Gender-affirming hormone therapy: Difference between revisions

'''TransgenderGender-affirming hormone therapy''' ('''GAHT'''), also called '''hormone replacement therapy''' ('''HRT''') or '''gender-affirmingtransgender hormone therapy''' ('''GAHT'''), is a form of [[hormone therapy]] in which [[sex hormone]]s and other [[sex-hormonal agent|hormonal medication]]s are administered to [[transgender]] or [[gender nonconforming]] individuals for the purpose of more closely aligning their [[secondary sexual characteristic]]s with their [[gender identity]]. This form of hormone therapy is given as one of two types, based on whether the goal of treatment is [[masculinization]] or [[feminization (biology)|feminization]]:

* [[Masculinizing hormone therapy]] – for [[Trans man|transgender men]] or [[transmasculine]] people; consists of [[androgen]]s and occasionally [[antiestrogen]]s.

Eligibility for transgender hormone therapyGAHT may berequire concluded by assessing aan patientassessment for [[gender dysphoria]] or persistent gender incongruence,; thoughor many medical institutions now useduse an [[informed consent]] model., This modelwhich ensures patients are informed of the procedure process, including possible benefits and risks, while removing many of the historical barriers needed to start hormone therapy. Treatment guidelines for therapy have been developed by several medical associations.

Some [[intersex]] people may also undergo hormone therapy, either starting in childhood to confirm the [[sex assignment|sex they were assigned at birth]], or later in order to align their [[sex]] with their gender identity. [[Non-binary people]] may also engage in hormone therapy in order to achieve a desired balance of sex hormones or to help align their bodies with their gender identities.<ref name="Ferguson">{{cite journal| vauthors = Ferguson JM |title=What It Means to Transition When You're Non-Binary|journal=Teen Vogue|date=November 30, 2017|url=https://www.teenvogue.com/story/non-binary-transitioning|access-date=March 20, 2018|archive-date=December 13, 2019|archive-url=https://web.archive.org/web/20191213162006/https://www.teenvogue.com/story/non-binary-transitioning|url-status=live}}</ref> Many transgender people obtain hormone therapy from a licensed health care provider and others [[DIY transgender hormone therapy|obtain and self-administer hormones]].

{{See|Feminizing hormone therapy#History|Masculinizing_hormone_therapyMasculinizing hormone therapy#History}}

Historically, many health centers required a psychiatric evaluation and/or a letter from a therapist before beginning therapy. Many centers now use an [[informed consent]] model that does not require any routine formal psychiatric evaluation but instead focuses on reducing barriers to care by ensuring a person can understand the risks, benefits, alternatives, unknowns, limitations, and risks of no treatment.<ref name="UCSF_Transgender_Care">{{cite book | veditors = Deutsch MB | title = Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People | edition = 2nd | date = June 2016 | url = https://transcare.ucsf.edu/guidelines | location = San Francisco, CA | publisher = UCSF Transgender Care, Department of Family and Community Medicine, University of California San Francisco. | access-date = 2021-05-13 | archive-date = 2022-05-11 | archive-url = https://web.archive.org/web/20220511053603/https://transcare.ucsf.edu/guidelines | url-status = live }}</ref> Some LGBT health organizations (notably Chicago's [[Howard Brown Health Center]]<ref>{{cite web| vauthors = Schreiber L |title=Howard Brown Health Center Establishes Transgender Hormone Protocol|url=http://www.howardbrown.org/hb_news.asp?id=1228|work=www.howardbrown.org|publisher=Howard Brown|access-date=2011-08-25|archive-url=https://web.archive.org/web/20111008012906/http://howardbrown.org/hb_news.asp?id=1228|archive-date=2011-10-08|url-status=dead}}</ref> and [[Planned Parenthood]]<ref>{{Cite web|url=https://www.plannedparenthood.org/learn/sexual-orientation-gender/trans-and-gender-nonconforming-identities/what-do-i-need-know-about-trans-health-care|title=What Health Care & Services Do Transgender People Require?|website=www.plannedparenthood.org|access-date=2019-10-16|archive-date=2017-05-11|archive-url=https://web.archive.org/web/20170511180448/https://www.plannedparenthood.org/learn/sexual-orientation-gender/trans-and-gender-nonconforming-identities/what-do-i-need-know-about-trans-health-care|url-status=live}}</ref>) advocate for this type of informed consent model.

