How to start HRT as a transgender person?

How to start HRT: the main steps

Although the process can vary depending on where you live and the healthcare provider you choose, starting gender-affirming hormone therapy generally involves several stages.

1. Find a healthcare professional experienced in transgender health

Your first step is to find a doctor or specialist who understands gender-affirming hormone therapy and can provide appropriate medical guidance.

Depending on your needs, this may be an endocrinologist or another suitably trained healthcare professional. Ideally, they should have experience supporting transgender and non-binary patients and understand the potential effects, risks and monitoring requirements of hormone treatment.

You can start by arranging an initial consultation to discuss your goals and ask questions about the treatment process.

You do not necessarily need to have started a social transition, changed your legal documents or undergone surgery before discussing hormone therapy with a qualified professional. Your healthcare needs and treatment goals should be considered individually.

2. Discuss your goals and medical history

During your first appointment, your doctor will want to understand what you hope to achieve with hormone therapy.

For example, you may be considering:

• Feminising hormone therapy to encourage certain feminine physical characteristics.
• Masculinising hormone therapy to encourage certain masculine physical characteristics.
• A personalised hormone regimen to achieve specific changes.
• A lower-dose or partial hormone approach that better reflects your individual goals.

Your doctor will also review your medical history, current medication, allergies and relevant health conditions. Depending on the circumstances, they may assess factors such as blood pressure, cardiovascular health, metabolic risk and previous hormone use.

This assessment helps determine which options may be appropriate and whether any additional investigations or precautions are needed before treatment.

Importantly, there is no requirement for every transgender person to pursue the same physical changes. Your treatment plan should be based on your own preferences and clinical circumstances.

3. Understand the benefits, risks and expected changes

Before starting HRT, it is important to understand what hormone therapy can and cannot achieve.

Your doctor should explain the expected physical changes, how long they may take to develop, which effects may be permanent and what potential side effects or health risks are associated with treatment.

You should also have the opportunity to discuss any concerns and make an informed decision about whether to proceed.

Gender-affirming hormone therapy is not a standard treatment that works in exactly the same way for everyone. The treatment approach, dosage and monitoring requirements depend on the individual.

4. Have the necessary medical tests

Before prescribing hormone therapy, your healthcare professional may request blood tests and other assessments to establish a baseline and identify any relevant health considerations.

Depending on the treatment being considered, tests may include:

• Testosterone and oestradiol levels.
• Blood count.
• Liver function.
• Lipid profile and other metabolic markers.
• Additional tests based on your medical history and risk factors.

These investigations help your doctor assess your health before treatment and provide a reference point for future monitoring.

Not everyone requires exactly the same tests. Your doctor will determine which investigations are appropriate for your circumstances.

5. Discuss fertility preservation before starting treatment

One important consideration before starting gender-affirming HRT is its potential effect on fertility.

Hormone therapy can affect reproductive function and the ability to produce sperm or eggs. Some changes may be reversible after stopping treatment, but fertility cannot be guaranteed to return to its previous level.

If having biological children in the future is important to you, discuss fertility preservation options before starting hormones.

Depending on your circumstances, these may include sperm freezing or egg freezing. Your doctor can explain whether referral to a fertility specialist would be appropriate.

The Endocrine Society specifically recommends discussing fertility preservation with people considering gender-affirming hormone treatment before therapy begins.

6. Start treatment with an individualised prescription

Once the assessment is complete and you have discussed the potential benefits, risks and alternatives, your doctor can determine whether hormone therapy is appropriate and develop a treatment plan.

The medication will depend on your goals and clinical needs. Feminising and masculinising hormone therapy involve different approaches, and some non-binary patients may prefer a more individualised regimen.

Your doctor will explain how to use the prescribed medication, what changes to expect and what symptoms or side effects should prompt medical advice.

It is important not to use hormones obtained without appropriate medical supervision or change your dosage independently. Taking more medication does not necessarily produce faster or better results, and inappropriate hormone levels can increase health risks.

7. Attend regular follow-up appointments

Starting HRT is not the end of the process. Regular medical follow-up is essential to assess how your body responds and whether your treatment remains appropriate.

Your healthcare professional may monitor:

• Hormone levels.
• Physical changes and treatment goals.
• Potential side effects.
• Blood pressure and relevant cardiovascular risk factors.
• Blood count and metabolic markers, where appropriate.
• Other health indicators depending on your treatment.

Follow-up is often more frequent during the first year, when your doctor may need to assess your response and make adjustments. Once hormone levels and treatment are stable, monitoring may become less frequent, although ongoing medical care remains important.

Your treatment plan can be reviewed over time to reflect changes in your health, preferences and goals.