HRT should not be used as a substitute for any therapy or psychiatric care, but your therapist may suggest undergoing feminizing HRT in addition to whatever treatments you already have in place. Be sure to loop in psychologists and psychiatrists through your process to work together for the most productive outcomes.
Is feminizing hormone therapy for me?
This is a question no one can answer but yourself. Medically transitioning is not a requirement to be trans, as there are no formal requirements. For those questioning their own gender identity and have unanswered concerns about whether or not they are transfeminine, reading guides such as this one can help. Although transness is as old as history itself, the current language we use to describe it is less than 100 years old, so there is so much room to explore your identity, and say who you are. No one can take that away from you. If you say you’re trans, you are, with or without HRT.
If you feel you want to pursue feminizing HRT for your own transition, then it is for you.
“Each individual should reflect on their own goals of treatment and what they really want when considering HRT,” Ducar said about what a patient should do before considering whether to medically transition.
Ducar added that not everyone needs to go on feminizing HRT, and that you should only do so if you feel medically transitioning is that important for your transition goals.
How do I access feminizing hormone therapy? Is HRT covered by insurance?
Getting a prescription for HRT depends on a number of factors. First, it depends on the provider, the provider’s location, and if insurance covers the medication.
Ideally, when searching for HRT, patients will have done research online about the treatment’s effects and have some idea about what they are pursuing. A number of clinics in response have begun operating under the informed consent model.
According to the American Medical Association, informed consent is when “communication between a patient and physician results in the patient’s authorization or agreement to undergo a specific medical intervention.” This means that as long as a doctor provides patients with potential side effects and risks and a patient agrees to treatment, the doctor can provide it.
Many clinicians who do not follow the informed consent model require a referral letter and a formal diagnosis of gender dysphoria to start HRT. For many patients, this can be a time-intensive and prohibitive barrier to affirming care.
The informed consent model grew out of mistrust that transgender people have had for the medical establishment that has minimized their needs in the past, and has grown in recent years. There is no official, centralized database of informed consent clinics, but when researching a clinic that offers gender-affirming care, many websites will list that providers follow this model. If a clinic does not, it is a good idea to call ahead if you want to understand its methods.
Those who are still unable to find a provider in their area, or who are in situations where they have to hide their transition, tend to gravitate towards DIY HRT providers online. Understanding that access to transition-related care could be a life-or-death need, it is important to note that there are some risks of taking HRT without doctor supervision.
Ducar says that it is possible to cause an overdose on HRT, and that you could put yourself at risk for “breast cancer, stroke, blood clots, gallstones, and a range of heart issues” without being properly monitored.
“The most common testosterone-blocker, spironolactone, can cause dehydration and weaken the kidneys,” she added. “All of these are potential risks when not monitored by a provider, or someone trained and with access to a lab.”
Most major private insurers cover feminizing HRT, however, the types of care covered and possible exclusions may vary. As ring-wing lawmakers attack access to gender-affirming care through public insurers like Medicaid, coverage for feminizing HRT may change depending on your state.
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