Estradiol
Brand names: Estrace, Climara, Vivelle-Dot, Minivelle, Divigel, EstroGel, Elestrin, Evamist, Vagifem, Imvexxy, Estring, Femring, Bijuva. Also called 17β-estradiol, E2, estrogen, bioidentical estradiol, menopause hormone therapy.
Estrogen (17β-estradiol) 8 graded human studies Last checked
The short answer
From 28 sourcesEstradiol is the main estrogen the ovaries make before menopause. As a medicine it comes as pills, skin patches, gels, a spray and vaginal tablets, creams and rings. It is the most effective treatment for hot flashes, protects bone, and treats vaginal dryness; anyone with a uterus who uses it systemically also takes a progestogen.
Key facts
Which estradiol products are approved, and for what?
Estradiol pills, patches, gels, spray, vaginal products and the Bijuva capsule are FDA-approved prescription drugs. Boxed warnings now differ by product: after the FDA's February 2026 relabeling, Divigel and generic 0.1% gels keep only the endometrial-cancer warning, Estring and Bijuva carry none, and most other estradiol labels still carry the full warning.
Status by form
8 forms| Form | Status | Approved for | Boxed warning |
|---|---|---|---|
| Oral tablets (0.5, 1, 2 mg)Estrace, generics | FDA-approved prescription drug1 | Hot flashes; vaginal atrophy; low estrogen from hypogonadism, ovary removal or primary ovarian failure; prevention of osteoporosis; palliative treatment of some breast and prostate cancers | Yes: endometrial cancer, cardiovascular disorders, breast cancer and probable dementia (current generic label) |
| Skin patchesClimara, Vivelle-Dot, Minivelle, Menostar, generics | FDA-approved prescription drugs23 | Hot flashes; vaginal atrophy; low estrogen from hypogonadism, ovary removal or primary ovarian failure; prevention of osteoporosis | Yes: endometrial cancer, cardiovascular disorders, probable dementia and breast cancer |
| Gel 0.1% (Divigel and generic 0.1% gels)Divigel, generics | FDA-approved prescription drugs45 | Moderate to severe hot flashes of menopause | Endometrial cancer with unopposed estrogen only; the cardiovascular, breast cancer and dementia items were removed in February 2026 |
| Other gels and sprayEstroGel, Elestrin, Evamist | FDA-approved prescription drugs678 | Hot flashes (EstroGel also vaginal atrophy) | Yes: full warning (Evamist adds unintentional secondary exposure to children and pets) |
| Low-dose vaginal ringEstring | FDA-approved prescription drug9 | Moderate to severe vaginal atrophy symptoms of menopause | None on the current label |
| Vaginal inserts, cream and systemic ringVagifem, Yuvafem, Imvexxy, Estrace cream, Femring | FDA-approved prescription drugs10111213 | Vaginal atrophy or painful sex from menopause; Femring also hot flashes | Yes: full warning on current labels |
| Estradiol plus progesterone capsuleBijuva | FDA-approved prescription drug14 | Moderate to severe hot flashes in women with a uterus | None on the current label |
| Compounded estradiol and estradiol-estriol creams ("Biest") | Made by compounding pharmacies; not FDA-approved. ACOG: should not be prescribed routinely when approved forms exist1516 | None | No FDA label |
What is estradiol and how does it work?
Estradiol binds estrogen receptors throughout the body. Falling estradiol at menopause drives hot flashes, bone loss and thinning of vaginal tissue, and replacing it reverses much of that. Taken by mouth it passes through the liver first, which raises clotting factors and binding proteins; through the skin or vagina it largely bypasses that first pass.
How it works
Estrogen (17β-estradiol)Estradiol activates estrogen receptors in the brain's temperature centre, bone, vaginal and urinary tissue, breast and uterus. Restoring it after menopause damps hot flashes, slows bone loss and rebuilds vaginal tissue, but it also stimulates the uterine lining, which is why a progestogen is added when a uterus is present. Oral estradiol passes through the liver first and raises binding proteins and clotting factors; skin and vaginal forms largely avoid that.1415
What doses are on the label and in studies?
Labels start low and adjust to symptoms: 1 to 2 mg a day for pills, 0.025 to 0.0375 mg a day for patches, 0.25 mg a day for the lowest gel, and 4 to 10 mcg inserts twice weekly for vaginal symptoms. These are label amounts, not a dose for any one person; a prescriber sets that and reviews it.
