Primary Care Providers are well positioned to prescribe hormone therapy for our transgender patients. We can play an important role in shortening the wait time to access to treatment for people suffering from Gender Dysphoria. As demonstrated in the 2013 Trans Pulse study – PDF, the time between a person identifying that they need to transition and accessing treatment is a high risk time for suicide. Our goal as care providers should be to minimize delays in accessing appropriate treatment for those that need it.
WPATH criteria for hormone therapy
Per the Standards of Care, version 7 – PDF (page 34), the criteria for hormone therapy are:
- Persistent, well-documented gender dysphoria;
- Capacity to make a fully informed decision and to consent for treatment;
- Age of majority in a given country (if younger, follow the SOC outlined in section VI);
- If significant medical or mental health concerns are present, they must be reasonably well-controlled.
Responsibilities of hormone-prescribing providers
Per the Standards of Care, page 42:
- Perform an initial evaluation that includes discussion of a patient’s physical transition goals, health history, physical examination, risk assessment, and relevant laboratory tests.
- Discuss with patient the expected effects of feminizing/masculinising medications and the possible adverse health effects. These effects can include a reduction in fertility. Therefore, reproductive options should be discussed with patients before starting hormone therapy.
- Confirm that patients have the capacity to understand the risks and benefits of treatment and are capable of making an informed decision about medical care.
- Provide ongoing medical monitoring, including regular physical and laboratory examination to monitor hormone effectiveness and side effects.
- Communicate as needed with a patient’s other health care providers including primary care, mental health professionals and surgeons.
- If needed, provide patients with a brief written statement indicating that they are under medical supervision and care that includes feminizing/masculinizing hormone therapy. Particularly during the early phases of hormone treatment, a patient may wish to carry this statement at all times to help reduce difficulties with the police and other authorities.
Prior to starting hormone therapy, providers should consider having an informed consent conversation with patients. The following consent forms can help to facilitate and document that the conversation occurred.
- [Feminizing Hormone Consent]
- [Masculinizing Hormone Consent]
Guidelines and information about hormones
- Sherbourne Health Centre: Guidelines and Protocols for Comprehensive Primary Care for Trans Clients 2015 – PDF
- Vancouver Coastal Health: Endocrine Therapy for Transgender Adults in British Columbia: Suggested Guidelines – PDF
- The Endocrine Society: Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline – PDF
Hormone therapy for clients who are nonbinary/do not identify as M or F
Some practitioners who are developing a comfort with medical care for patients who are transitioning from Male to Female or Female to Male are unsure of how to best support clients who do not identify as Male or Female, but would like to modify their gender presentation in a more masculine or feminine direction. There is evolving consensus that masculinising or feminizing therapies can reduce gender dysphoria for this group of patients.
Sherbourne Health Centre in Toronto, Ontario offers guidance on this in their Guidelines and Protocols for Comprehensive Primary Care for Trans Clients 2015 – PDF.
”Non-binary clients (eg. genderqueer, gender fluid, pangender, agender) may feel that their gender falls somewhere between the binary notions of ‘man’ or ‘woman’, is both, neither, or in flux. Just as other trans clients do, non-binary clients may seek medical assistance with modification of secondary sex characteristics that contribute to clinically significant gender dysphoria. Those seeking minimization of the endogenous effects of testosterone and/or feminization may follow the protocols outlined for trans women (see Part II: Feminizing Hormone Therapy). Those seeking minimization of the endogenous effects of estrogen and/or masculinization may follow the protocols outlined for trans men (see Part III: Masculinizing Hormone Therapy).”