Many international guidelines and institutions require persistent, well-documented gender dysphoria as a pre-requisite to starting gender-affirmation therapy. [[Gender dysphoria]] refers to the psychological discomfort or distress that an individual can experience if their sex assigned at birth is incongruent with that person's gender identity.<ref name="ColemanBockting2012">{{cite journal | vauthors = Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, DeCuypere G, Feldman J, Fraser L, Green J, Knudson G, Meyer WJ, Monstrey S, Adler RK, Brown GR, Devor AH, Ehrbar R, Ettner R, Eyler E, Garofalo R, Karasic DH, Lev AI, Mayer G, Meyer-Bahlburg H, Hall BP, Pfaefflin F, Rachlin K, Robinson B, Schechter LS, Tangpricha V, van Trotsenburg M, Vitale A, Winter S, Whittle S, Wylie KR, K Zucker K |display-authors=6 |title= Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7 |journal=International Journal of Transgenderism |date=August 2012 |volume=13 |issue=4 |pages=165–232 |doi=10.1080/15532739.2011.700873|s2cid=39664779}}</ref> Signs of gender dysphoria can include comorbid mental health stressors such as [[depression (mood)|depression]], anxiety, low [[self-esteem]], and [[social isolation]].<ref>{{Cite web|date=2017-10-23|title=Gender dysphoria|url=https://www.nhs.uk/conditions/gender-dysphoria/|access-date=2021-11-15|website=nhs.uk|language=en|archive-date=2020-03-20|archive-url=https://web.archive.org/web/20200320050603/https://www.nhs.uk/conditions/gender-dysphoria/|url-status=live}}</ref> Not all [[gender nonconforming]] individuals experience gender dysphoria, and measuring a person's gender dysphoria is critical when considering medical intervention for gender nonconformity.<ref>{{cite journal | vauthors = Olson-Kennedy J, Cohen-Kettenis PT, Kreukels BP, Meyer-Bahlburg HF, Garofalo R, Meyer W, Rosenthal SM | title = Research priorities for gender nonconforming/transgender youth: gender identity development and biopsychosocial outcomes | journal = Current Opinion in Endocrinology, Diabetes, and Obesity | volume = 23 | issue = 2 | pages = 172–179 | date = April 2016 | pmid = 26825472 | pmc = 4807860 | doi = 10.1097/MED.0000000000000236 }}</ref>

