BHRT for Women Over 40: What It Costs, What Is Included, and Your First Three Months

Start here if you are earlier in the decision. This page is about money, logistics and timeline. If you are still working out whether hormone therapy is right for you at all — the symptom picture, the timing window, what the evidence does and does not support — read our main guide first: Hormone Therapy for Women Over 40: When to Start, What to Expect, and Why It Matters. Come back here when you want the numbers.

The short version. The first visit is $35, applied toward your treatment plan. The ongoing BHRT programme is $299 per month and includes your consultations, your medication, and four B12 and four Lipo injections per year. Labs are billed separately through LabCorp or Quest. Expect a baseline panel, a start date, a recheck at 4 to 6 weeks, and a fuller reassessment at around three months.

What the BHRT Programme Costs

The first visit: $35

Your first visit is a clinical conversation, not a sales appointment. It costs $35 and that $35 is applied toward your treatment plan. In that visit we take a full history, talk through what you are actually experiencing, review personal and family medical history, and decide together which labs are worth drawing. Nobody is asked to commit to a programme in the first visit.

The ongoing programme: $299 per month

Arbour Longevity's BHRT programme for women is $299 per month on an ongoing basis. That monthly fee covers:

• Your consultations and follow-up visits, in-office in Ann Arbor or by telehealth anywhere in Michigan
• Your prescribed hormone medication
• Four B12 injections and four Lipo injections per year
• Review and interpretation of your follow-up labs, and dose adjustments as your body responds

What is billed separately

• Laboratory work. Labs are ordered through LabCorp or Quest Diagnostics and billed by the lab, not by us. Depending on your insurance plan, some or all of a panel may be partially covered even though the clinic itself is cash-pay.
• Procedures outside the standard programme, such as additional in-office treatments you choose to add.

How payment works

The clinic operates on a cash-pay basis. That is a deliberate choice: it buys longer appointments and lets treatment decisions follow clinical judgement rather than an insurance formulary. HSA and FSA funds are accepted, and detailed receipts are available if you want to pursue out-of-network reimbursement.

Before You Start: The Baseline Visit and Lab Panel

Nothing is prescribed off a symptom list alone. A baseline panel typically covers total and free testosterone, estradiol, progesterone, a full thyroid picture including free T3, free T4 and reverse T3, DHEA-S, AM cortisol, pregnenolone, SHBG, and the relevant metabolic and inflammatory markers. If you want the detail on what each of those markers means and how often we recheck them, we go through it in our guide to hormone lab testing and monitoring.

One expectation worth setting now, because it shapes everything that follows: systemic estrogen is titrated to your symptoms and your tolerance, not to a target number on a lab slip. Levels confirm absorption and check for unintentionally high exposure. Testosterone is the marker we do watch closely against a range, with the goal of keeping concentrations within the physiologic premenopausal range rather than above it, in line with the International Society for the Study of Women's Sexual Health clinical practice guideline (Parish et al., J Sex Med, 2021, DOI).

Your First Three Months, Week by Week

Individual responses vary, and your provider will track yours specifically rather than assume the average. That said, here is the shape of a typical first twelve weeks.

Weeks 0 to 2: starting

You begin your protocol. If you have chosen pellets, that is a single in-office insertion; creams and injections start at home. Most women notice very little in the first ten days, and that is normal — this is the point at which people most often assume it is not working. Keep a simple daily note on sleep, mood and hot flashes; it becomes the most useful thing in the room at your first follow-up.

Weeks 2 to 4: the first signals

Sleep and vasomotor symptoms usually move first. Systemic estrogen reduces the frequency of hot flashes and night sweats by roughly 75 percent, with oral and transdermal routes similarly effective (Crandall et al., JAMA, 2023, DOI). Where vaginal dryness or discomfort is part of the picture, low-dose vaginal estrogen improves symptom severity by approximately 60 to 80 percent, and it works on its own timeline — often four to eight weeks (Crandall et al., 2023, DOI). Energy usually follows sleep rather than leading it.

Weeks 4 to 6: the first recheck

This is the appointment that matters most. For pellet therapy specifically, a follow-up lab is scheduled 4 to 6 weeks after insertion to confirm you have reached your optimal range. For creams and injections the recheck lands in the same window. We compare what your labs show against what your notes say, and adjust. Roughly speaking, expect an adjustment more often than not — the first dose is a well-informed starting point, not a final answer.

Weeks 6 to 12: the substantive changes

Libido, body composition and cognitive clarity typically become evident in this window rather than earlier. Testosterone in particular takes six to twelve weeks for full effect. Body composition changes are the slowest of the group and depend heavily on what else you are doing: hormones preserve the muscle that resistance training builds, they do not replace the training.

Around month three: the reassessment

By twelve weeks there is enough signal to make a real judgement. We review symptoms against baseline, repeat the relevant labs, and decide whether to hold, adjust, add or stop. Continuing is a decision that gets made again, not a default — the 2022 Menopause Society position statement is explicit that therapy should be individualized with periodic reevaluation of whether to continue (Menopause, 2022, DOI). Any unscheduled or postmenopausal bleeding is evaluated at any point, regardless of what your labs show.

Delivery Method: What It Changes About Cost and Visit Cadence

The clinical differences between delivery methods matter, but for planning purposes the practical difference is how often you come in.