Label and study amounts, not a dose for you. A prescriber decides whether and how much; these show what the labels print and what trials used.
Doses by use
12 rows| Use | Form | Amount and schedule | Basis |
|---|---|---|---|
| Hot flashes (menopause) | Oral tablets | Usual starting range 1 to 2 mg daily, adjusted to symptoms; the label describes cyclic use (e.g. 3 weeks on, 1 week off)1 | Label |
| Hot flashes (menopause) | Patch (Climara, once weekly) | Start at 0.025 mg/day; strengths 0.025 to 0.1 mg/day2 | Label |
| Hot flashes and vaginal atrophy | Patch (Vivelle-Dot, twice weekly) | Start at 0.0375 mg/day; 0.025 mg/day for osteoporosis prevention3 | Label |
| Hot flashes (menopause) | Gel 0.1% (Divigel) | Start with 0.25 g (0.25 mg estradiol) once daily on the thigh; range 0.25 to 1.25 g4 | Label |
| Hot flashes and vaginal atrophy | Gel 0.06% (EstroGel) | 1.25 g (0.75 mg estradiol, one pump) daily to the arm6 | Label |
| Hot flashes (menopause) | Spray (Evamist) | One spray (1.53 mg) daily to the forearm, up to 2 to 3 sprays8 | Label |
| Vaginal atrophy | Vaginal insert (Vagifem 10 mcg) | 1 insert daily for 2 weeks, then twice weekly10 | Label |
| Painful sex from vaginal atrophy | Vaginal insert (Imvexxy 4 or 10 mcg) | Start with 4 mcg daily for 2 weeks, then twice weekly11 | Label |
| Vaginal atrophy | Vaginal ring (Estring) | One ring releasing about 7.5 mcg a day, left in place for 3 months9 | Label |
| Vaginal atrophy | Vaginal cream 0.01% (Estrace) | 2 to 4 g daily for 1 to 2 weeks, then lower; maintenance 1 g one to three times a week12 | Label |
| Hot flashes and vaginal atrophy | Systemic vaginal ring (Femring) | Start at 0.05 mg/day; each ring lasts 3 months13 | Label |
| Hot flashes, uterus present | Estradiol plus progesterone capsule (Bijuva) | Start with 0.5 mg estradiol / 100 mg progesterone each evening14 | Label |
What is estradiol combined with?
Estradiol is paired with a progestogen when a uterus is present, to protect its lining; without a uterus it is used alone. Skin forms appear to carry less clot risk than pills in observational data. Low-dose vaginal estradiol needs no progestogen, and estrogen pills can raise the thyroid hormone dose someone needs.
Estradiol plus a progestogen, when you have a uterus
Estrogen alone overgrows the uterine lining.
The estradiol tablet label says a progestin should also be started for a postmenopausal woman with a uterus to reduce endometrial cancer risk, and that a woman without a uterus does not need one. The Menopause Society calls this protection Level I evidence; oral micronized progesterone is one option, and Bijuva combines both in one capsule.115414
Checked: Unexplained or persistent bleeding is investigated, including endometrial sampling when indicated.
Estrogen alone, after a hysterectomy
Without a uterus there is no lining to protect.
In WHI's estrogen-alone trial of 10,739 women without a uterus, conjugated estrogens raised stroke (HR 1.39) and cut hip fractures (HR 0.61). Over 20 years of follow-up, breast cancer was lower than on placebo (238 vs 296 cases, HR 0.78) and so were breast cancer deaths (HR 0.60). WHI tested conjugated estrogens, not estradiol.1718
Skin vs pill: clots and liver effects
Estradiol through the skin skips the liver's first pass.
In the French ESTHER case-control study, oral estrogen carried an odds ratio for venous clots of 4.2 and transdermal estrogen 0.9. The Endocrine Society recommends a non-oral route at the lowest effective dose for women at higher clot risk. In KEEPS, transdermal estradiol lowered insulin resistance while oral conjugated estrogens raised CRP; neither changed blood pressure.192322
Low-dose vaginal estradiol on its own
Vaginal tablets, creams and the Estring ring treat dryness and painful sex with little reaching the bloodstream.
