Bioidentical hormone replacement therapy in Bellingham.

For most healthy women initiating hormone replacement therapy in their early menopausal years using bioidentical hormones and modern delivery routes — transdermal estradiol with oral micronized progesterone — the modern evidence on safety is substantially more favorable than the 2002 WHI headlines suggested. The risks that exist (a small absolute increase in breast cancer with long-duration combined therapy, a venous thromboembolism signal that is much lower with transdermal than oral estrogen) are real and discussed openly in the screening visit. Hormone replacement therapy isn’t right for everyone — women with active hormone-sensitive cancers, untreated thromboembolic disease, or active liver disease are not candidates. We screen carefully, weigh individual risk-benefit, and prescribe accordingly.

The 2002 WHI trial tested a specific regimen — older oral synthetic estrogens with a synthetic progestin — in a population whose average age was 63, many of whom started therapy more than a decade after menopause. The trial reported a small increase in breast cancer in the combined-therapy arm and an unexpected absence of cardiovascular benefit. The headlines simplified the result into “hormone replacement therapy causes breast cancer and heart disease,” and prescribing collapsed for two decades. Reanalysis of the same data finds that the risk-benefit profile is substantially different for healthy women initiating bioidentical hormone replacement therapy in their early menopausal years using transdermal estradiol and oral micronized progesterone. The 2022 NAMS Position Statement and the 2024 reaffirmation reflect that updated reading. Estrogen Matters by Bluming and Tavris is one accessible synthesis of where the evidence has landed.

Compounded hormones are prescribed through Empower Pharmacy — one of the largest and most quality-controlled 503B compounding pharmacies in the country, with third-party purity testing and consistent formulation. Standard FDA-approved formulations (estradiol patches, micronized progesterone capsules, certain creams) are filled at your regular retail pharmacy when they’re the right delivery vehicle. We don’t over-compound when an FDA-approved option works as well.

Full hormone panel — estradiol, progesterone, testosterone (total and free), SHBG, DHEA-S, FSH, LH — plus full thyroid (TSH, free T3, free T4, reverse T3, TPO antibodies), fasting insulin, HbA1c, ApoB, Lp(a), and a complete metabolic and inflammation workup. All accessible at our negotiated Quest rates, typically 70–90% below retail. Most lab orders can be processed through your insurance if you prefer; we write the order, you choose how to fill it.

The consultation, lab review, follow-up, dose titration, refills, and physician supervision are included in concierge primary care membership ($300/month individual, $570/month couple). The hormones themselves are billed separately at member rates: bioidentical estradiol from $38/month, oral micronized progesterone from $27/month, compounded testosterone from $66 per 60-day supply, DHEA from $36 per 60-day supply, compounded thyroid from $49/month. The full pricing picture lives on this page — see the Pricing section above for detail.

Yes — testosterone pellets are available for women who prefer the cadence of quarterly insertion over daily cream. We discuss the trade-offs honestly: pellets give very stable serum levels and freedom from daily dosing, but the dose is committed for 3–4 months and can’t be adjusted mid-cycle. Most patients start with cream or troche and switch to pellets only after a steady-state dose is established. We do not pellet-dose estradiol — transdermal patch or cream is the preferred delivery route for estrogen.

There’s no fixed duration anymore. The old “lowest dose for the shortest time” framing was a WHI-era reflex. Current consensus from the North American Menopause Society is that for healthy women without contraindications, hormone replacement therapy can be continued for as long as the symptom relief and the quality-of-life benefit justify it — with periodic re-evaluation. Many patients stay on hormone replacement therapy for a decade or more. Some choose to taper. Some try a planned discontinuation at five or ten years and resume if symptoms return. The decision is iterative, and the conversation continues every year.

Yes. Men’s testosterone replacement therapy is offered as a separate program with its own baseline panel — total and free testosterone, SHBG, estradiol, LH, FSH, plus a full metabolic and cardiovascular workup. See the testosterone replacement therapy page for protocol detail and pricing.

Yes, in many scenarios. Progesterone-only therapy is often the right first step for women in early perimenopause whose primary symptoms are sleep disruption, anxiety, and heavy or irregular cycles — and it's an appropriate long-term option for women who can't or shouldn't take estrogen. Combined estrogen-plus-progesterone is added or substituted later when the clinical picture calls for it. The decision is individual: Dr. Scribner will review your symptoms, history, and labs and discuss which protocol fits.