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Hi! I was wondering what exactly I have to do to get t, and who I need to talk to? I know I probably need a note from a therapist, but what after that? Sorry if this has been answered before ;;

Ren says:

This really depends on where you live! I can tell you a little about the US.

[Note: Lee has added in some links!]

Option #1:

Informed consent. This means that you discuss the effects of transition with a doctor, typically an endocrinologist (AMAB folks can also see urologists for HRT services, I have no idea why that’s the case), and confirm that you understand what you’re getting into. You’ll have to read and sign a document that lists all the changes to expect and potential health risks. (Examples of that document are here). You’ll get some tests done and then you’ll be good to go!

Important to note: You must be 18 years of age or older to consent for yourself. I haven’t heard of any minors getting informed consent with their parents’ help, although it may be possible. Also, not all insurances will cover informed consent services. If you want insurance to cover your HRT, speak to your provider (call the number on the back of your insurance card).

Resources: ICATH has some good US-specific resources for informed consent. @plannedparenthood also provides informed consent services for HRT in some locations (source). This Google Maps list here has a lot of informed consent clinics listed as well to check out, although it’s not a full list of all of them.

Option #2:

Therapist’s letter. This is the “traditional” method, based on the (now-sorta-outdated) WPATH Harry Benjamin Standards of Care. Basically, you talk to a therapist for several months. Usually, the therapist is one who knows about gender identity issues, or even specializes in them, but it doesn’t have to be - the main idea is that you’re looking for someone who can keep up with you and isn’t going to tell you that you’re mentally ill because you’re trans, so finding an LGBTQ-friendly therapist is a must. They write a note, hand it off to insurance and your doctor, and you’re on your way.

How long you have to see your therapist before their letter will work for you depends on a) the therapist, b) the doctor you want to see, and c) your insurance (if you plan on seeking coverage). You’ll have to communicate with all of these people in order to work out their requirements. The timeframe is typically around 3 months, but it can be longer or shorter depending on those factors. Information on getting a therapist is here.

An example of that letter is here.

Important to note: Not all insurances will cover HRT with a therapist’s letter, either, although many states are making it illegal to deny transition-related services. Be sure to check with your insurance provider first!

Finding a doctor can also be hit-or-miss. You can speak to your GP (general practitioner; i.e. the doctor you go to for regular checkups) - sometimes they know what they’re doing, and I’ve definitely heard of GPs prescribing HRT or hormone blockers to their patients. However, most of them will refer you to an endocrinologist (and many insurance plans require referrals before you can skip off to a specialist, too) for the actual hormones. Some doctors won’t let you do HRT. It’s okay if you shop around. Look around online; call their office first to make sure they work with trans patients. Remember, if a doctor refuses you healthcare, you have a right to refuse them your business!

Once you get to a doctor, you’ll get a preliminary blood test and a general health screening to check for contraindications (any medical conditions that might make it difficult or impossible for you to be on HRT). Nearly every contraindication is possible to work around, though, so don’t worry too much! They’ll likely be looking at your cholesterol levels and heart and liver functions in particular, although this may vary from doctor to doctor and treatment to treatment.

Finally - as long as all medical conditions are sorted out - you’ll be prescribed your hormones. You can choose which delivery method you receive. For testosterone, there’s injections (which involve needles, but typically only need to be administered once a week or every 10 days), patches (daily, can badly irritate sensitive skin), and creams / gels (daily, have to be careful so that you don’t get it on another person). AMAB folks will need to take both estrogen and an anti-androgen. Typically, estrogen is oral, but can also come in the forms of injections; anti-androgens are nearly always oral.

Stick to the instructions they give you in terms of dosage and administration - they give these instructions for good reason! Your doctor should monitor your hormone levels and health status / conditions, and will likely adjust your dosage as time goes by to ensure it is still accurate, so make sure you continue to go in for checkups.

This post on convincing your parents to allow you to start HRT is also a good place to look!

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