Comprehensive medication guide to Estratest including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$10–$50 copay for generic; typically Tier 2–3 on formularies; some plans require prior authorization or step therapy through estrogen-only products first.
Estimated Cash Pricing
$30–$150 retail for generic (EEMT/Covaryx) depending on pharmacy; as low as $28–$52 with GoodRx or SingleCare coupons for a 30-day supply.
Medfinder Findability Score
42/100
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Estratest is a combination hormone therapy that pairs esterified estrogens with methyltestosterone — a synthetic testosterone — in a single oral tablet. The original Estratest brand was manufactured by Solvay Pharmaceuticals and marketed in the United States starting in 1964. Solvay discontinued the brand in March 2009, but the medication remains available as a generic under names including EEMT, EEMT HS, and Covaryx.
It is prescribed for postmenopausal women experiencing moderate to severe vasomotor symptoms — primarily hot flashes and night sweats — who have not gotten adequate relief from estrogen-only therapy. This makes it a second-line hormone therapy, typically tried after standard estrogen replacement has proven insufficient.
Estratest/EEMT comes in two strengths: full strength (1.25 mg esterified estrogens / 2.5 mg methyltestosterone) and half strength (0.625 mg esterified estrogens / 1.25 mg methyltestosterone). It is taken orally in a cyclic regimen of 3 weeks on and 1 week off.
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Estratest works through two complementary hormonal mechanisms. The esterified estrogens component acts as a prodrug, converting primarily to estradiol after oral ingestion. These estrogens bind to estrogen receptors throughout the body and reduce the release of LHRH from the hypothalamus and gonadotropins from the pituitary gland — dampening the hormonal signals that cause hot flashes and night sweats.
The methyltestosterone component is a synthetic testosterone derivative that is orally bioavailable (unlike natural testosterone, which is largely destroyed on first pass through the liver). It binds to androgen receptors in the brain, bone, and reproductive tissues, potentially improving libido, energy, mood, and sense of well-being in menopausal women — areas where estrogen-only therapy may fall short.
Together, the estrogen and testosterone components address the dual hormonal decline (both estrogen and androgen loss) that occurs during and after menopause. This is why Estratest may be effective for patients whose symptoms persist despite adequate estrogen replacement alone.
1.25 mg / 2.5 mg — tablet
Full strength (EEMT DS / Covaryx) — 1.25 mg esterified estrogens and 2.5 mg methyltestosterone per tablet
0.625 mg / 1.25 mg — tablet
Half strength (EEMT HS / Covaryx HS) — 0.625 mg esterified estrogens and 1.25 mg methyltestosterone per tablet. Most patients start here.
Estratest and its generic equivalents (EEMT, Covaryx) are consistently among the harder hormone therapies to find at retail pharmacies. The original Estratest brand was discontinued in 2009, and the generics that replaced it are produced by only a small number of manufacturers. This limited manufacturer base, combined with DEA regulatory requirements for the methyltestosterone component and a relatively niche patient population, creates ongoing supply gaps at retail pharmacies.
The medication is not currently on the FDA's official drug shortage list, but patients frequently report having to call multiple pharmacies before finding it in stock. Independent pharmacies and mail-order pharmacies often have better availability than major chains. Asking for the medication by all its generic names — EEMT, Covaryx, and esterified estrogens/methyltestosterone — rather than just "Estratest" (the discontinued brand) is critical.
If you're having trouble locating Estratest, medfinder calls pharmacies near you to check which ones have your specific medication and dose in stock — eliminating the need for you to make multiple phone calls yourself.
Estratest/EEMT requires a valid prescription from a licensed prescriber who holds a DEA registration number. Because methyltestosterone is a controlled substance (or an exempt anabolic steroid depending on the specific formulation), prescribers must be DEA-registered. In practice, this means all physicians, nurse practitioners, and physician assistants with full prescriptive authority can prescribe it.
OB/GYNs: Most common prescribers; specialize in women's health and menopause hormone therapy
Menopause specialists (NAMS-certified): Highly knowledgeable about all HRT options; find one at menopause.org
Endocrinologists: Hormone specialists who often manage complex menopause cases
Internal medicine / Family medicine physicians: PCPs with women's health experience; familiarity varies
NPs and PAs: In most states, NPs and PAs with full prescriptive authority and DEA registration can prescribe EEMT
Telehealth availability: Several menopause-focused telehealth platforms (such as Midi Health, Evernow, and Gennev) prescribe hormone therapy. However, because some EEMT formulations involve controlled substance rules, telehealth prescribing depends on state laws and the specific platform's policies. Confirm with the telehealth provider before booking.