For transgender youth, the [[Dutch protocol]] existed as among the earlier guidelines for hormone therapy by delaying puberty until age 16.<ref>{{Cite journal |last1=Shumer |first1=Daniel E. |last2=Spack |first2=Norman P. |date=January 2015 |title=Paediatrics: Transgender medicine--long-term outcomes from 'the Dutch model' |journal=Nature Reviews. Urology |volume=12 |issue=1 |pages=12–13 |doi=10.1038/nrurol.2014.316 |issn=1759-4820 |pmc=4349440 |pmid=25403246}}</ref><ref>{{Cite journal |last1=Delemarre-van de Waal |first1=Henriette A |last2=Cohen-Kettenis |first2=Peggy T |date=November 2006 |title=Clinical management of gender identity disorder in adolescents: a protocol on psychological and paediatric endocrinology aspects |url=https://doi.org/10.1530/eje.1.02231 |journal=European Journal of Endocrinology |volume=155 |issue=suppl_1 |pages=S131–S137 |doi=10.1530/eje.1.02231 |issn=0804-4643 |access-date=2024-02-17 |archive-date=2024-03-11 |archive-url=https://web.archive.org/web/20240311212505/https://academic.oup.com/ejendo/article-abstract/155/Supplement_1/S131/6695708?redirectedFrom=fulltext |url-status=live }}</ref> The [[World Professional Association for Transgender Health]] (WPATH) and the [[Endocrine Society]] later formulated guidelines that created a foundation for health care providers to care for transgender patients.<ref>{{Cite journal |last1=Hembree |first1=Wylie C. |last2=Cohen-Kettenis |first2=Peggy |last3=Delemarre-van de Waal |first3=Henriette A. |last4=Gooren |first4=Louis J. |last5=Meyer |first5=Walter J. |last6=Spack |first6=Norman P. |last7=Tangpricha |first7=Vin |last8=Montori |first8=Victor M. |date=2009-09-01 |title=Endocrine Treatment of Transsexual Persons:An Endocrine Society Clinical Practice Guideline |url=https://doi.org/10.1210/jc.2009-0345 |journal=The Journal of Clinical Endocrinology & Metabolism |volume=94 |issue=9 |pages=3132–3154 |doi=10.1210/jc.2009-0345 |pmid=19509099 |issn=0021-972X |doi-access=free }}</ref><ref>{{cite journal | vauthors = Unger CA | title = Hormone therapy for transgender patients | journal = Translational Andrology and Urology | volume = 5 | issue = 6 | pages = 877–884 | date = December 2016 | pmid = 28078219 | pmc = 5182227 | doi = 10.21037/tau.2016.09.04 | doi-access = free }}</ref> [[University of California, San Francisco|UCSF]] guidelines are also sometimes used.<ref name="UCSF_Transgender_Care" /> There is no generally agreed-upon set of guidelines, however.<ref>{{Cite journal |last1=Houssayni |first1=Sarah |last2=Nilsen |first2=Kari |date=Feb 28, 2018 |title=Transgender Competent Provider: Identifying Transgender Health Needs, Health Disparities, and Health Coverage |journal=Kansas Journal of Medicine |volume=11 |issue=1 |pages=15–19 |doi=10.17161/kjm.v11i1.8679 |pmid=29844850 |pmc=5834239 }}</ref>

Adolescents experiencing gender dysphoria may opt to undergo puberty-suppressing hormone therapy at the onset of puberty. The Standards of Care set forth by [[World Professional Association for Transgender Health|WPATH]] recommend individuals pursuing puberty-suppressing hormone therapy wait until at least experiencing Tanner Stage 2 pubertal development.<ref name="ColemanBockting2012" /> [[Tanner scale|Tanner Stage]] 2 is defined by the appearance of scant pubic hair, breast bud development, and/or slight testicular growth.<ref>{{cite book | vauthors = Emmanuel M, Bokor BR | chapter = Tanner Stages |date=2021 | chapter-url= http://www.ncbi.nlm.nih.gov/books/NBK470280/ | title = StatPearls |place= Treasure Island (FL) |publisher=StatPearls Publishin |pmid=29262142 |access-date=2021-11-12 |archive-date=2022-02-10 |archive-url=https://web.archive.org/web/20220210190036/https://www.ncbi.nlm.nih.gov/books/NBK470280/ |url-status=live }}</ref> [[WPATH]] classifies puberty-suppressing hormone therapy as a "fully reversible" intervention. Delaying puberty allows individuals more time to explore their gender identity before deciding on more permanent interventions and prevents the physical changes associated with puberty.<ref name="ColemanBockting2012" />