A Cochrane review of 30 trials (6,235 women) found vaginal estrogens improve atrophy symptoms with no clear difference between preparations. The Menopause Society says no progestogen is needed with low-dose vaginal estrogen. In WHI's observational cohort of 45,663 women, users had no higher rate of stroke, breast, colorectal or endometrial cancer, or clots.241525
Estradiol with levothyroxine
Oral estrogen raises the protein that carries thyroid hormone in the blood.
The estradiol tablet label says patients on thyroid replacement may need higher doses; the Divigel label advises monitoring thyroid function. The Synthroid label lists oral estrogens among drugs that raise thyroxine-binding globulin.1426
Checked: Thyroid tests after starting or changing estrogen.
When estradiol is started
Age and years since menopause change the balance of benefit and risk.
The Menopause Society says the balance is favourable for women under 60 or within 10 years of menopause who have bothersome hot flashes or bone loss risk. In ELITE (643 women), oral estradiol 1 mg slowed carotid artery thickening in women under 6 years past menopause but not in those 10 or more years past it.1521
How does estradiol relate to fertility and pregnancy?
Estradiol is not a fertility drug in these labels, but pills and patches are labelled for low estrogen caused by hypogonadism, removal of the ovaries or primary ovarian failure, which includes early menopause. Those are uses where replacing estrogen to normal levels is the goal rather than treating symptoms after natural menopause.
Fertility, pregnancy and breastfeeding
What gets checked during treatment?
Blood estradiol and FSH levels are not used to set the dose: labels and The Menopause Society say symptoms guide it. What labels do ask for is a review every 3 to 6 months, regular blood pressure checks, mammograms by age and risk, investigation of unexplained bleeding, and thyroid tests in anyone on thyroid hormone.
Monitoring
6 checks| Check | When | Why |
|---|---|---|
| Need for therapy | Reevaluate at 3- to 6-month intervals and try to taper or stop (tablet, Femring and Bijuva labels); newer labels say periodically11314 | Use the lowest effective dose for as long as it is needed |
| Blood estradiol and FSH | Not used to set the dose; serum testing is rarely needed, saliva and urine tests are unreliable1415 | Symptoms guide dosing |
| Blood pressure | At regular intervals14 | Rare large rises have been reported as idiosyncratic reactions |
| Breast exam and mammogram | Scheduled by age, risk and prior results1415 | Estrogen can increase breast density and abnormal mammograms |
| Unexplained vaginal bleeding | Whenever it occurs4 | Rule out endometrial cancer, including sampling when indicated |
| Thyroid tests | After starting or changing estrogen, in anyone on thyroid hormone14 | Higher thyroid-binding globulin can change the dose needed |
What does the research show?
Nine graded rows from eight trials and reviews. Oral estrogen cut hot flashes by about 75% in a 24-trial Cochrane review, and estrogen reduced fractures in WHI. In WHI's estrogen-alone trial, stroke rose while breast cancer fell over 20 years. Starting early slowed artery thickening in ELITE but not in women 10 or more years past menopause.
Every graded row
9 rows from 8 studiesShowing 9 of 9 outcomes. Human trials only.
AGrade AHot flash frequencyHot flashesImprovedMeta-analysis · 24 studies
n 3,329 · 2004
Weekly hot flashes fell by about 75% more than placebo (95% CI 64% to 82%); severity also fell (OR 0.13).
- Design
- Meta-analysis, 24 studies, n = 3,329, 2004
- Population
- Postmenopausal women in 24 randomized trials
- Form
- Oral estrogen, with or without progestogen
- Dose
- Various oral doses
- Duration
- 3 months to 3 years
- Source
- Reference 20 · PubMed 15495039 (opens PubMed)
BGrade BAll-cause mortality, 18 yearsMortalityNo effectRCT
n 27,347 · 2017
No difference in death from any cause (estrogen alone HR 0.94, 0.88 to 1.01).
- Design
- RCT, n = 27,347, 2017
- Population
- Both WHI hormone trials
- Form
- Conjugated equine estrogens alone, or with MPA
- Dose
- CEE 0.625 mg/day ± MPA 2.5 mg/day
- Duration
- 18 years cumulative
- Source
- Reference 27 · PubMed 28898378 (opens PubMed)
BGrade BHip fractureBoneImprovedRCT
n 10,739 · 2004
Hip fractures fell (HR 0.61, 0.41 to 0.91) and all fractures fell (HR 0.70).