Yes, with an important nuance. Methyltestosterone, one of the two active ingredients in Estratest, is classified as a DEA Schedule III controlled substance under the Anabolic Steroids Act of 1990. This means it has a recognized potential for misuse and requires a valid prescription from a licensed prescriber who holds a DEA registration number.
However, the DEA issued a ruling in June 2020 (85 FR 36148) that designated several specific esterified estrogens/methyltestosterone combination products as exempt anabolic steroid products. For these exempt formulations, the full Schedule III regulatory requirements do not apply — they can be prescribed like a standard prescription medication. Other formulations not explicitly listed as exempt remain subject to Schedule III restrictions.
The practical impact: some pharmacies apply controlled substance dispensing rules (limiting refills, requiring specific prescription formats), while others do not, depending on which specific generic they stock. When filling your prescription, ask your pharmacist whether the product they carry requires controlled substance handling. Your prescriber should write the prescription accordingly.
Common side effects include:
Nausea and stomach discomfort
Headache
Breast tenderness
Bloating and fluid retention
Acne
Weight changes
Mood changes or depression
Blood clots: Leg pain/swelling, chest pain, shortness of breath
Stroke: Sudden weakness, slurred speech, severe headache
Heart attack: Chest pain or pressure, nausea, cold sweat
Liver damage: Jaundice, dark urine, severe abdominal pain
Androgenic effects: Voice deepening, excess hair growth — report immediately as some can be permanent
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Estradiol (Estrace, Climara, Vivelle-Dot)
Estrogen-only bioidentical therapy; most widely available HRT; generic available; $5–$20/month with coupons. Add progestogen if uterus intact.
Premarin (Conjugated Estrogens)
Estrogen-only, derived from pregnant mare urine; well-studied; brand and generic available. Add progestogen if uterus intact.
Prempro (Conjugated Estrogens/Medroxyprogesterone)
Estrogen-progestin combo in one tablet; no testosterone component; for women with intact uterus; brand-only ~$99/month.
Bijuva (Estradiol/Progesterone)
Bioidentical estradiol and progesterone combo; FDA-approved 2018; brand-only; GoodRx ~$85/month. No testosterone component.
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Warfarin (Coumadin)
majorMethyltestosterone significantly increases warfarin's anticoagulant effect, raising bleeding risk. Close INR monitoring required; warfarin dose reduction usually needed.
Cyclosporine
majorMethyltestosterone decreases cyclosporine metabolism, raising cyclosporine levels and risk of nephrotoxicity and hepatotoxicity. Avoid or monitor very closely.
Aromatase Inhibitors (anastrozole, letrozole, exemestane)
majorDirect pharmacological conflict — estrogens counteract aromatase inhibitor activity. Avoid concomitant use.
Carbamazepine / Phenobarbital / Rifampin
moderateCYP3A4 inducers that increase estrogen metabolism, potentially reducing hormone therapy effectiveness.
Ketoconazole / Itraconazole / Erythromycin
moderateCYP3A4 inhibitors that decrease estrogen metabolism, potentially raising estrogen levels and side effects.
Insulin / Oral Antidiabetics
moderateMethyltestosterone may enhance hypoglycemic effect; monitor blood glucose when starting or stopping EEMT.
St. John's Wort
moderateStrong CYP3A4 inducer; significantly reduces estrogen blood levels, decreasing hormone therapy effectiveness. Avoid.
Grapefruit Juice
minorCYP3A4 inhibitor; may increase estrogen blood levels. Moderate intake generally acceptable; excessive use not recommended.
Estratest (esterified estrogens/methyltestosterone) is a unique hormone therapy that has been helping postmenopausal women manage vasomotor symptoms for over 60 years. Its combination of estrogen and testosterone makes it a distinct option for women who haven't found relief from estrogen alone — and its history and regulatory complexity make it one of the more misunderstood medications in women's health.
In 2026, the practical challenges of finding Estratest at a pharmacy remain significant. Limited manufacturers, DEA regulatory requirements, and a niche patient base create ongoing supply gaps that are unlikely to fully resolve. Patients who need this medication should use all generic names when calling pharmacies, plan ahead before running out, and consider mail-order options for more consistent supply.
If you're struggling to find Estratest in stock, medfinder can help — the service calls pharmacies near you to identify which ones currently have your medication and dose in stock, saving you hours of phone calls and frustration.
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