[[Feminizing hormone therapy]] is typically used by transgender women, who desire the development of feminine [[secondary sex characteristic]]s. Individuals who identify as non-binary may also opt-in for feminizing hormone treatment to better align their body with their desired gender expression.<ref>{{Cite web |title=Hormone Use for Non-Binary People | work = GenderGP |url=https://www.gendergp.com/non-binary-hormone-use/ |access-date=2020-10-18 |archive-date=2022-05-03 |archive-url=https://web.archive.org/web/20220503200510/https://www.gendergp.com/non-binary-hormone-use/ |url-status=live }}</ref> Feminizing hormone therapy usually includes medication to suppress [[testosterone]] [[biosynthesis|production]] and induce [[feminization (biology)|feminization]]. Types of medications include [[estrogen (medication)|estrogen]]s, [[antiandrogen]]s (testosterone blockers), and [[progestogen (medication)|progestogen]]s.<ref name="Transgender_Care_Estrogen">{{Cite web|url=https://www.gendergp.com/non-binary-hormone-use/|title=Information on Estrogen Hormone Therapy | work = Transgender Care| publisher =transcare.ucsf.edu|access-date=2019-08-07|archive-date=2022-05-03|archive-url=https://web.archive.org/web/20220503200510/https://www.gendergp.com/non-binary-hormone-use/|url-status=live}}</ref> Most commonly, an estrogen is combined with an antiandrogen to suppress and block testosterone.<ref name="Gender Affirming Health Program">{{Cite web|title=Overview of feminizing hormone therapy | work = Gender Affirming Health Program|url=https://transcare.ucsf.edu/guidelines/feminizing-hormone-therapy|access-date=2021-11-12| publisher = transcare.ucsf.edu}}</ref> This allows for [[demasculinization]] and promotion of feminization and [[breast development]]. Estrogens are administered in various modalities including injection, transdermal patch, and oral tablets.<ref name="Gender Affirming Health Program" />

| Decreased [[sex drive]] || 1–3 months || Temporary<ref name="pmid32008926">{{cite journal | vauthors = Defreyne J, Elaut E, Kreukels B, Daphne Fisher A, Castellini G, Staphorsius A, Den Heijer M, Heylens G, T'Sjoen G | title = Sexual Desire Changes in Transgender Individuals Upon Initiation of Hormone Treatment: Results From the Longitudinal European Network for the Investigation of Gender Incongruence | journal = The Journal of Sexual Medicine | volume = 17 | issue = 4 | pages = 812–825 | date = April 2020 | doi = 10.1016/j.jsxm.2019.12.020 | pmid = 32008926 | url = https://pubmed.ncbi.nlm.nih.gov/32008926/ | access-date = 2023-11-15 | archive-date = 2023-11-01 | archive-url = https://web.archive.org/web/20231101125905/https://pubmed.ncbi.nlm.nih.gov/32008926/ | url-status = live }}</ref> || Reversible

