Transgender hormone therapy - a guide to starting HRT from Dr Helen Webberley

1. Transgender HRT
How to start hormone therapy
Dr Helen Webberley
www.transgender.mywebdoctor.co.uk

2. Transgender Health
 In addition to the usual health needs that everyone has,
transgendered people also have more specific needs in
relation to gender dysphoria or gender reassignment,
realignment or confirmation.
 The particular needs of transgendered people may be
looked after by the specifically targeted health services
offered through NHS gender identity clinics as well as an
individual’s GP. Some people prefer to use private services
rather than the NHS.

3. 1. Contact a Doctor
 You can get advice on gender issues from your GP. They can refer you to
an NHS Gender Identity Clinic. Some people prefer to access private
clinics to avoid long waits or because they don’t want to involve their GP.
 Before you can go down the NHS gender identity clinic route you will need
a referral. This is usually provided by your GP although a private doctor
can also do this and sometimes a self-referral is accepted, although this is
rare and will depend upon the clinic and their guidelines.
 Whoever you speak to will need to know that this is the right path for you
as well as ensuring that you are physically and emotionally able to cope
with the treatment. Your doctor will ask some standard medical history
questions but be sure to add anything extra that they don’t already know so
that they can make sure the treatment is the best available for you, and the
safest.

4. 2. Give Your Consent
 Like with any treatment, you will be given a consent form
for hormone therapy. This will be in the form of a
document provided to you which will need to be read,
understood, signed and returned.
 Make sure you are happy with all that it says, and ask your
doctor if you have any queries. The consent form will
explain everything about the treatment and what it will
mean for you. Be sure you are comfortable with it before
you begin treatment.

5. 3. Undergo Counseling
 Part of the assessment, treatment and ongoing support of
gender therapy will include counseling / talking therapy /
psychotherapy. This may be a pre-requisite of the GIC referral
or it may happen as part of that process – or both.
 When going privately you will need to undergo an assessment
to make sure that you are ready for all of the changes that are
going to happen, or to give you the tools and mechanisms to
get ready. Waiting lists are long on the NHS so be prepared for
a wait. Privately, an experienced counselor will have a chat with
you and this may be a single session or take several sessions.
They will want to make sure you understand everything and to
make sure that gender therapy is right for you.

6. 4. Health Checks
 As mentioned at the start, you will need to be healthy enough to receive
treatment. As part of the medical assessment blood tests and a blood
pressure reading will need to be organised before the start of the
treatment. These can be done by your GP, local pharmacy, or you can even
use private home testing kits.
 The minimum tests required are:
 • Liver
 • Cholesterol
 • Diabetes
 • Blood pressure

7. 5. Take the Medication as
Prescribed
 It sounds simple but this step is crucial to your ongoing care –
once you have been issued a prescription you will need to take
the treatment only as prescribed. Adjusting your prescription
appropriately will be impossible if you amend the amounts
taken. It may feel slow but the changes will come.
 You will be recommended feminization or masculinisation
hormones as oestrogen or testosterone. Blockers to your
natural hormones may be given as well. The oestrogen will
develop the female features for you and the blockers will block
testosterone to make the oestrogen work better. Testosterone
will cause masculine features to develop in Transmen.

8. 6. Watch Your Body
Change
 This is then the very exciting time when your body will
change to match your true gender. Everyone changes at
different rates and it is best to go slowly and steadily.
 If you think that your changes are too fast or too slow
then discuss this with your doctor.
 If you notice anything that you weren’t expecting then ask
your doctor.

9. Tips
 • Be honest at all points during the process. Hiding
information may cause your treatment to be stopped and
may be dangerous for you.
 The counselling sessions are there to help so be as open
as you are able or ask for help to open up more –
otherwise you may not get the outcome you are hoping
for.

10. Warnings:
 • Only take the medication as prescribed. It is not an instant fix
but the results will come.
 • Do not self-medicate. You will not know how reliable the
source is and if the medication is as described. You will need to
be properly monitored throughout treatment. If you are self-
medicating, ask a fully registered doctor to swap your
prescription for a real one.
 • You can stop taking the hormones at any time if you feel that
the effects are unhelpful or unpleasant. However, effects
already seen as a result of treatment may not be fully reversed.

11. Risks
The most serious risks when taking oestrogens are:
 * Thrombosis.
 * Altered liver function.
The most serious risks when taking testosterone is:
 * Polycythaemia (over production of the red blood cells).

12. RESOURCES
 https://transgender.mywebdoctor.co.uk/
 http://www.nhs.uk/Livewell/Transhealth/Documents/g
ender-dysphoria-guide-for-gps-and-other-health-care-
staff.pdf
 http://patient.info/doctor/gender-dysphoria-pro
 http://gendertrust.org.uk/
 http://www.gires.org.uk/