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Hormone replacement therapy (HRT) replaces a hormone the body no longer makes in sufficient amounts. Here is how to get HRT in Germany: see a gynaecologist or an endocrinologist, have an examination and blood tests, and receive a prescription — no clinic sells a ready-made course.
It matters most for women with hard-to-bear menopausal symptoms and for people whose thyroid, adrenal glands or testes make too little hormone. It is not an anti-ageing treatment. Below: indications, tests, medication forms, risks and AlenMed’s role.
What HRT is and who it is for
HRT returns a missing hormone in the amount the body needs and is prescribed mainly to women with marked menopausal symptoms and to people with a hormone deficiency. More is not better — the risk of thrombosis, for instance, rises with the oestrogen dose — so the dose follows symptoms and test results.
At menopause the ovaries stop producing oestrogen, which can bring hot flushes, night sweats, poor sleep, vaginal dryness and, over time, bone loss. HRT is considered when symptoms disrupt daily life: the German guideline recommends offering it to women with hot flushes once benefits and risks have been explained. Women who still have a uterus also take a progestogen to protect its lining. The gynaecologist and the patient decide together — see gynaecology in Germany.
Other deficiencies are managed by endocrinologists (see endocrinology in Germany). Missing thyroid hormone is taken as tablets, dosed by blood tests — more on thyroid treatment. In adrenal insufficiency, cortisol is replaced, and aldosterone too if lacking; patients learn to raise the cortisol dose during illness or stress. Men receive testosterone only when blood tests confirm a deficiency linked to their symptoms.
Tests before starting
Hormone blood tests are always read alongside symptoms: a single result without symptoms decides nothing. At the usual age, the German guideline advises diagnosing menopause from the cycle and symptoms, without hormone tests; FSH, the pituitary hormone that drives the ovaries, is checked in younger women with symptoms, and early menopause is not diagnosed from one test. Endocrinologists check TSH, thyroid hormones, cortisol and, in men, morning testosterone, as levels shift during the day. More on hormone blood tests.
Women have a gynaecological examination with a cervical smear, a pelvic ultrasound if needed, a breast examination and mammography in line with screening rules. Blood pressure, liver and kidney function and thrombosis risk are also checked, and the doctor asks about breast cancer, thrombosis and embolism in close relatives. This decides whether hormones are possible and in which form.
Forms of medication and follow-up
Hormones come as tablets, gels, sprays, patches, vaginal creams, pessaries and rings, plus injections and implants under the skin, used for testosterone, for example. A tablet passes through the liver first, where concentrated oestrogen stimulates clotting factor production. Gels and patches reach the blood through the skin, sparing the liver this load, and carry a lower thrombosis risk than tablets. The German guideline therefore generally prefers transdermal forms, which matters most when age, weight or inherited factors already raise that risk. Vaginal forms act locally against dryness.
Patients then return for regular check-ups: the doctor asks about wellbeing and bleeding, repeats blood tests and, if needed, does an ultrasound and a bone density scan. If bones are weakening, osteoporosis treatment is discussed as well. Dose and form can be changed, and therapy continues only while the benefit outweighs the risk.
Risks and contraindications
HRT is not prescribed for hormone-dependent tumours such as current or past breast cancer and endometrial cancer, after thrombosis or embolism, in acute liver disease, for unexplained genital bleeding, or in severe heart and vascular disease, for example after a heart attack or stroke. After breast cancer it is considered only in individual cases, when non-hormonal treatments have failed and symptoms severely affect quality of life.
Otherwise the doctor weighs benefit against risk for the individual: age, blood pressure, weight, family history and symptom severity. The main risks are thrombosis and, with oestrogen plus progestogen, a small rise in breast cancer risk, so the need to continue is reviewed regularly. The German guideline on peri- and postmenopause calls HRT unsuitable for preventing heart disease, and the German Society of Endocrinology stresses that testosterone is a vital hormone, not a lifestyle drug. German guidelines make no room for hormones as “rejuvenation”.
Frequently asked questions
Do you need a prescription for HRT in Germany?
Yes, hormone preparations for HRT are available in Germany on prescription. A gynaecologist or an endocrinologist writes it after an examination and blood tests, once there is a clear reason for treatment and no contraindication. There is no ready-made “hormone course” to buy: the medicine, form and dose are chosen individually and adjusted at follow-ups.
Does HRT increase the risk of breast cancer?
It can, slightly, depending on the type and duration of treatment. According to the German Cancer Information Service (Krebsinformationsdienst), the risk rises mainly with oestrogen combined with a progestogen; with oestrogen alone the effect is smaller, and newer long-term data suggest the risk may even fall. After HRT is stopped, the risk slowly declines again.
What happens when you stop HRT?
Hot flushes and other menopausal symptoms may come back; doctors mention this before treatment starts. HRT can be stopped at once or tapered: tapering may mean fewer symptoms at first, but in the long run there is no difference. How to stop is decided with the doctor, and cortisol replacement for adrenal insufficiency is never stopped on one’s own.
How to Get HRT in Germany with AlenMed
AlenMed prepares your documents, finds a suitable hospital and helps with the trip. Send your medical reports, recent hormone tests, ultrasound and mammography reports and a medication list; the coordinator arranges a German translation so the hospital doctor can review them in advance.
For menopause, patients see gynaecological endocrinologists; for other deficiencies, endocrinology departments such as the Klinik für Endokrinologie, Diabetologie und Stoffwechsel at Essen University Hospital, the Klinik für Endokrinologie und Diabetologie at Düsseldorf University Hospital or, in Munich, the endocrinology department of München Klinik Schwabing. The hospital issues a cost estimate (Kostenvoranschlag), and AlenMed helps with the visa invitation and, if needed, medical interpreters. AlenMed’s office is in Munich, with partner hospitals across Germany; the final cost follows the hospital’s estimate.
This material is for reference only and is not an offer. Whether to use hormone therapy, which kind and for how long is decided by a doctor at an in-person appointment.
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