'''Sources:''' ''Guidelines:''<ref name="pmid28945902">{{cite journal | vauthors = Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, Rosenthal SM, Safer JD, Tangpricha V, T'Sjoen GG | display-authors = 6 | title = Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 102 | issue = 11 | pages = 3869–3903 | date = November 2017 | pmid = 28945902 | doi = 10.1210/jc.2017-01658 | s2cid = 3726467 | doi-access = free }}</ref><ref name="ColemanBockting2012" /><ref name="Bourns2018">{{cite web | vauthors = Bourns A | title = Guidelines and Protocols for Comprehensive Primary Care for Trans Clients | publisher = Sherbourne Health Centre | year = 2015 | access-date = 15 August 2018 | url = http://sherbourne.on.ca/wp-content/uploads/2014/02/Guidelines-and-Protocols-for-Comprehensive-Primary-Care-for-Trans-Clients-2015.pdf | archive-date = 10 May 2020 | archive-url = https://web.archive.org/web/20200510012134/http://sherbourne.on.ca/wp-content/uploads/2014/02/Guidelines-and-Protocols-for-Comprehensive-Primary-Care-for-Trans-Clients-2015.pdf | url-status = live }}</ref> ''Reviews/book chapters:'' <ref name="pmid25403429c">{{cite journal | vauthors = Fabris B, Bernardi S, Trombetta C | title = Cross-sex hormone therapy for gender dysphoria | journal = Journal of Endocrinological Investigation | volume = 38 | issue = 3 | pages = 269–282 | date = March 2015 | pmid = 25403429 | doi = 10.1007/s40618-014-0186-2 | hdl-access = free | s2cid = 207503049 | hdl = 11368/2831597 }}</ref><ref name="pmid12915619a">{{cite journal | vauthors = Moore E, Wisniewski A, Dobs A | title = Endocrine treatment of transsexual people: a review of treatment regimens, outcomes, and adverse effects | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 88 | issue = 8 | pages = 3467–3473 | date = August 2003 | pmid = 12915619 | doi = 10.1210/jc.2002-021967 | doi-access = free }}</ref><ref name="AsschemanGooren1993">{{cite journal | vauthors = Asscheman H, Gooren LJ | title = Hormone Treatment in Transsexuals | journal = Journal of Psychology & Human Sexuality | volume = 5 | issue = 4 | year = 1993 | pages = 39–54 | issn = 0890-7064 | doi = 10.1300/J056v05n04_03| s2cid = 144580633 }}</ref><ref name="pmid14510900u">{{cite journal | vauthors = Levy A, Crown A, Reid R | title = Endocrine intervention for transsexuals | journal = Clinical Endocrinology | volume = 59 | issue = 4 | pages = 409–418 | date = October 2003 | pmid = 14510900 | doi = 10.1046/j.1365-2265.2003.01821.x | s2cid = 24493388 }}</ref> ''Studies:''<ref name="deKlaver2016">{{cite journal | vauthors = de Blok C, Klaver M, Nota N, Dekker M, den Heijer M | title = Breast development in male-to-female transgender patients after one year cross-sex hormonal treatment | journal = Endocrine Abstracts | year = 2016 | volume = 41 | issn = 1479-6848 | doi = 10.1530/endoabs.41.GP146}}</ref><ref name="pmid29165635">{{cite journal | vauthors = de Blok CJ, Klaver M, Wiepjes CM, Nota NM, Heijboer AC, Fisher AD, Schreiner T, T'Sjoen G, den Heijer M | display-authors = 6 | title = Breast Development in Transwomen After 1 Year of Cross-Sex Hormone Therapy: Results of a Prospective Multicenter Study | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 103 | issue = 2 | pages = 532–538 | date = February 2018 | pmid = 29165635 | doi = 10.1210/jc.2017-01927 | s2cid = 3716975 | doi-access = free }}</ref>}}

[[Masculinizing hormone therapy]] is typically used by transgender men, who desire the development of masculine secondary sex characteristics. Masculinizing hormone therapy usually includes [[testosterone (medication)|testosterone]] to produce [[masculinization]] and suppress the production of [[estrogen]].<ref>{{Cite web|url=https://www.mayoclinic.org/tests-procedures/ftm-hormone-therapy/about/pac-20385099|title=Masculinizing hormone therapy - Mayo Clinic|website=www.mayoclinic.org|access-date=2019-08-02|archive-date=2019-07-16|archive-url=https://web.archive.org/web/20190716035520/https://www.mayoclinic.org/tests-procedures/ftm-hormone-therapy/about/pac-20385099|url-status=live}}</ref> Treatment options include [[oral administration|oral]], [[parenteralSubcutaneous administration|subcutaneous injections]], or [[subcutaneous implant|implant]], and [[transdermal administration|transdermal]] ([[transdermal patch|patches]], [[transdermal gel|gel]]s). Dosing is patient-specific, depending on the patient's rate of [[metabolism]], and is discussed with the physician.<ref name="Transgender_Care_Testosterone">{{Cite web|url=https://transcare.ucsf.edu/article/information-testosterone-hormone-therapy|title=Information on Testosterone Hormone Therapy | work = Transgender Care| publisher = transcare.ucsf.edu|access-date=2019-08-07|archive-date=2019-11-22|archive-url=https://web.archive.org/web/20191122161637/https://transcare.ucsf.edu/article/information-testosterone-hormone-therapy|url-status=live}}</ref> The most commonly prescribed methods are [[intramuscular injection|intramuscular]] and [[subcutaneous injection]]s.{{Citation needed|date=August 2024}} This dosing can be daily, weekly or biweekly depending on the [[route of administration]] and the individual patient.{{Citation<ref needed|datename=October"Transgender_Care_Testosterone" 2019}}/>

