Informed Consent HRT
Online Gender Affirming Hormone Therapy
Hormone therapy is endocrine care, and it deserves an endocrinologist. Informed consent HRT for transgender and nonbinary adults, by secure video, from a triple board-certified endocrinologist.
Virtual self-pay care for adults 18 and over in New York, Minnesota, and Wisconsin. Initial consultation: $435. No referral required. Consultations available in English and Spanish.
You May Benefit From This If
- You want to begin hormone therapy and would rather start with a physician than a subscription app
- You have been on HRT for a while and no one has reviewed your labs in over a year
- You started through an online platform and now want someone who will manage the long term
- Your dose has never been adjusted, or it was adjusted once and never revisited
- You have another endocrine condition, such as a thyroid disorder or PCOS, that interacts with hormone therapy
- You have questions about bone density, cholesterol, or cardiovascular risk that no one has answered
- You are tired of explaining the basics to a different clinician every time
Why See an Endocrinologist for Transgender Hormone Therapy
Estrogen and testosterone are endocrine hormones, and the endocrine system does not work in compartments. Changing sex hormone levels affects bone metabolism, cholesterol, how the body handles glucose, prolactin, and the way thyroid hormone is carried in the blood. Most of those changes are expected and manageable. They still need to be watched by someone who recognizes them for what they are.
That is the difference between a prescription and a treatment plan. A prescription is a starting dose. A treatment plan is the dose, the labs that follow it, the adjustment when the numbers or your symptoms call for one, and attention to everything else the endocrine system is doing at the same time.
This matters most when something else is already going on. An underactive or overactive thyroid changes how you feel on a stable hormone dose, and it is easy to blame HRT for symptoms the thyroid is causing. PCOS interacts with testosterone therapy in ways a general provider may not anticipate. Bone density deserves attention over the long term, particularly where hormone levels have been low or interrupted for a stretch. Cholesterol and blood pressure shift for some people and need following rather than ignoring.
A subscription platform is not built to see any of that. It is built to start a prescription and keep it renewed. An endocrinologist manages the whole system the hormones sit inside.
What Makes This Different
- An endocrinologist, not a platform. Most informed consent HRT delivered online comes from nurse-led subscription services. This is care from a physician board certified in Endocrinology, Diabetes and Metabolism.
- Informed consent. Care is provided on an informed consent basis, so a letter from a mental health professional is not required before treatment can begin.
- The same physician every visit, rather than whoever is next in a queue.
- The whole endocrine picture. Thyroid function, bone health, cholesterol and metabolic effects are followed by the person managing your hormones, not referred elsewhere.
- Continuity for care that started somewhere else. Transfers are welcome, and prior records are reviewed rather than ignored.
- Not a med spa, and not a prescription platform.
Two Ways to Work With Dr. Bernal Riera
Comprehensive Consultation
A long first visit at $435. Full history, review of any previous records and labs, an informed consent discussion, and a written plan. Appropriate if you want a thorough evaluation, a second opinion, or a reset on care that has drifted.
Comprehensive Endocrine Care Membership
$185 per month for ongoing care. Includes check-ins every few months, direct messaging between visits, priority scheduling, and additional visits at $175. Appropriate if you want hormone therapy managed over time rather than handed to you once.
Not sure which fits? Start with a consultation and we will work it out together.
How It Works
Book a consultation.
No referral and no insurance authorization are needed.
Share what you have.
Complete your intake and send any previous records, lab results, or current prescriptions.
Meet by secure video.
Your history, your goals, the risks and benefits of treatment, and any labs that need drawing near you.
Get your plan.
And the monitoring schedule that goes with it. Follow-up is where hormone therapy is actually managed.
Meet Dr. María Bernal Riera
Dr. Bernal Riera is triple board certified in Internal Medicine, in Endocrinology, Diabetes and Metabolism, and in Obesity Medicine. She completed her endocrinology fellowship at the University of Florida and her internal medicine residency at Montefiore New Rochelle Hospital, and earned her medical degree at Universidad Central de Venezuela. She sees patients in English and Spanish.
- Board Certified · Internal Medicine
- Board Certified · Endocrinology
- Board Certified · Obesity Medicine
Specialist Care Designed Around You, Not Insurance Limitations
Apex Endocrinology Health is a self-pay telemedicine practice and does not bill insurance. This allows for longer appointments and a level of evaluation that a rushed visit or questionnaire-based platform is not built to provide. A superbill is available on request for out-of-network reimbursement, and HSA and FSA funds can usually be used. Laboratory work is billed separately by the laboratory that performs it.
- Initial comprehensive consultation $435
- Comprehensive Endocrine Care Membership $185/month
- Available to adults 18 and over in New York, Minnesota, Wisconsin
- Referral Not required
Care is delivered entirely by secure video, and patients are seen from home anywhere in those states. There is no office to drive to and no waiting room.
Frequently Asked Questions
How do I know if hormone therapy is right for me?
That is the question the first visit exists to answer, and it is a reasonable place to start rather than something to have settled in advance. A consultation covers what you are hoping for, what HRT can and cannot do, what is reversible and what is not, the timeline effects tend to follow, and anything in your health history that changes the picture. You are not committing to treatment by booking a conversation about it.
Do I need a letter from a therapist before I can start?
No. Care is provided on an informed consent basis. That means the conversation about risks, benefits, expected effects and what is reversible happens directly between you and your physician, and treatment does not wait on documentation from anyone else. You are welcome to involve a therapist if you want to, and that can be helpful, but it is not a condition of care here.
Do you provide this care to anyone under 18?
No. This service is for adults aged 18 and over.
Do you see patients in Florida for hormone therapy?
Not at present. Florida law currently requires that the written informed consent for this specific care be signed in person with the physician, which a virtual practice cannot do. Dr. Bernal Riera is licensed in Florida and continues to see Florida patients for thyroid conditions, PCOS, perimenopause and menopause, insulin resistance, and weight, none of which are affected by that requirement. The Florida law is the subject of ongoing litigation, so this position may change.
I already take hormones. Can you take over my care?
Yes, and this is a common reason people come here. Bring whatever you have, including prescriptions, lab results, and the history of any dose changes. Care that began on a platform or with a clinician you no longer see can be picked up and managed properly from there.
Can HRT really be managed by telehealth?
Yes, and hormone therapy is better suited to it than most care. The work is history, conversation, lab interpretation and dose adjustment, none of which needs you in a room. Blood draws happen at a lab near you and the results come back to the same physician each time. Telehealth also removes the part people most often cite for falling out of care, which is the drive and the time off work that follow-up visits demand.
What monitoring is involved?
Hormone therapy is followed with periodic blood work, which typically includes hormone levels along with measures of blood count, liver function, cholesterol and, depending on your history, bone health. The schedule is closer together at the start and spaces out as levels settle. Labs are drawn at a facility near you and reviewed with you rather than sent without explanation.
Will I be prescribed hormones at the first visit?
No prescription is guaranteed, and nothing is started before the evaluation is complete. What happens at the first visit depends on your history, your records, and what the evaluation finds. If treatment is appropriate, the plan and the monitoring that goes with it are explained before anything begins.
Do you bill insurance?
No. This is a self-pay practice, which is what allows visits to be long enough to do this properly and keeps the plan between you and your physician. A superbill is provided on request so you can seek out-of-network reimbursement from your insurer, and HSA and FSA funds can usually be applied.