Winona vs. Evernow vs. Alloy: Compounded DHEA/Estrogen Creams vs. FDA-Approved Patches & True 12-Month Prescription Math

01How direct-to-consumer HRT platforms work

All three companies follow the same basic flow: you complete an online health questionnaire, a licensed clinician in your state reviews it (sometimes with a short video or message exchange), and the prescription ships to your door or to a pharmacy. You pay one monthly price that bundles clinician access and, in most plans, the medication. There is usually no membership fee on top and no in-person exam.

What separates them is the product shelf.

Winona

Winona is best known for compounded bioidentical creams — estradiol body cream and other topical formulas mixed by a compounding pharmacy — plus FDA-approved estradiol patches and progesterone. Its published pricing has been roughly $54–$89 a month for estrogen cream, about $39 a month for progesterone and around $149 a month for patches. The formula of each compounded product is set by the prescriber and pharmacy, not by an FDA-approved label.

Evernow

Evernow focuses on FDA-approved hormone therapy — estradiol as patches, pills or gel, and oral micronized progesterone — plus non-hormonal options, delivered through a subscription. Published plans have generally bundled clinician access and medication, often between about $35 and $100 a month depending on commitment length and product. Evernow’s pricing and insurance options have changed over time, so check the current plan page.

Alloy

Alloy offers FDA-approved estradiol (patch, pill, gel), progesterone and vaginal estrogen, plus its own non-prescription and prescription skin products. Its published prescription pricing has typically fallen between about $40 and $120 a month per product combination, with some plans charging a one-time intake fee.

The model works well when your case is straightforward. It works less well when you have abnormal bleeding, a history of blood clots, breast cancer, migraine with aura, or complex conditions such as endometriosis or PCOS, which need an examining clinician.

02Head-to-head prescription price ledger

Prices below are each company’s typical published ranges in 2026 plus IntegrativeGyn.com estimates for the insurance route. The highlighted column — FDA-approved generics through your own pharmacy benefit — is usually the lowest 12-month cost for the same active hormones.

Table 1 · Company figures are typical published prices and change often; insurance-route figures are IntegrativeGyn.com estimates for a commercial plan with a met or low deductible. Confirm before you buy.

Two notes on reading the table. First, Winona’s range is higher because it combines a separate estrogen and progesterone charge; the patch-plus-progesterone path runs about $188 a month. Second, the insurance column includes one or two clinician visits a year; if your deductible is high and unmet, add $150–$300 per visit until you meet it.

03Compounded DHEA and estrogen creams vs FDA-approved patches

The most important clinical difference between these platforms is not price — it is whether the hormone you receive is an FDA-approved product with a fixed, tested dose or a compounded preparation.

FDA-approved bioidentical options

Estradiol patches (generic versions of Climara, Vivelle-Dot, Minivelle and others), estradiol gels and oral micronized progesterone are chemically identical to the hormones your ovaries make. They are “bioidentical” and FDA-approved, with labeled doses, manufacturing standards and decades of safety data. Transdermal estradiol avoids first-pass liver metabolism, and observational data suggest a lower blood-clot risk than oral estrogen.

Compounded creams

Compounded estradiol, estriol or DHEA creams are mixed by a pharmacy for an individual prescription. They are not FDA-approved, which means no FDA review of dose consistency, absorption or long-term safety. Skin absorption of creams varies with application site, amount and skin, so blood levels can be less predictable than with a patch. A 2020 National Academies report concluded there is insufficient evidence to support the safety and effectiveness of most compounded bioidentical hormone preparations and recommended reserving them for patients who cannot use an approved product.

Progesterone: the safety point that matters most

If you have a uterus and use systemic estrogen, you need a progestogen to protect the uterine lining. Oral micronized progesterone is the FDA-approved bioidentical option. Progesterone creams have not been shown to reliably protect the endometrium. If any platform offers progesterone as a cream, ask how endometrial protection is ensured and what happens if you bleed.

DHEA

The only FDA-approved DHEA product for menopause is prasterone vaginal inserts (Intrarosa), approved for painful intercourse due to menopause. Compounded DHEA creams and oral DHEA supplements are not approved for menopause symptoms.

For a deeper look at price and dosing differences, read compounded BHRT vs FDA-approved bioidentical hormones.

04True 12-month prescription math

Monthly prices look small; annual totals do not. Here is the same treatment goal — systemic estradiol plus progesterone for someone with a uterus — priced five ways over 12 months.

1. Winona compounded cream + progesterone — $1,116–$1,536. $54–$89 cream plus $39 progesterone, every month, no insurance offset.
2. Winona patch + progesterone — about $2,256. Roughly $149 plus $39 a month.
3. Evernow plan — about $420–$1,200. Depends on commitment length and product; check whether medication is fully included.
4. Alloy — about $480–$1,490. $40–$120 a month plus any one-time intake fee.
5. Generic patch + oral progesterone via insurance — $430–$1,240. $15–$45 a month in copays ($180–$540) plus one or two visits ($250–$700 depending on copay or deductible).