The desired effects of masculinizing hormone therapy focus on the development of masculine [[secondary sex characteristic]]s. These desired effects include: increased muscle mass, increased bone turnover,<ref>{{Cite journal |last1=Van Caenegem |first1=E |last2=Wierckx |first2=K |last3=Taes |first3=Y |last4=Schreiner |first4=T |last5=Vandewalle |first5=S |last6=Toye |first6=K |last7=Lapauw |first7=B |last8=Kaufman |first8=J-M |last9=T'Sjoen |first9=G |date=February 2015 |title=Body composition, bone turnover, and bone mass in trans men during testosterone treatment: 1-year follow-up data from a prospective case–controlled study (ENIGI) |url=https://academic.oup.com/ejendo/article-abstract/172/2/163/6660907?redirectedFrom=fulltext |journal=European Journal of Endocrinology |volume=172 |issue=2 |pages=163–171 |doi=10.1530/eje-14-0586 |pmid=25550352 |issn=0804-4643}}</ref> development of facial hair, voice deepening, increase and thickening of body hair, and more.<ref>{{Cite web | vauthors = Deutsch MB | date = 17 June 2016 | title = Overview of masculinizing hormone therapy | work = UCSF Gender Affirming Health Program | url = https://transcare.ucsf.edu/guidelines/masculinizing-therapy | access-date = 2021-11-12 | location = San Francisco, CA | publisher = The University of California | archive-date = 2023-06-19 | archive-url = https://web.archive.org/web/20230619070340/https://transcare.ucsf.edu/guidelines/masculinizing-therapy | url-status = live }}</ref>

|Increased RBCred blood cell count

Hormone therapy for transgender individuals has been shown in medical literature to be generally safe, when supervised by a qualified medical professional.<ref>{{cite journal | vauthors = Weinand JD, Safer JD | title = Hormone therapy in transgender adults is safe with provider supervision; A review of hormone therapy sequelae for transgender individuals | journal = Journal of Clinical & Translational Endocrinology | volume = 2 | issue = 2 | pages = 55–60 | date = June 2015 | pmid = 28090436 | pmc = 5226129 | doi = 10.1016/j.jcte.2015.02.003 }}</ref> There are potential risks with hormone treatment that will be monitored through screenings and lab tests such as blood count (hemoglobin), kidney and liver function, blood sugar, potassium, and cholesterol.<ref name="Transgender_Care_Testosterone" /><ref name="Transgender_Care_Estrogen" /> Taking more medication than directed may lead to health problems such as increased risk of cancer, heart attack from thickening of the blood, blood clots, and elevated cholesterol.<ref name="Transgender_Care_Testosterone" /><ref>{{cite journal | vauthors = | title = A randomized, double-blind study of two combined oral contraceptives containing the same progestogen, but different estrogens. World Health Organization Task Force on Oral Contraception | journal = Contraception | volume = 21 | issue = 5 | pages = 445–459 | date = May 1980 | pmid = 7428356 | doi = 10.1016/0010-7824(80)90010-4 }}</ref>Hormone therapy has been shown to improve the psychosocial well-being among transgender individuals. It's been seen to lower levels of distress in transgender individuals. <ref>{{Cite journal |last1=Doyle |first1=David Matthew |last2=Lewis |first2=Tom O. G. |last3=Barreto |first3=Manuela |date=August 2023 |title=A systematic review of psychosocial functioning changes after gender-affirming hormone therapy among transgender people |journal=Nature Human Behaviour |language=en |volume=7 |issue=8 |pages=1320–1331 |doi=10.1038/s41562-023-01605-w |pmid=37217739 |issn=2397-3374|pmc=10444622 }}</ref>