Pellet therapy. A rice-grain-sized bioidentical pellet is inserted just beneath the skin, usually in the upper hip area, in a procedure that generally takes under 15 minutes. After a local anesthetic a small incision is made, the pellet is placed, and the site is closed with steri-strips — no stitches. Most patients return to normal activity the same day with light restrictions for 24 to 48 hours. Pellets last 3 to 6 months for women, so most patients need 2 to 4 in-office maintenance visits per year. This is the option that requires the fewest touches and no daily routine.

Topical creams. Applied daily at home. Flexible dosing and easy to titrate between visits, which suits women who want to fine-tune month to month. No procedure visits required.

Injections. Intramuscular or subcutaneous testosterone cypionate, self-administered at home after training. Precise dosing and consistent levels; visit cadence is similar to creams.

Oral and sublingual options. Available for certain hormones depending on your protocol and goals.

There is no universal best option. A woman with a demanding travel schedule often prefers the set-and-forget quality of pellets, since one insertion covers months. Someone who wants to adjust frequently usually prefers a cream.

What Happens After Month Three

Full optimization generally lands somewhere between three and six months, as adjustments accumulate. After that the pattern settles: periodic labs, 2 to 4 maintenance visits a year for pellet patients, fewer for cream and injection patients, and a standing review of whether continuing still makes sense for you. The monthly programme fee does not change with the season or with how well you are doing.

Longer-term, hormone work sits inside a broader plan. Many patients layer it with hormone optimization follow-through, nutrition and resistance training, and in some cases peptide therapy. None of that is required, and none of it is bundled into the $299.

Getting Here

Arbour Longevity is at 2217 Packard St #15, in the Eastover Professional Center, Ann Arbor, MI 48104. We are open Thursday through Monday, 10am to 7pm, closed Tuesday and Wednesday. Parking is free and directly outside — no meters, no structure. Suite 15 is down a flight of stairs; if stairs are difficult for you, please call (734) 436-3357 before your visit so we can make arrangements.

Initial and follow-up consultations are available by telehealth for patients throughout Michigan. Procedures that require an in-person visit, such as pellet insertion, are performed at the Ann Arbor clinic.

Frequently Asked Questions About BHRT Cost and Timeline

What does the first visit cost? $35, applied toward your treatment plan.

What is the ongoing cost? $299 per month, including consultations, medication, and four B12 and four Lipo shots per year. Labs are billed separately by LabCorp or Quest.

Are labs included in the $299? No. Lab work is ordered through LabCorp or Quest and billed by the lab. Depending on your plan, part of a panel may be covered by insurance even though the clinic is cash-pay.

Do you take insurance? The clinic is cash-pay. HSA and FSA funds are accepted, and detailed receipts are available for potential out-of-network reimbursement.

How soon will I feel something? Sleep and hot flashes usually move first, commonly within 2 to 4 weeks. Libido, body composition and cognitive clarity typically become evident at 6 to 12 weeks. Full optimization is generally a 3 to 6 month process.

How many appointments are in the first three months? Typically three: the $35 first visit, the start-of-treatment visit, and the 4 to 6 week recheck — plus a reassessment at around month three.

How long do hormone pellets last? Pellets typically last 3 to 6 months for women, depending on individual metabolism, which usually works out to 2 to 4 maintenance visits per year.

Does pellet insertion hurt? The procedure is typically under 15 minutes with a local anesthetic, closed with steri-strips rather than stitches. Most patients return to normal activity the same day with light restrictions for 24 to 48 hours.

Can I do this entirely by telehealth? Consultations, yes, anywhere in Michigan. Pellet insertion requires an in-person visit in Ann Arbor. Creams and injections can be managed remotely.

What if it is not working at three months? Then we say so and change the plan. Continuing is reviewed at every reassessment rather than assumed.

Take the Next Step

If you have read this far, the question you are weighing is probably whether the money and the appointments are worth it for you specifically. The honest answer is that it depends on what your baseline looks like, and the cheapest way to find that out is the $35 first visit.

Arbour Longevity offers a free two-minute Hormone Score Quiz if you would like a sense of whether your symptoms point toward a hormonal root cause before you book. Serving Ann Arbor, Dexter, Saline, Ypsilanti, and Southeast Michigan, with telehealth statewide. Book your $35 first visit or call (734) 436-3357.

Arbour Longevity · 2217 Packard St #15, Ann Arbor, MI 48104 · (734) 436-3357 · arbourlongevity.com

References

According to PubMed, the clinical evidence cited on this page includes:

1. Crandall CJ, Mehta JM, Manson JE. Management of Menopausal Symptoms: A Review. JAMA. 2023;329(5):405-420. PMID: 36749328. DOI: 10.1001/jama.2022.24140
2. Parish SJ, Simon JA, Davis SR, et al. International Society for the Study of Women's Sexual Health Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women. J Sex Med. 2021;18(5):849-867. PMID: 33814355. DOI: 10.1016/j.jsxm.2020.10.009
3. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794. PMID: 35797481. DOI: 10.1097/GME.0000000000002028

Pricing described here is current at the date of review and may change. Clinical information is drawn from articles retrieved from PubMed and provided for education. It is not medical advice, a diagnosis, or a promise of any result.

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