- Design
- RCT, n = 10,739, 2004
- Population
- Women aged 50 to 79 without a uterus (WHI)
- Form
- Conjugated equine estrogens (not estradiol)
- Dose
- 0.625 mg/day
- Duration
- 6.8 years average
- Source
- Reference 17 · PubMed 15082697 (opens PubMed)
BGrade BStrokeHeart and strokeWorsenedRCT
n 10,739 · 2004
Stroke rose (HR 1.39, 1.10 to 1.77), about 12 more strokes per 10,000 person-years.
- Design
- RCT, n = 10,739, 2004
- Population
- Women aged 50 to 79 without a uterus (WHI)
- Form
- Conjugated equine estrogens (not estradiol)
- Dose
- 0.625 mg/day
- Duration
- 6.8 years average
- Source
- Reference 17 · PubMed 15082697 (opens PubMed)
BGrade BBreast cancer, 20-year follow-upBreastImprovedRCT
n 10,739 · 2020
Fewer breast cancers than placebo (238 vs 296 cases, HR 0.78) and fewer breast cancer deaths (HR 0.60).
- Design
- RCT, n = 10,739, 2020
- Population
- WHI estrogen-alone trial participants
- Form
- Conjugated equine estrogens (not estradiol)
- Dose
- 0.625 mg/day
- Duration
- Median 20 years of follow-up
- Source
- Reference 18 · PubMed 32721007 (opens PubMed)
BGrade BVaginal atrophy symptomsVaginal healthImprovedMeta-analysis · 30 studies
n 6,235 · 2016
Vaginal estrogens improved atrophy symptoms more than placebo (low-quality evidence), with no clear difference between preparations.
- Design
- Meta-analysis, 30 studies, n = 6,235, 2016
- Population
- Postmenopausal women in 30 randomized trials
- Form
- Vaginal estrogens (tablets, creams, rings)
- Dose
- Various
- Duration
- Various
- Source
- Reference 24 · PubMed 27577677 (opens PubMed)
BGrade BCarotid artery thickening, oral vs skinHeart and strokeNo effectRCT
n 727 · 2014
Artery thickening rose similarly in all groups; no blood pressure change; insulin resistance fell with transdermal estradiol.
- Design
- RCT, n = 727, 2014
- Population
- Women aged 42 to 58, within 3 years of menopause
- Form
- Transdermal estradiol 50 mcg/day or oral CEE 0.45 mg/day, each with progesterone
- Dose
- As listed
- Duration
- 4 years
- Source
- Reference 22 · PubMed 25069991 (opens PubMed)
BGrade BCarotid artery thickening, by time since menopauseHeart and strokeMixedRCT
n 643 · 2016
Slowed thickening in women under 6 years past menopause (0.0044 vs 0.0078 mm/year); no effect in those 10+ years past it.
- Design
- RCT, n = 643, 2016
- Population
- Healthy postmenopausal women, under 6 or 10+ years past menopause
- Form
- Oral 17β-estradiol (plus vaginal progesterone if uterus present)
- Dose
- 1 mg/day
- Duration
- Median 5 years
- Source
- Reference 21 · PubMed 27028912 (opens PubMed)
BGrade BSpine bone density, ultra-low-dose patchBoneImprovedRCT
n 417 · 2004
Spine density rose 2.6% vs 0.6% on placebo; hip 0.4% vs -0.8%.
- Design
- RCT, n = 417, 2004
- Population
- Women aged 60 to 80
- Form
- Transdermal estradiol patch
- Dose
- 0.014 mg/day, unopposed
- Duration
- 2 years
- Source
- Reference 28 · PubMed 15339752 (opens PubMed)
What are the side effects and risks?
The risks in the labels come mainly from the Women's Health Initiative: more strokes and blood clots, and endometrial cancer if estrogen is used without a progestogen by someone with a uterus. Common side effects with gel include irregular bleeding and breast tenderness. A history of breast cancer, clots, stroke or liver disease rules it out.
