoms and menstrual history than on a hormone panel, but we still test to rule out other causes such as thyroid disease or anemia, and to screen for conditions that would change the plan.
Is hormone therapy something I stay on forever?+
There is no fixed answer, and anyone who gives you one without knowing you is guessing. Current guidance favors periodic reassessment rather than an arbitrary stop date, weighing your ongoing symptoms against your current risk profile, which changes as you age. Some patients use hormone therapy for a defined period and taper off; others continue longer with ongoing monitoring. It is a decision you revisit with your physician, not one you make once.
Will hormone therapy help me lose weight?+
It is not a weight-loss treatment and we do not present it as one. Some patients find that improved sleep and reduced symptoms make it easier to be consistent with exercise and eating, which can help indirectly. But if weight is your main concern, it deserves a dedicated evaluation rather than being treated as a hormone problem by default. Our medical weight-loss programs are assessed separately, and your physician can tell you whether one is appropriate for you.
Can I get hormone therapy if I have a history of breast cancer or blood clots?+
Those histories are generally contraindications to systemic hormone therapy, and you should not expect us to prescribe it on request. There may be other options, including non-hormonal treatments for hot flashes, and in some cases low-dose vaginal estrogen is discussed with a patient's oncologist. That is a conversation to have with a physician who has your full records, ideally in coordination with your cancer care team.
How do I schedule an evaluation?+
Call our Buckhead office at (404) 264-9553 or use the contact page. We are at 5009 Roswell Road NE, Suite 201, Atlanta, GA 30342 — one location, open Monday through Thursday 9 to 6 and Friday 9 to 4. Bring a list of your medications and supplements, and any recent lab work you have.
Costs and appointment planning
Review pricing questions, insurance and coverage information, and telehealth visit planning before booking. Confirm the costs and services that apply to your individual care.
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