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Board-Certified Internist Former Mayo Clinic Faculty 20+ Years Faculty Experience

Hormone Replacement Therapy for Women

Physician-supervised HRT for perimenopause and menopause. Comprehensive hormone workup, FDA-approved medications, ongoing monitoring, and a physician who actually listens.

One flat monthly membership · founding-member rates · no per-visit charges · Cancel anytime · Hindi · Urdu · Punjabi spoken

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From Dr. Sahni

I spent 20 years as an internal medicine physician — Mayo Clinic, University of Minnesota faculty, complex chronic disease. The 2002 Women's Health Initiative trial made a generation of doctors cautious about HRT, and many women have gone without treatment as a result. Age-stratified reanalyses and modern formulations have refined the picture for women who start within the appropriate window. I prescribe HRT the way I'd prescribe to a sister: cardiovascular and breast-cancer risk assessed first, FDA-approved formulations only, monitored closely, and adjusted for what you actually feel.

How we do HRT differently

Most HRT prescribing in 2026 is either too cautious or too loose. We try to be neither.

It's Not “Just Your Age”

Hot flashes, night sweats, insomnia, brain fog, anxiety, weight gain, joint pain, low libido. Too many women are told this is just what getting older feels like. It's not. These are symptoms of the menopause transition — and for many women, they're treatable.

For women under 60 or within 10 years of menopause, hormone replacement therapy is the most effective treatment for these symptoms. The evidence supports it, major medical societies recommend it, and yet most primary care physicians either don't offer it or aren't comfortable prescribing it. We are.

How the Program Works

1. Baseline Labs

Targeted hormone and metabolic labs to clarify what's driving your symptoms and screen for risk factors before prescribing.

2. Physician Evaluation

Extended visit to review your labs, symptoms, medical history, family history, and risk factors. We assess whether HRT is appropriate and discuss all your options — not just medications.

3. Treatment & Monitoring

If you're a candidate, we prescribe FDA-approved HRT and monitor you closely. Follow-up labs, symptom checks, dose adjustments, and breast cancer risk screening as indicated.

What We Prescribe

Estradiol

Patch or oral — FDA-approved

The primary estrogen used in HRT. Transdermal patch is preferred for most women (lower clot risk than oral). Relieves hot flashes, night sweats, vaginal dryness, and bone loss.

Progesterone

Micronized (Prometrium) — FDA-approved

Required for women with a uterus to protect the endometrium. Micronized progesterone is body-identical and also helps with sleep. Taken orally at bedtime.

Testosterone

Low-dose topical — when indicated

Considered off-label for women with persistent low libido despite adequate estrogen replacement. No testosterone product is currently FDA-approved for women in the US; we prescribe at physiologic doses with informed consent and close monitoring.

We prescribe FDA-approved, evidence-based HRT. We do not prescribe compounded bioidentical hormones, pellets, or unregulated formulations.

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or call (916) 512-1912

Who Is a Candidate

HRT is most beneficial for women who are:

  • Symptomatic — hot flashes, night sweats, insomnia, vaginal dryness, mood changes, brain fog, joint pain
  • Under 60 or within 10 years of menopause — the window where benefits most clearly outweigh risks
  • Without contraindications — we screen for breast cancer history, estrogen-dependent cancers, history of stroke or heart attack, active liver disease, unexplained vaginal bleeding, and blood clotting disorders

Known risks of HRT. Oral estrogen carries a small increased risk of venous thromboembolism (blood clots) and stroke; transdermal estradiol (patch) largely avoids this. Combined estrogen-progesterone therapy may modestly increase breast cancer risk with longer-term use. We assess your individual cardiovascular and breast cancer risk before prescribing and monitor you throughout treatment.

All patients complete a medical evaluation and informed consent before beginning treatment. Not sure if you're a candidate? Start with our Women's Hormone Panel — we'll run the labs and evaluate your situation before recommending anything.

Pricing

HRT is included in both of our membership plans — Direct Primary Care and Concierge Internal Medicine — when clinically indicated. See our programs →

FDA-approved HRT medications typically cost $20–60/month at cash-pay pricing.

Why Private MD for HRT

  • Board-certified internist — not a med spa or wellness clinic. Your hormones are managed by a physician trained in internal medicine with 20+ years of experience.
  • Evidence-based — we follow the Menopause Society and Endocrine Society guidelines. No unregulated compounded hormones, no pellets, no pseudoscience.
  • Real evaluation first — we confirm your hormone levels and assess your risk profile before prescribing. No questionnaire-only assessments.
  • Safety monitoring — regular follow-up labs, breast cancer risk assessment, and cardiovascular screening as indicated.
  • Whole-patient care — hormones are one piece. We also manage your thyroid, metabolic health, bone density, mood, and everything else. That's the advantage of getting HRT from your primary care physician.
  • Responsive communication — message your physician with questions about symptoms, dosing, or side effects.
  • Hindi, Urdu, Punjabi spoken — care in the language you're most comfortable with.

Frequently Asked Questions

For most women under 60 or within 10 years of menopause, the benefits of HRT outweigh the risks. The 2022 Menopause Society position statement and the Endocrine Society both support HRT for symptomatic women who are appropriate candidates. The old fears from the Women's Health Initiative (2002) have been largely revised — transdermal estradiol and micronized progesterone carry a much better safety profile than the older formulations studied in that trial.

The estradiol and micronized progesterone we prescribe are bioidentical — they're molecularly identical to what your body produces. The difference is that ours are FDA-approved, pharmacy-dispensed, and quality-controlled. Compounded "bioidentical" hormones from compounding pharmacies are not FDA-regulated, have inconsistent dosing, and lack safety data. We don't prescribe them.

No. Perimenopause is often when symptoms are worst — irregular cycles, hot flashes, insomnia, mood swings. HRT can be started during perimenopause to manage symptoms. We'll evaluate your hormone levels and symptoms to determine the right time and approach.

Yes. After your initial evaluation (telemedicine), most follow-up visits can be done via telemedicine. Lab work is done at local Quest Diagnostics sites in Granite Bay, Folsom, or El Dorado Hills and we review results together virtually.

There's no fixed timeline. Current guidelines say HRT should be continued as long as the benefits outweigh the risks, with periodic reassessment. Some women use HRT for a few years during the worst of their symptoms; others continue long-term for bone protection and quality of life. We reassess annually and adjust as needed.

Join With Your Partner

Hormonal changes affect both men and women in their 40s and 50s. Many of our members join as a couple — one on HRT, the other on testosterone replacement therapy. Having one physician who knows both of you makes coordination easier and ensures nothing falls through the cracks.

Mention your partner when you fill out the form below and we'll schedule you together.

Interested in Hormone Replacement Therapy?

Tell us a bit about you and we'll reach out within one business day.

Request an introduction Call (916) 512-1912