Transgender hormone therapyGAHT may limit fertility potential.<ref name="T'Sjoen_2013">{{cite journal | vauthors = T'Sjoen G, Van Caenegem E, Wierckx K | title = Transgenderism and reproduction | journal = Current Opinion in Endocrinology, Diabetes, and Obesity | volume = 20 | issue = 6 | pages = 575–579 | date = December 2013 | pmid = 24468761 | doi = 10.1097/01.med.0000436184.42554.b7 | s2cid = 205398449 }}</ref> Should a transgender individual choose to undergo [[sex reassignmentgender-affirming surgery]], their fertility potential is lost completely.<ref name="De_Sutter_2001">{{cite journal | vauthors = De Sutter P | title = Gender reassignment and assisted reproduction: present and future reproductive options for transsexual people | journal = Human Reproduction | volume = 16 | issue = 4 | pages = 612–614 | date = April 2001 | pmid = 11278204 | doi = 10.1093/humrep/16.4.612 }}</ref> Before starting any treatment, individuals may consider fertility issues and [[fertility preservation]]. Options include [[semen cryopreservation]], [[oocyte cryopreservation]], and [[ovarian tissue cryopreservation]].<ref name="T'Sjoen_2013" /><ref name="De_Sutter_2001" />

A study presented at ENDO 2019 (the [[Endocrine Society]]'s conference) shows that even after one year of treatment with testosterone, a [[transgender]] man can preserve his fertility potential.<ref>{{Cite web |title=Ovary function is preserved in transgender men at one year of testosterone therapy | work = Endocrine Society |url=https://www.endocrine.org/news-and-advocacy/news-room/2019/endo-2019--ovary-function-is-preserved-in-transgender-men-at-one-year-of-testosterone-therapy |access-date= 25 March 2019 | date = 23 March 2019 |archive-date=22 May 2022 |archive-url=https://web.archive.org/web/20220522015341/https://www.endocrine.org/news-and-advocacy/news-room/2019/endo-2019--ovary-function-is-preserved-in-transgender-men-at-one-year-of-testosterone-therapy |url-status=live }}</ref>

===FakeCounterfeit products===

Some online scammers have been targeting trans consumers with products that do not contain any hormones or contain ones that are opposite of what is advertised. This can happen when legislations outlaw or restrict access to treatments by legitimate medical professionals.<ref>{{cite news |last1=Xiang |first1=Chloe |title=A Sketchy Website Advertised Fake Hormone Pills to Trans People. Then, It Disappeared. |url=https://www.vice.com/en/article/z3mm88/a-sketchy-website-advertised-fake-hormone-pills-to-trans-people-then-it-disappeared |work=Vice |date=14 June 2023 |language=en |access-date=2 June 2024 |archive-date=25 July 2024 |archive-url=https://web.archive.org/web/20240725032506/https://www.vice.com/en/article/z3mm88/a-sketchy-website-advertised-fake-hormone-pills-to-trans-people-then-it-disappeared |url-status=live }}</ref>

Many providers use [[informed consent]], whereby someone seeking hormone therapy can sign a statement of informed consent and begin treatment without much gatekeeping. For other providers, eligibility is determined using major diagnostic tools such as [[ICD-11]] or the ''[[Diagnostic and Statistical Manual of Mental Disorders]]'' (DSM) to classify a patient with [[gender dysphoria]]. Psychiatric conditions can commonly accompany or present similar to gender incongruence and gender dysphoria. For this reason, patients are assessed using DSM-5 criteria or ICD-11 criteria in addition to screening for psychiatric disorders. The Endocrine Society requires physicians that diagnose gender dysphoria and gender incongruence to be trained in psychiatric disorders with competency in ICD-11 and DSM-5. The healthcare provider should also obtain a thorough assessment of the patient's mental health and identify potential psychosocial factors that can affect therapy.<ref>{{cite journal | vauthors = | title = CORRIGENDUM FOR "Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline" | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 103 | issue = 7 | pages = 2758–2759 | date = July 2018 | pmid = 29905821 | doi = 10.1210/jc.2018-01268 | doi-access = free }}</ref>

The WPATH Standards of Care, most recently published in 2022, outlines a series of guidelines which should be met before a patient should be allowed transgendergender-affirming hormone replacement therapy:<ref name=":0" />

Some organizations – butorganizations—but fewer than in the past – requirepast—require that patients spend a certain period of time living in their desired gender role before starting hormone therapy. This period is sometimes called real-life experience (RLE).

