Understanding Gender Affirming Hormone Assessments: What to Expect and How to Prepare

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Gender-affirming hormone therapy can be an important aspect of medical care for transgender and gender non-conforming individuals seeking to align their physical characteristics with their gender identity. Before beginning hormone therapy, it is necessary to undergo a comprehensive hormone assessment to determine readiness and the appropriate hormone regimen. In this blog post, we will delve into the details of what a gender-affirming hormone assessment entails, including healthcare authority-mandated medical and psychological evaluations, hormone level testing, and a discussion of potential risks and benefits. We will also explore how to prepare for and what to expect during the assessment process. By understanding the steps involved in a hormone assessment, individuals can make informed decisions about their transition journey and access the care they need to live authentically.

A gender-affirming hormone assessment is a conversation-based evaluation that you complete with a healthcare or mental health professional to explore your readiness to begin hormone therapy. In BC, this assessment can be done with your doctor, nurse practitioner, nurse, social worker, or other licensed healthcare professional. In the case that you don’t have access to a trans-competent family doctor, nurse practitioner, nurse, social worker, or healthcare clinic to help you complete an assessment, I’m qualified by RCC-level mentorship, multi-year WPATH GEI professional training, and ongoing transgender care-related supervision to complete an assessment with you. I have been providing gender-affirming hormone assessments since July 2020. I’ve completed my own assessment with a psychologist back in 2013.

Why do you need a gender-affirming hormone assessment? In Canada, the trend has been to follow the World Professional Association of Transgender Health (WPATH) Standards of Care. Version 7, which is the version still used by most practitioners in BC, of the standards of care state that the “Initiation of hormone therapy may be undertaken after a psychosocial assessment has been conducted and informed consent has been obtained by a qualified health professional, as outlined in section VII of the SOC. A referral is required from the mental health professional who performed the assessment unless the assessment was done by a hormone provider who is also qualified in this area” (p. 33). Please note that BC and other provinces are moving to adopt version 8 of the Standards of Care, which was published by WPATH in July 2022. Hormone therapy can help alleviate gender dysphoria, which is the distress caused by a mismatch between a person’s gender identity and the sex they were assigned at birth.

Gender-affirming hormone therapy is a medical intervention that involves the use of hormones to assist individuals in aligning their physical characteristics with their gender identity. For individuals who identify as trans-masculine, hormone therapy usually involves testosterone. Conversely, for those who identify as trans-feminine, hormone therapy typically involves a combination of estrogen and anti-androgens. While hormone therapy is commonly associated with changes in physical appearances, such as body hair, fat distribution, and muscle mass, it can also impact other aspects of an individual’s physiology. In trans-masculine individuals, hormone therapy can lead to the cessation of menstruation. Furthermore, hormone therapy can also affect the voice, and may cause other physical and emotional changes that can have a positive impact on an individual’s overall well-being. It is important to note that hormone therapy is a medical treatment that should only be administered after careful consideration and evaluation by a qualified medical professional.

What are the criteria for hormones for adolescents?  The criteria for hormones for adolescents are outlined in the SOC8 (Standards of Care, version 8) updates. These criteria are designed to ensure that adolescents seeking gender-affirming medical treatments meet certain requirements before receiving hormone therapy. The criteria include 1) having marked and sustained gender diversity or incongruence, 2) meeting the diagnostic criteria for gender incongruence when necessary for accessing healthcare, 3) demonstrating the emotional and cognitive maturity required to provide informed consent/assent for the treatment, 4) addressing any mental health concerns that may interfere with diagnostic clarity or capacity to consent, 5) being informed of the reproductive effects of the treatment, including the potential loss of fertility and available options to preserve fertility, and 6) having reached Tanner stage 2. These criteria are important to ensure that adolescents are receiving appropriate care and treatment and to minimize any potential risks or negative side effects associated with hormone therapy.

What are the criteria for gender-affirming hormones for adults? The criteria for gender-affirming hormones for adults may vary depending on the healthcare provider or medical institution. However, some common criteria may include 1) a diagnosis of gender dysphoria, which is the distress experienced due to a mismatch between one’s gender identity and assigned sex at birth, 2) being at least 18 years old, although some providers may start treatment for individuals who are 16 or 17 years old with parental or guardian consent, 3) having stable mental health, which means that any mental health concerns or comorbid conditions have been addressed and are under control, 4) understanding the risks and benefits of hormone therapy, including potential changes to fertility and sexual function, and 5) having discussed and explored other options for gender affirmation, such as social transitioning and gender expression, with a qualified healthcare provider. These criteria aim to ensure that adults receive appropriate care and treatment for a gender mismatch or gender dysphoria and minimize the risks associated with hormone therapy.

During a hormone assessment with me, we may discuss your gender history and relational history. We will explore your goals and expectations for gender-affirming hormone treatment, as well as any concerns or questions you may have. Additionally, we will discuss any mental health concerns you may have, and I may recommend coping skills, identify support systems, and share creative resources. You may be asked to complete some brief mental health questionnaires to provide additional information. The hormone assessment typically requires two 50-minute sessions or one 90-minute session to complete, depending on your individual needs and circumstances. Overall, the goal of the hormone assessment is to ensure that you receive the appropriate care and support as you begin your gender-affirming journey with hormone therapy.

What is the total fee for a hormone assessment? The total cost is $570, which includes two 50-minute sessions, evaluation, scoring, interpretation, and a written assessment.  The fee can be paid by credit card or e-transfer. Other counselling services, such as support during transition, family meetings, letters for document changes, etc., will be charged separately.

Where can you get an affordable gender-affirming hormone assessment? If affordability is an issue, there are many good local options to consider. While the waitlists may be long, these options still provide you with a quality assessment for hormones. For low-cost or free gender-affirming hormone assessments, contact Trans Care BC at 1-866-999-1514. In Alberta, contact The Gender Program at 780-407-6693 or check out the Trans Wellness Initiative. In Vancouver, Catherine White Holman Wellness Centre provides free hormone readiness assessments.

What can you do to start this process? Talking to peers who have gone through similar experiences can provide insight and support. Medical providers can help guide you through the medical aspects of transition, such as hormone therapy or surgical options. A gender-affirming psychotherapist can offer specialized support and counselling, helping you explore your feelings and goals, and work through any challenges that may arise.

Online psychotherapy with me can provide a convenient and safe space to discuss your gender transition concerns and receive support. As a licensed mental health professional, I offer a non-judgmental, supportive, and affirming environment where you can explore your identity, work through any issues that may arise, and develop a plan to achieve your transition goals.

Remember, your gender transition journey is unique to you, and seeking support from those who understand and respect your experiences is an important part of the process. Don’t hesitate to reach out to peers, medical professionals, or gender-affirming therapists to help you feel confident and informed in your decisions.

How do you book a telehealth-based hormone assessment? View my schedule in Jane App, join the waitlist, or contact me to book your assessment.

Disclaimer: This blog shares general information only, not professional advice or recommendations. Consult healthcare providers for personal guidance. Decisions based on content are the reader's responsibility. Thank you.

Clayre runs a group practice of three queer and trans therapists, including youth therapist Audrey Wolfe, RCC, LGBT therapist Camber Giberson, RCC, CCC, and gender-affirming therapist Clayre Sessoms, RP, RCT, RCC, CCC, ATR-P. Work with us: book a session.

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