There is no one way to transition, if you choose to take hormones, this document outlines different options including medication, short/long term monitoring, costs, side effects and contraindications. Not everyone requires a referral to a specialist to begin a medical transition and your Primary Care Provider would be a great place to start.
The main goal of hormone treatments is to facilitate physical changes to better match your gender identity. This process is different for each individual and your Primary Care Provider will work with you to help you meet those goals.
Your Primary Care Provider will want to ensure you have a thorough understanding of the medication, anticipated changes, irreversible changes, risks & benefits and fertility preservation options. You will be required to provide informed consent and review consent documents with your provider.
It’s important to understand that even though you may be coming to your provider with a vast understanding of Medical Transitioning, you will still be required to go through all the consent documents before beginning. To help prepare you for this appointment an example consent form is linked below:
Hormones affect every individual differently and the rate/degree in which your body changes will vary. It is important to note that some changes caused by hormone therapy are irreversible, while others may be reversible over time. Although hormones can lead to many desired changes and outcomes, there are some gender-affirming features that are not obtainable through hormone therapy.
The information is summarized in the chart below:
Reference: Sherbourne Health Trans Primary Care Guidelines 2020
There are 4 different testosterone ("T") options available currently. They vary in cost, dose, and route of application. Your Primary Care Provider will discuss these different options with you to determine which option is the best fit. As with all medications, it is important to follow the prescribed dosing and administration schedule.
It is also important to note that the starting doses of hormones will vary from one individual to the next based on health history, bloodwork results, and desire for physical changes. The options are outlined below:
*Injectable Testosterone is currently the most cost effective option, however it requires a weekly or bi-weekly injection. If self-injecting is a barrier for you, discuss this with your Primary Care Provider and your clinic or local pharmacy may be able to provide the injections to you.
Bloodwork will be required more frequently during the first year of therapy than it will be afterwards. It is very important to complete routine blood work to ensure the selected therapies are safe as well as effective for you.
Monitoring and Blood work
Bloodwork will be required more frequently during the first year of therapy than it will be afterwards. It is very important to complete routine blood work to ensure the selected therapies are safe as well as effective for you:
- Baseline: this will be required before starting any medication so that your Primary Care Provider can get a good sense of where your levels are
- Bloodwork will also be required 1 month, 3 months, 6 months and 1 year after hormones have been initiated to ensure the medications are safe and effective
- You may also be asked to do additional blood work if you notice any adverse side effects or outcomes from starting hormones (more information on this will be provided below)
Contraindications & Adverse Event Monitoring
Your Primary Care Provider will need to determine if there are any health considerations which may delay a start to hormone therapy. If you experience any of these considerations, it is important to be transparent so that you can be referred appropriately.
Note: medical transition is still possible if you experience these health considerations
- Cardiac Disease
- Breast or Endometrial Cancer
- Pregnancy or chest feeding
You may also experience some adverse side effects after starting hormone therapy. These side effects may vary depending on the medication you are taking. For more information contact your Primary Care Provider. Some adverse side effects may include
- Abnormal bleeding
- Hair loss
Hormones will impact you in many ways, this section will explore considerations for contraception, surgery, and for non-binary individuals.
Testosterone: may cause your period to stop, however that is NOT sufficient to prevent pregnancy. Discuss other birth control options with your Primary Care Provider.
It is also important to remember to continue routine testing and following appropriate STI prevention methods. Some options include: IUD, Progestin only tablet, Depo-Provera injection, condoms
If you are having surgery while on testosterone, there are no specific considerations. It is not required to stop hormones before or after surgery and you will likely continue on the same dose post surgery.
For Non-Binary Individuals
As a non-binary person beginning hormones, your Primary Care Provider should have a conversation about what transitioning means to you and how they can facilitate that.
It is important to note that some irreversible changes will happen with hormone therapy and your provider will want to ensure you are aware and accepting of all possible changes/effects.
If one of your goals with hormone therapy is to stop menstruation, it is important to know that the dose of testosterone likely required to stop menstruation may cause a change in voice. If this is not desired, your Primary Care Provider may suggest other options such as an IUD or Progestin Contraceptive Pill.