Regulatory status. Every estradiol product on this page is an FDA-approved prescription drug except compounded creams; boxed warnings vary by product, from none (Estring, Bijuva) to endometrial cancer only (Divigel and generic 0.1% gels) to the full four-part warning on most pills, patches and other forms.124914
Most common side effects on the label
Warnings on the label
- Stroke and blood clots
- In WHI's estrogen-alone trial, stroke rose (HR 1.39): about 12 more strokes per 10,000 women a year. Clots in the legs or lungs are listed in every systemic estrogen label.171
- Endometrial cancer
- Estrogen without a progestogen raises endometrial cancer risk in women with a uterus; unexplained bleeding needs evaluation.14
- Secondary exposure (spray, gels)
- Children and pets can be exposed to estradiol on the skin where a spray or gel was applied.8
Who should not use it (label contraindications)
Abnormal genital bleeding without a known cause; current or past breast cancer; estrogen-dependent cancer; active or past deep vein thrombosis or pulmonary embolism; active or past arterial clotting disease such as stroke or heart attack; liver impairment or disease; protein C, protein S or antithrombin deficiency; known hypersensitivity to the product.4
What does estradiol interact with?
Drugs that speed up the liver enzyme CYP3A4, such as St John's wort, carbamazepine and rifampin, can lower estrogen levels; inhibitors such as ketoconazole, clarithromycin, ritonavir and grapefruit juice can raise them. Oral estrogen raises thyroid-binding globulin, so people on levothyroxine may need a higher dose. The Interaction map covers estradiol.
Interactions
3 agents| With | What happens | Evidence |
|---|---|---|
| CYP3A4 inducersSt John's wort, phenobarbital, carbamazepine, rifampin | May lower estrogen levels, reducing its effect or changing the bleeding pattern.1 | Drug label |
| CYP3A4 inhibitorserythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir, grapefruit juice | May raise estrogen levels and side effects.1 | Drug label |
| Thyroid hormonelevothyroxine | Oral estrogen raises thyroid-binding globulin; people on thyroid replacement may need a higher dose.126 | Drug label |
Check your own medicines and supplements in the Interaction map: every edge is sourced, and nothing you enter leaves your browser.
How do the options compare?
Pills, patches, gels and vaginal products all deliver estradiol, but they differ in how much reaches the whole body and whether it passes through the liver first. Vaginal tablets and rings act mostly locally. The table sets out what each form is labelled for, its starting dose and what the evidence says about clots.
Estradiol by form
| Pills | Patches, gels, spray | Low-dose vaginal (inserts, cream, Estring) | |
|---|---|---|---|
| Reaches the whole body | Yes, through the liver first | Yes, through the skin | Mostly local |
| Labelled for | Hot flashes, vaginal atrophy, low estrogen, bone | Hot flashes; some also vaginal atrophy and bone | Vaginal atrophy, painful sex |
| Typical starting dose | 1 to 2 mg daily | Patch 0.025 to 0.0375 mg/day; gel 0.25 mg/day | 4 to 10 mcg insert twice weekly; ring 7.5 mcg/day |
| Venous clots (ESTHER) | OR 4.2 | OR 0.9 | No rise seen in the WHI cohort |
| Progestogen needed with a uterus | Yes | Yes | Not at low dose |
Which tools and services help with this?
Free tools
2 toolsGetting a prescription
Frequently asked questions
Common questions
8 answersIs estradiol the same as bioidentical estrogen?
Patch, gel or pill: which carries less clot risk?
Do I need progesterone with estradiol?
Does estradiol cause breast cancer?
It depends on the regimen. In WHI, estrogen alone in women without a uterus lowered breast cancer over 20 years (HR 0.78), while estrogen plus medroxyprogesterone raised it (HR 1.28). Estradiol itself was not tested in WHI.18
Should my estradiol level be tested?
Is vaginal estradiol safe long term?
Is it too late to start estradiol after 60?