In Sweden, for instance, patients seeking to access gender affirming healthcare must first undergo extended evaluations with psychiatric professionals, during which they must - withoutmust—without any form of medical transition - successfullytransition—successfully live for one full year as their desired gender in all professional, social, and personal matters. Gender clinics are recommended to provide patients with wigs and breast prostheses for the endeavor. The evaluation additionally involves, if possible, meetings with family members and/or other individuals close to the patient. Patients may be denied care for any number of "psychosocial dimensions", including their choice of job or their marital status.<ref>{{Cite journal |journal=Sexuality Research and Social Policy |title=Two Steps Forward, One Step Back: A Policy Analysis of the Swedish Guidelines for Trans-Specific Healthcare |last1=Linander |first1=Ida |last2=Lauri |first2=Marcus |year=2021 |volume=18 |issue=2 |pages=309–320 |doi=10.1007/s13178-020-00459-5|s2cid=256073192 |doi-access=free }}</ref><ref>{{Cite web |url=https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/kunskapsstod/konsdysfori-vuxna-metodbilaga.pdf |title=God vård av vuxna med könsdysfori |access-date=2024-02-07 |archive-date=2024-07-25 |archive-url=https://web.archive.org/web/20240725032349/https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/kunskapsstod/konsdysfori-vuxna-metodbilaga.pdf |url-status=live }}</ref>

Access to medication can be poor even where health care is provided free. In a patient survey conducted by the [[United Kingdom]]'s [[National Health Service]] in 2008, 5% of respondents acknowledged resorting to self-medication, and 46% were dissatisfied with the amount of time it took to receive hormone therapy. The report concluded in part: "The NHS must provide a service that is easy to access so that vulnerable patients do not feel forced to turn to DIY remedies such as buying drugs online with all the risks that entails. Patients must be able to access professional help and advice so that they can make informed decisions about their care, whether they wish to take the NHS or private route without putting their health and indeed their lives in danger."<ref>{{Cite web|url = http://www.gires.org.uk/assets/Medpro-Assets/AIAUSatisfactionAuditJune2008.pdf|title = Survey of Patient Satisfaction with Transgender Services | publisher = National Health Service | work = The Audit Information & Analysis Unit |access-date = 2016-01-08|archive-url = https://web.archive.org/web/20160304073200/http://www.gires.org.uk/assets/Medpro-Assets/AIAUSatisfactionAuditJune2008.pdf|archive-date = 2016-03-04|url-status = dead}}</ref> Self-administration of hormonecross-gender replacement medicationshormones without medical supervision may have untoward health effects and risks.<ref name="pmid10604171">{{cite journal | vauthors = Becerra Fernández A, de Luis Román DA, Piédrola Maroto G | title = [Morbidity in transsexual patients with cross-gender hormone self-treatment] | language = es | journal = Medicina Clinica | volume = 113 | issue = 13 | pages = 484–487 | date = October 1999 | pmid = 10604171 | url = https://www.saludtrans.cl/wp-content/uploads/2012/10/morbilidad-automedicacic3b3n-en-transexuales.pdf | access-date = 2018-11-11 | url-status = dead | trans-title = Morbidity in transsexual patients with cross-gender hormone self-treatment | archive-url = https://web.archive.org/web/20171208140414/http://www.saludtrans.cl/wp-content/uploads/2012/10/morbilidad-automedicacic3b3n-en-transexuales.pdf | archive-date = 2017-12-08 }}</ref>

[[Category:Gender transitioningtransition and medicine]]