What should I know about transfemme HRT?
Finding a provider
(Unfortunately, much of this section is specific to the United States, as healthcare varies worldwide.)
HRT is prescription medication, so you will need to speak with some sort of medical provider in order to get it.
It wasn't too long ago that HRT was quite difficult to get. Thankfully, many providers today operate on an "informed consent" model. That is, they will ask you questions about why you want HRT, and what your expectations are. If you demonstrate you understand what medical transition entails, they will write you a prescription.
Erin Reed has a crowdsourced map of providers that use the informed consent model.
Types of Provider
During my investigation, I came across several different routes to getting HRT:
Endocrinologist - An endocrinologist is a doctor who specializes in hormones. Many endocrinologists prescribe HRT and work with transgender patients. Depending on your insurance, you may want to meet with your "primary care" doctor first, and have them refer you to one.
I ended up going this route because I liked having a doctor who specialized in this type of treatment. Another plus is that I would see the same doctor every visit. The downsides of this route are that endocrinologists are often considered conservative in terms of treatment, so if you're looking for the bleeding edge HRT regimens, they may be more reluctant to provide them. That said, they do often see a lot of transgender patients, so they are aware of what works and what doesn't. They've also got many years of hormone-related training and experience.
LGBTQIA+ Clinic - in some (mostly urban, and/or progressive) areas, you will find clinics that cater to the LGBTQIA+ population. These clinics often offer HRT as part of a wider set of care.
Depending on the clinic, you may end up seeing a doctor or a nurse. There's also a lot of variation in treatment guidelines and so forth with these clinics, so it pays to show up informed and make sure you know what your goals are.
Planned Parenthood - Planned Parenthood also offers HRT. In my area, they exclusively offer telemedicine appointments. That can be both a pro and a con, depending on your preference. While they are able to serve a wider area, some people prefer to meet their provider in person. They also don't have you see the same provider every time.
I met with a nurse for Planned Parenthood when I was in search of HRT, and I found that she was willing to listen to my questions and concerns, and tailored the treatment regimen to my specific health needs and transition goals.
Blood Draws
Regardless of where you go to get your HRT, you should also be getting blood draws periodically. The information from this is used to properly regulate medication and dosages.
Questions to ask
If you get the chance to ask these questions before your appointment, great! Some of this might also be covered on the practice's website. Otherwise, coming into your appointment as informed as possible and asking questions like these will help guide you and your provider towards a good outcome.
- What percentage of your patients are transgender? Obviously, if you're the only trans person going to a particular practice, that means the doctors and nurses might not be as up on transgender medicine. You want a provider that is comfortable with HRT.
- How often will we have appointments? Three months seems to be about standard as far as I've noticed. You likely won't have a blood draw or have your medication adjusted any more frequently than that.
- What guidelines do you follow around HRT dosage? There are various standards, and practices may have their own rules they follow which they've found give their patients good results. It can help to understand how the treatment plan is going to go, so that you know what to expect from follow-up appointments.
You should also discuss your transition goals. I know it's uncomfortable, but talking about whether or not you're going to keep your penis, and what kind of function you want to have out of it during and post transition are important.
If you have a preference around what type of HRT you want to take for one reason or another, that's another thing to bring up. Good providers should be able to explain the risks and rewards of a particular treatment regimen, and answer any questions you might have. (We'll get to how to acquire information about HRT here in a second)
If you meet with the provider and they're not willing to listen, or you don't "mesh" in terms of those questions (or others you might have), consider taking the prescription and using the time between appointments to find a different provider. We don't always have the luxury of choice, but when we do - we should take advantage.
Sources of information
We've established how to get HRT, and that it pays to be informed about your options before and while you're on it. But where can you learn about the medications, dosages, timelines, etc?
Good Sources
There is a lot of information out there, but I prefer to refer to science when making decisions about my body. You may agree or disagree - this is always your choice.
The hitch when it comes to transgender HRT is that there's not a lot of great science out there. A lot of studies are limited to a couple of dozen participants monitored over short period, for instance.
The current standard for transgender care is contained in the "The World Professional Association for Transgender Health" (WPATH) guidelines. The "Standards of Care" document can be found here. Note that it is very technical, and not really for people without a medical background.
The best website I have found for HRT details is TransFemmeScience. While they don't do research themselves, they do collect good sources and provide meaningful commentary and tools. I suggest getting as much information from them as possible. They are also relatively technical, but I found it more understandable than the WPATH SOC.
I suggest browsing through the introduction article and doing your best to understand the various types of estrogens and antiandrogens, so that you can be informed about the options available.
Less-Good Sources
Even though the science is limited, some science is better than none, and I'd urge you to avoid sources that cite anecdotal data, fail to cite any data, or go by informal straw polls on Reddit or similar.
I have dedicated a whole page to why you shouldn't take medical advice from strangers on the internet. It comes up very often, and logical fallacies and unsourced claims abound. Please, please, please take the time to read and understand it before you start taking any advice you hear from Reddit, Discord, YouTube, etc.
One source in particular I will cite as less trustworthy is Dr. Will Powers. I single him out because he's prominent in the space, and the fact that he is a doctor lends him more credibility than most other internet strangers you might encounter. He has some strong opinions about the current state of transgender healthcare, and I think that's understandable.
However, a lot of the things he presents as factual and scientific has yet to be proven. TransFemScience published a critique of his techniques, and debunked many of his claims. However, it's hard to find because Dr. Powers threatened a lawsuit against them. As of this writing, this archive copy is still up.
To summarize, these sources of information might be useful. They might be more correct in some ways than what you'll learn from your HRT provider. But sorting the bits that are "better" from the ones that are "worse" is the process of science. Trusting these sources means that in a lot of ways you're taking the responsibility for your medications out of the hands of your doctor and into the hands of whoever you are choosing to trust. Choose wisely!
Getting the medications
(Again, this is mostly United States-specific)
Getting the prescription is often only half the battle. Filling it and paying for it can be difficult as well.
Keeping medication costs down
A couple of resources I'll leave here for people who are sensitive to the cost of their medications:
- Cost Plus Drugs is a mail order pharmacy that can fill 90-day supplies of many different medications. As of this writing, they appear to be able to supply at least some estradiol pills, patches, and creams.
- GoodRx can list prices for medications in your area, giving you a chance to find the cheapest nearby pharmacy. They also offer a free discount service that often lowers the price, as well as a paid service that they claim can lower it further.
I personally prefer mail order when I can get it - there's no awkward conversation with a person who may or may not approve of my HRT, plus I get 3-month supplies so I don't have to worry about refills as often.
Injection supplies
If your provider prescribes an injectable medication, you'll need needles and syringes. The pharmacy may offer you these, but if they don't, or their prices are insanity, here are some online shops that can fill the gap:
- https://www.shopmedvet.com/
- https://www.farrislabs.com/
I haven't yet needed these shops; others recommended them. Proceed with caution!