Sources
Sources cited on this page
28 sources- 1Estradiol tablets USP: prescribing information (DailyMed, version effective 2026-02-26)Label Epic Pharma, 2026
- 2CLIMARA (estradiol transdermal system): prescribing information (DailyMed, version effective 2026-03-26)Label Bayer, 2026
- 3VIVELLE-DOT (estradiol transdermal system): prescribing information (DailyMed, version effective 2023-11-17)Label Sandoz, 2023
- 4DIVIGEL (estradiol gel) 0.1%: prescribing information (DailyMed, version effective 2026-02-27)Label Vertical Pharmaceuticals, 2026
- 5Estradiol gel 0.1% (generic): prescribing information (DailyMed, version effective 2026-05-18)Label Xiromed, 2026
- 6ESTROGEL (estradiol gel) 0.06%: prescribing information (DailyMed, version effective 2026-05-29)Label 2026
- 7ELESTRIN (estradiol gel) 0.06%: prescribing information (DailyMed, version effective 2023-12-15)Label 2023
- 8EVAMIST (estradiol transdermal spray): prescribing information (DailyMed, version effective 2024-10-29)Label 2024
- 9ESTRING (estradiol vaginal ring): prescribing information (DailyMed, version effective 2026-04-23)Label Pfizer, 2026
- 10VAGIFEM (estradiol vaginal inserts): prescribing information (DailyMed, version effective 2025-02-10)Label Novo Nordisk, 2025
- 11IMVEXXY (estradiol vaginal inserts): prescribing information (DailyMed, version effective 2026-09-29)Label Mayne Pharma, 2026
- 12ESTRACE (estradiol vaginal cream) 0.01%: prescribing information (DailyMed, version effective 2024-05-29)Label 2024
- 13FEMRING (estradiol acetate vaginal ring): prescribing information (DailyMed, version effective 2025-12-09)Label 2025
- 14BIJUVA (estradiol and progesterone) capsules: prescribing information (DailyMed, version effective 2026-09-29)Label Mayne Pharma, 2026
- 15The 2022 hormone therapy position statement of The North American Menopause SocietyGuideline Menopause, 2022 · PMID 35797481
- 16Compounded bioidentical menopausal hormone therapy: ACOG Clinical Consensus No. 6Guideline Obstetrics & Gynecology, 2023 · PMID 37856860
- 17Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trialRCT JAMA, 2004 · PMID 15082697
- 18Association of menopausal hormone therapy with breast cancer incidence and mortality during long-term follow-up of the Women's Health Initiative randomized clinical trialsRCT JAMA, 2020 · PMID 32721007
- 19Hormone therapy and venous thromboembolism among postmenopausal women: impact of the route of estrogen administration and progestogens (ESTHER)Observational Circulation, 2007 · PMID 17309934
- 20Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes (Cochrane review)Meta-analysis Cochrane Database of Systematic Reviews, 2004 · PMID 15495039
- 21Vascular effects of early versus late postmenopausal treatment with estradiol (ELITE)RCT New England Journal of Medicine, 2016 · PMID 27028912
- 22Arterial imaging outcomes and cardiovascular risk factors in recently menopausal women: a randomized trial (KEEPS)RCT Annals of Internal Medicine, 2014 · PMID 25069991
- 23Treatment of symptoms of the menopause: an Endocrine Society clinical practice guidelineGuideline Journal of Clinical Endocrinology & Metabolism, 2015 · PMID 26444994
- 24Local oestrogen for vaginal atrophy in postmenopausal women (Cochrane review)Meta-analysis Cochrane Database of Systematic Reviews, 2016 · PMID 27577677
- 25Breast cancer, endometrial cancer, and cardiovascular events in participants who used vaginal estrogen in the Women's Health Initiative Observational StudyObservational Menopause, 2018 · PMID 28816933
- 26SYNTHROID (levothyroxine sodium) tablets: prescribing information (DailyMed, version effective 2024-02-20)Label AbbVie, 2024
- 27Menopausal hormone therapy and long-term all-cause and cause-specific mortality: the Women's Health Initiative randomized trialsRCT JAMA, 2017 · PMID 28898378
- 28Effects of ultralow-dose transdermal estradiol on bone mineral density: a randomized clinical trialRCT Obstetrics & Gynecology, 2004 · PMID 15339752
What changed
Change log
1 entry| Date | Change | Who and why |
|---|---|---|
| Page created: status by product after the February 2026 relabeling, label doses for every form, combinations, monitoring, nine graded rows, safety, interactions and a comparison by form. | Writer: Kymata Health EditorialTrigger: Owner request (2026-10-22): hormone library |
Kymata Health hormone library. Educational information only; it is not medical advice and does not replace a clinician. Doses are shown as labels and studies print them; a prescriber decides whether and how any hormone is used.