After consensus has been reached by you and your gender clinicians, a recommendation can be made to your GP about hormones. This would normally only happen after your second assessment appointment.
Separate protocols exist for children and adolescents – read more on the Gender Identity Development Service website
The GIC has patients from all over the UK, so it is not possible for us to prescribe and monitor hormones directly. We depend on GPs or local services to do this, with our guidance.
Non-binary people seek a variety of hormonal outcomes at the clinic. Therefore there is not a standard hormone treatment protocol and endocrinology appointments will be offered for those who wish to discuss non-binary hormonal outcomes.
Risks
There is some uncertainty about the possible risks of long-term masculinising and feminising hormone treatment. We will always discuss the potential risks and importance of regular monitoring with you before hormonal treatment begins.
Smoking
Typically we ask people to stop smoking before they commence on hormone therapies. This is because of the increased cardiovascular and thromboembolic risk of smoking in combination with hormone therapy. If someone is smoking on hormone therapies, we typically would not increase the dose above standard HRT doses for cisgendered people and would use topical formulations (rather than oral estradiol or injectable testosterone). Studies from the cisgender population show this minimises risk of thromboembolism and cardiovascular disease. Smoking also affects microcirculation and thus tissue healing following any surgery, should this be required. Patients who are smoking should be advised to stop, for these reasons, and also for general health. Tobacco-free nicotine replacement therapy and smoking cessation services may help patients to stop smoking.
Ultrasound screening for trans and nonbinary patients with a uterus
The advice is that trans and non-binary patients who have a uterus still in place and are receiving testosterone treatment ought to have a pelvic ultrasound scan every two years in order to ascertain the thickness of the endometrial lining. Because the lining of the uterus is not being lost every month there is a risk that this lining may thicken and if that happens there could be a very small risk of endometrial cancer. Consequently a two year scan is advised.
Read more about screening in general on our Sexual health and screening information page.
Fertility
Hormone therapy can reduce fertility and may eventually render people completely infertile. Your specialist will discuss the potential impacts of hormone treatment on fertility before starting treatment. They will also discuss with you the option of storing eggs or sperm (known as gamete storage) in case you want to have children in the future. We advise that people seeking hormone therapy decide whether they wish to retain fertility before beginning treatment as there is no guarantee that fertility will return to normal if hormones are stopped.
Please see the Human Fertilisation and Embryology Authority website for information about local fertility services:
Monitoring
While you are taking hormones you will need to have regular check-ups, usually at your local GP surgery, to check for any health problems and to find out if the hormone treatment is working.
You may be frustrated with how long hormone therapy takes to produce results, as it can take some months for physical changes to develop. It is important to have realistic expectations about what hormones can achieve for you. For example, hormones cannot change bone structure or height. More information about the risks and effects associated with hormone treatment can be found on our 'Updates on physical interventions' page.
Self-medicating with hormones
There are significant health risks associated with self-medication with hormones, so we cannot endorse this. However, we also do not penalise people for it, nor do we discriminate against patients who have chosen to access private gender care.
Our main concern is that hormones are taken safely. We routinely carry out blood tests, where appropriate, and will advise you about any risks to your health. Remember that hormones bought over the internet may not be licensed or safe.