Before you agree to hormone therapy, ask seven things: what my diagnosis is and what testing supports it, which exact product you are prescribing and whether it is FDA approved, how and how often you will monitor me, who performs the procedure, what the risks are given my history, what happens if it does not work, and how I stop. A clinician who answers all seven plainly is doing the job. One who turns every question into talk of optimization is selling, not prescribing.
Take this list to any clinic, including ours.
1. What is my diagnosis, and what testing supports it?
Hormone therapy treats defined conditions, not a general sense of being off.
For women, the recognised indications are vasomotor symptoms such as hot flashes and night sweats, genitourinary syndrome of menopause, and prevention of bone loss in appropriate candidates. The Menopause Society’s 2022 hormone therapy position statement calls hormone therapy the most effective treatment for those symptoms, and recommends that the decision be individualised by age and time since menopause, and re-evaluated periodically.
For men, the diagnosis is hypogonadism: consistent symptoms plus a low morning fasting total testosterone confirmed on more than one occasion. The Endocrine Society’s clinical practice guideline does not support diagnosing on a single borderline reading.
Here is the part nobody selling hormones volunteers. Fatigue, weight gain and low mood are real symptoms, and they are also non-specific ones. They are produced by poor sleep, iron deficiency, thyroid disease, depression, alcohol and a long list of medications. Hormones belong on that list, but they are not its default answer.
Ask which tests were actually used. ACOG’s 2023 clinical consensus on compounded bioidentical menopausal hormone therapy notes that there are no FDA-approved salivary or urinary tests for measuring steroid hormones, and that evidence for using them to guide prescribing and dosing is limited, so they are not recommended for that purpose. We broke down what a proper workup covers in what a full hormone panel actually measures.
2. Which exact product, and is it FDA approved?
Ask for the name, the form and the approval status.
Compounded hormones are not FDA approved. As the FDA puts it in its guidance on compounded drugs, the agency does not verify the safety, effectiveness or quality of these products before they reach patients. When the FDA commissioned the National Academies to review compounded bioidentical hormones, the resulting report found a lack of rigorous evidence of safety and effectiveness from well-designed studies.
That does not make compounding illegitimate. There are sound reasons for it, including a documented allergy to an ingredient in an approved product, or a dose that is not commercially manufactured. Those are the reasons to hear. “Compounded means natural, and natural means safer” is not one of them.
3. How will you monitor me, and how often?
Monitoring separates a serious prescriber from a subscription.
For men on testosterone, the Endocrine Society guideline advises checking hematocrit at baseline and again at three to six months, stopping therapy if it rises above 54 percent, and assessing prostate cancer risk before starting and again three to twelve months in. Symptoms, testosterone level and blood pressure get reviewed alongside that.
For women, the Menopause Society frames it as periodic re-evaluation of whether the benefits still outweigh the risks for you, which changes with age.
Ask for the actual cadence in writing. If nobody can tell you when your next blood draw is, there is no monitoring plan.
Regulation moves too. In 2025 the FDA issued class-wide labeling changes for testosterone products after reviewing the TRAVERSE trial, removing boxed warning language about increased cardiovascular risk, keeping the limitation of use for age-related hypogonadism, and adding product-specific information on blood pressure. Your prescriber should be able to explain what that means for you.
4. Who performs the procedure, and what do the guidelines say about pellets?
If pellets are proposed, ask who inserts them, how many they have placed, and what happens if you react badly.
Then hear the limitation, because it is a real one. ACOG recommends preparations other than pellet therapy for delivering testosterone, citing the lack of safety data and the fact that a pellet cannot be removed once it is in. Adverse events reported in connection with compounded hormone pellets include endometrial cancer, stroke, heart attack, deep vein thrombosis, cellulitis and pellet extrusion.
Convenience is a real benefit for people who will not stick with a daily gel. But a clinician who offers pellets without mentioning that a major professional body advises against them for testosterone is not giving you what you need to consent.
5. What are the risks for someone with my history?
This should be a personal answer, not a leaflet. The Endocrine Society advises against starting testosterone in men with an elevated hematocrit, breast or prostate cancer, untreated severe sleep apnea, severe lower urinary tract symptoms, uncontrolled heart failure, thrombophilia, or a recent heart attack or stroke.
For estrogen therapy, the calculation turns on your age, how long since your final period, and your clotting, cardiac and breast history.
Bring your medication list and family history. If the risk conversation lasts thirty seconds, it did not happen.
6. What happens if it does not work, and 7. how do I stop?
Ask what timeline to expect before judging results, what the plan is if symptoms do not improve, and when the diagnosis gets revisited rather than the dose raised again. We set out realistic timelines in how long hormone therapy takes to work.
Then ask about stopping. Gels, patches, pills and injections can be discontinued. A pellet cannot. Testosterone also suppresses sperm production, which matters if you may want children.
Red flags worth walking out over
- A diagnosis made from a saliva or urine kit alone
- A treatment plan set before baseline results are back
- No scheduled follow-up
- A clinician who cannot name the product or its approval status
- Any promise of a specific number on the scale
- The claim that everyone your age needs this
Get urgent care, not a follow-up appointment
Chest pain, shortness of breath, swelling or pain in one calf, sudden severe headache, vision changes, weakness on one side, or unexpected vaginal bleeding after menopause. These need assessment now, not at your next visit.
If you are weighing hormone therapy in Florida, our hormone therapy service page explains how we test, prescribe and monitor.
Medically reviewed by Krishna Borges, MSN, APRN, FNP-C. This article is for general education and is not a substitute for individual medical advice.