Cash without insurance

If you have no pharmacy coverage, generic estradiol patches often run $30–$90 a month with a discount card and generic progesterone $15–$40, so $540–$1,560 a year before visit costs. Pair that with a self-pay telehealth visit or two and you land close to the subscription range, with the advantage of choosing your pharmacy.

HSA and FSA

Prescription hormones are qualified medical expenses, so you can pay any of these routes with HSA or FSA funds. That saves your marginal tax rate (often 22%–32%) whichever channel you pick, so it does not change the ranking.

05What an online intake can and cannot screen

An asynchronous questionnaire can safely start HRT for many people, because the main contraindications are found in your history rather than on an exam. But it relies on you knowing and reporting that history accurately, and it cannot examine you.

What a good intake asks

• Personal history of breast or endometrial cancer, blood clots, stroke, heart attack or liver disease.
• Migraine with aura, smoking status and current blood pressure.
• Your bleeding pattern: date of last period, any bleeding after 12 months without a period, and heavy or irregular bleeding.
• Date of your last mammogram and cervical screening.
• Current medications, including anything that interacts with estrogen.

What it cannot do

It cannot perform a pelvic or breast exam, order a transvaginal ultrasound, or take an endometrial biopsy. Any bleeding after menopause needs prompt in-person evaluation, and a virtual platform will refer you out. That visit is billed separately, often as a new-patient gynecology visit (99203–99204) plus an ultrasound (76830) or biopsy (58100), so keep a local gynecologist in your plan even if you buy hormones online.

When labs matter

Hormone levels are not needed to diagnose menopause after 45 with typical symptoms, and they are not useful for dosing standard estradiol. Blood tests do matter if you are under 45 (to rule out thyroid disease, pregnancy or primary ovarian insufficiency), if symptoms are atypical, or if you start testosterone, which requires baseline and follow-up total testosterone levels. A basic panel through your insurance lab with N95.1 or another code matching your symptoms usually costs far less than a cash bundle; see the lab panel cost builder to price one.

06Hidden costs and subscription questions

Direct-to-consumer subscriptions are simple to start and easy to forget. These are the questions that change your real cost.

• Auto-refill and billing cadence. Most plans auto-ship and auto-charge. Ask how far ahead you must cancel to stop the next shipment, and whether quarterly or annual plans are refundable.
• Dose changes. Ask whether a dose adjustment or product switch is included, or whether it starts a new plan at a new price.
• Separate charges. Some plans price estrogen, progesterone and vaginal products separately. Add them together before comparing.
• Labs and screening. Platforms typically ask you to self-report blood pressure and recent mammogram status. If they require labs, ask who orders them and whether your insurance lab can be used.
• Bleeding protocol. Ask what happens if you have unexpected bleeding: who evaluates you, and whether you must see a local clinician at your own cost for an ultrasound or biopsy.
• Prescription portability. FDA-approved prescriptions can usually be transferred to your local pharmacy and run through insurance. Compounded prescriptions are tied to a compounding pharmacy.
• State coverage. Each company is licensed state by state; moving can interrupt refills.

Ask for this in writing

Please confirm the full monthly price for every product in my plan, whether my prescription is FDA-approved or compounded, how many days before renewal I must cancel, and whether you will send an FDA-approved prescription to my own pharmacy if I want to use my insurance.

If a clinic instead recommends hormone pellets, compare the 3-year cost on our pellets vs patches page before you commit.

07Who should choose which

Choose Evernow or Alloy if…

• You want FDA-approved estradiol and progesterone without scheduling a visit, and you have a straightforward history.
• Your insurance has a high unmet deductible, so a bundled $35–$120 monthly price is predictable.
• You want vaginal estrogen added for dryness or painful sex.

Choose Winona if…

• You specifically want a compounded cream and understand it is not FDA-approved, or you prefer one vendor for several topical products.
• You are comfortable paying a higher monthly price without insurance coverage.

Use your insurance and a clinician instead if…

• You have pharmacy coverage: generics through your plan are usually the cheapest route to the same hormones.
• You are under 45, have irregular or heavy bleeding, any bleeding after menopause, a history of clots, stroke, breast cancer or liver disease, or migraine with aura.
• You have PCOS, endometriosis, thyroid disease or other conditions that need a fuller workup. See Midi vs Tia vs Parsley for insurance-billed telehealth, or our perimenopause protocol for a complete plan.
• Testosterone is your priority. There is no FDA-approved testosterone product for women in the US, it is a Schedule III controlled substance, and it needs blood-level monitoring that subscription platforms may not offer.

Whichever route you choose, schedule an annual review of your dose, blood pressure, breast screening and bleeding pattern. Our menopause longevity protocol lists the checks worth doing each year.

This comparison is educational and not individual medical advice; discuss treatment choices with your clinician.