1. Circle Care Center
618 West Ave
Norwalk, CT 06850
www.circlecarecenter.org
PH: (203) 852-9525
FAX: (203) 854-0371
Client Information for Informed Consent
FEMINIZING MEDICATIONS FOR TRANSGENDER CLIENTS
What are the differentmedicationsthatcan helpto feminize me?
Differenttypesof the hormone estrogencanhelpyouappearmore like awoman.Estrogenisthe female sex hormone.
There are alsomedicationsthatcanhelpyouappearlesslike aman.They are calledandrogenantagonistsoranti -
androgensorandrogenblockers.Androgenisthe male sex hormone.
Everymedicationhasrisks,benefits,andside effectsthatare importantto understandbeforestarting.Some needtobe
takencontinuouslytomaintaintheireffects.It’sespeciallyimportanttoknow how theywork.
Warning— who shouldnot take estrogen?
You wantto take estrogenandothermedicationstofeminize yourbody.Some of these medicationsneedtobe
takencontinually.Before usingthem,there are several thingsyouneedtoknow.Theyare the possible advantages,
disadvantages,risks,andwarning signs.We have listedthemhereforyou.It'simportantthatyou understandall of
thisinformationbefore youstart.We are happyto answeranyquestionsyouhave.
Estrogen shouldnot be usedby anyone who has a history
• an estrogen-dependentcancer
• a disorderthatmakesthemmore likelytogetbloodclotsthatcouldtravel tothe lungs
(unlesstheyare alsotakingbloodthinnersandare followedbyaspecialist)
Estrogenshouldbe usedwithcautionandonlyaftera full discussionof risksbyanyone who
• has a strong familyhistoryof breastcanceror othercancers that grow quickerwhenestrogensare present
• has uncontrolleddiabetes
• has heartdisease
• has chronichepatitisorotherliverdisease
• has uncontrolledhighcholesterol
• has migrainesorseizures
• is obese
• smokescigarettes

2. 2
Please initial and date each statementon this form to show that youunderstandthe benefits,risks,andchangesthat
may occur fromtakingthese medications.
Feminizing
I knowthat estrogenoranti-androgens –or both– maybe prescribedtohelpme appearlesslike amanand
more like a woman.
I knowit can take several monthsorlongerforthe effectstobecome noticeable.Iknow thatnoone can predict
howfast – or howmuch – change will happen.
I knowthat if I am takingestrogenIwill probablydevelopbreasts.
• I knowitcan take several yearsforbreaststoget totheirfull size.
• I knowthe breastswill remain,evenif Istoptakingestrogen.
• I knowI shouldexamine mybreastsassoonas theystart growing.Ishouldalsohave a clinicianexamine
themeveryyear.
• I knowI mighthave a milkydischarge frommynipples — galactorrhea.If Ido,I know I shouldcheckitout
withmyclinicianbecause itcouldbe causedbythe estrogenor bysomethingelse.
• I knowthatno one knowsif takingestrogenincreasesthe riskof breastcancer.
I knowthat the followingchangesare usuallynotpermanent — theyare likelytogoawayif I stoptakingthe
medicines.
• I knowmybodyhair will become lessnoticeable andwillgrow more slowly.Butitwon’tstopcompletely,
evenif Itake the medicinesforyears.
• I knowI will probablyhave lessfatonmyabdomenandmore onmy buttocks,hips,andthighs.Itwill be
redistributedtoa more female shape — changingfrom―apple shape‖to―pearshape.‖
• I knowthatif I have male patternbaldnessitmayslow down,butprobablynotstopcompletely.Itisalso
verylikelythathairthathas beenlostwill not grow back.
• I knowI maylose muscle andstrengthinmy upperbody.
• I knowthatmy skinmay become softer.
I knowthat my bodywill make lesstestosterone.Thismayaffectmysex life indifferentwaysandfuture ability
to cause a pregnancy:
• I knowmyspermmay no longergettomature.This couldmake me lessable tocause a pregnancy.Ialso
knowI mightneverproduce mature spermagain.ButI know that it’salsopossible thatmyspermcouldstill
mature.So,I knowthat I mightgetsomeone pregnantif we have vaginal intercourse andwe don’tuse birth
control.The optionsforspermbankinghave beenexplainedtome.
• I knowthatmy testiclesmayshrinkdowntohalf theirsize.Evenso,Iknow that I will needregularcheckups
for them.
• I knowthatI won’thave as much cum whenI come.
• I knowitis likelythatIwon’tbe hard inthe morningas oftenasbefore.AnditislikelythatIwill have fewer
spontaneouserections.
• I knowI maynot be able to gethard enoughforpenetrative sex.
• I knowthatI may have lesssex drive.
• I knowthistreatmentmay(butisnot assuredto) make me permanentlyunabletomake a woman
pregnant.

3. 3
I knowthat some partsof my bodywill notchange muchby usingthese medicines.
• I knowthe hairof my beardand moustache maygrow more slowlythanbefore.Itmaybecome less
noticeable,butitwill notgoaway.
• I knowthe pitchof myvoice will notrise,andmyspeechpatternswill notbecome more likeawoman’s.
• I knowmy―Adam’sapple‖will notshrink.
Althoughthese medicinescan’tmake these changeshappen,there are othertreatmentsthatmaybe helpful.
I knowif I have any concernsaboutthese issues,youcanmake referralsforme to helpme explore other
treatmentoptions.
Risks ofFeminizingMedications
I knowthat the side effectsandsafetyof these medicinesare notcompletelyknown.There maybe long-term
risksthat are notyetknown.
I knownot to take more medicine thanIam prescribed.Iknow itincreaseshealthrisks.Iknow thattakingmore
than I am prescribedwon’tmake changeshappenmore quicklyormore significantly.Iknow mybodycan
convertextraestrogenintotestosterone,andthatcan slow downor stop myappearingmore womanly.
I knowthese medicinesmaydamage the liverandmayleadtoleadto liverdisease.Iknow Ishouldbe checked
for possible liverdamage aslongas I take them.
I knowthese medicinescause changesthatotherpeople will notice.Some transgenderpeople have experienced
harassment, discrimination,andviolence because of this.Othershave lostthe supportof lovedones.Iknowmy
cliniciancanhelpme findadvocacyandsupportresources.
Risks ofEstrogen
I knowthat takingestrogenincreasesthe riskof bloodclotsthatcan resultin
• chronicproblemswithveinsinthe legs
• heartattack
• pulmonaryembolism –bloodclottothe lungs – whichmay cause permanentlungdamage ordeath
• stroke,whichmaycause permanentbraindamage ordeath
I knowthat the riskof bloodclotsismuch worse if I smoke cigarettes — especiallyif Iamover 40. I knowthe
dangeris sohighthat I shouldstopsmokingcompletelyif Istarttakingestrogen.Iknow thatI can askmy
clinicianforadvice abouthowtostop smoking.
I knowtakingestrogencanincrease the depositsof fataroundmyinternal organs.Thiscan increase myriskfor
diabetesandheartdisease.
I knowtakingestrogencanraise my bloodpressure.I know thatif it goesup,my cliniciancanworkwithme to
try to control it withdiet,lifestyle changes,and/ormedication.

4. 4
I knowthat takingestrogenincreasesmyriskof gettinggallstones.Iknow Ishouldtalkwithmyclinicianif Iget
severe orlong-lastingpaininmyabdomen.
I knowthat estrogencancause nauseaand vomiting.Iknow Ishouldtalkwithmyclinicianif Ihave long-lasting
nauseaor vomiting.
I knowthat estrogencancause headachesor migraines.Iknow Ishouldtalkwithmyclinicianif Ihave
headachesormigrainesoftenorif the painisunusuallysevere.
I knowthat itis not yetknownif takingestrogenincreasesthe riskof prolactinomas.Theseare non-cancerous
tumorsof the pituitarygland.Iknowtheyare not usuallylife-threatening,buttheycandamage visionandcause
headaches.Iknowthisneedstobe checkedonfor at leastthree yearsafterI start takingestrogen.
I knowthat I am more likelytohave dangerousside effectsif
• I smoke.
• I am overweight.
• I am over40 yearsold.
• I have a historyof bloodclots.
• I have a historyof highbloodpressure.
• My familyhasa historyof breastcancer.
Risks ofAndrogen Antagonists
I knowthat spironolactone affectsthe balance of waterandsaltsinthe kidneys.Thismay
• Increase the amountof urine Iproduce,makingitnecessarytourinate more frequently.
• Increase thirst.
• Rarely,cause highlevelsof potassiuminthe blood,whichcancause changesinheart rhythmsthat maybe
life-threatening.
• Reduce bloodpressure.
I knowsome androgenantagonistsmake itmore difficulttoevaluate testresultsforcancerof the prostate.This
can make it more difficulttocheckupon prostate problems.Iknow thatif I am over50, I shoulddiscuss
appropriate prostate cancerscreeningwithmycare provider.Iknow thatevenif I have genital sex reassignment
surgerythe prostate isnot usuallyremoved.
Prevention ofMedical Complications
I agree to take feminizingmedicationsasprescribed.AndIagree andto tell mycare providerif Ihave any
problemsoram unhappywiththe treatment.
I knowthat the dose and type of medicationthat’sprescribedforme maynot be the same as someone else’s.
I knowI needperiodicphysical examsandbloodteststocheckforany side effects.
I knowthat feminizationmedicationscaninteractwithotherdrugsandmedicines.These include alcohol,diet
supplements,herbs,otherhormones,andstreetdrugs.Thiskindof interactioncancause complications.Iknow
that I needtopreventcomplicationsbecause theycanbe life-threatening.That’swhyIneedtobe honestwith

5. 5
my clinicianaboutwhateverelse Itake.Ialsoknow that I will continuetogetmedical care here nomatter whatI
share about whatI take.
I knowthat itcan be riskyfor anyone withcertainconditionstotake these medicines.Iagree tobe evaluatedif
my clinicianthinksImayhave one of them.Thenwe will decide if it’sagoodideaforme to start or continue
usingthem.
I knowthat I shouldstoptakingestrogentwoweeks before anysurgeryorwhenImay be immobile foralong
time.Thiswill lowerthe riskof gettingbloodclots.Iknow I can start takingit againa weekafterI’mback to
normal or whenmycliniciansaysit’sokay.
I knowthat usingthese medicinestoappearmore womanlyisanoff-label use.Iknow thismeansitisnot
approvedbythe government.Iknowthatthe medicine anddose thatisrecommendedforme isbasedonthe
judgmentandexperience of the clinician.
I knowthat I can choose to stoptaking these medicinesatanytime.Iknow that if I decide todo that, I shoulddo
it withthe helpof myclinician.Thiswill helpme make sure there are nonegative reactions.Ialsoknowmy
clinicianmaysuggestthatI cut the doesor stop takingitat all if certainconditionsdevelop.Thismayhappenif
the side effectsare severe orthere are healthrisksthatcan’tbe controlled
Alternatives
There are alternativestousingfeminizingmedicinestohelppeople appearmore feminine.Some transgenderpeople
choose to nottake hormonesorhave surgeryandmay onlysociallytransition.If youare interestedinalternatives,talk
withyourhealthcare provideraboutyouroptions.
Our signatures belowconfirmthat

• My clinicianhastalkedwithme about
› the benefitsandrisksof takingfeminizingmedication
› the possible orlikelyconsequencesof hormone therapy
› potential alternative treatments
• I understandthe risksthatmaybe involved.
• I knowthatthe informationinthisformincludesthe knowneffectsandrisks.Ialsoknow thatthere may be unknown
long-termeffectsof risks.
• I have hadenoughopportunitytodiscusstreatmentoptionswithmyclinician.
• All of myquestionshave beenansweredtomysatisfaction.
• I believe Iknowenoughtogive informedconsenttotake,refuse,orpostpone therapywithfeminizingmedications.
• I am 18 yearsoldor older.

6. 6
Basedon all thisinformation
_____ I wantto begintakingestrogen.
_____ I wantto begintakingandrogenantagonists(e.g.,spironolactone).
_____ I do notwishto begintakingfeminizingmedicationatthistime.
PatientSignature Date
Prescribingcliniciansignature Date
Your healthisimportanttous. If you have anyquestionsorconcernsplease call
us at (203) 852-9525. We are happyto helpyou.