Hormone Readiness Assessment

Why is an assessment conducted?

Assessments are part of the current WPATH Standards of Care (Version 7) for starting hormone therapy.

Who provides assessments?

Any general practitioner, family physician, or nurse practitioner with some basic training can assess for and prescribe hormone therapy to adults, although many may not have received training.

Counsellors, psychologists and psychiatrists may also perform hormone readiness assessments and write letters of recommendation to clinicians who are able to prescribe.

Why is my doctor asking for a letter from a mental health professional?

Not all primary care providers are comfortable initiating hormone therapy and may require a letter from a mental health professional or other clinician with experience doing readiness assessments before writing you a prescription.

Not all PCP’s feel comfortable initiating hormone therapy, and may require a letter from a mental health professional before writing you a prescription. Some may prefer to refer to an endocrinologist or other clinician rather than being the prescribing clinician. We hope that as more PCP’s learn receive basic hormone therapy education, this will occur less frequently.

How can I find someone who can complete my assessment?

You can Contact Us for referrals to health professionals who conduct hormone readiness assessments.

Do I need counselling to start on hormone therapy?

Counselling is not typically required to get a prescription for hormones.

Counselling may be required or recommended if:

  • You are uncertain about whether hormone therapy is the right decision

  • You are not out to significant others and do not have a plan in place to come out, or

  • You have significant mental health or substance use concerns

How long does a hormone assessment take?

It depends on the health care provider, clinic protocols and your needs. It generally takes a few visits to your health care provider, over the course of 2-6 months, before starting on hormone therapy.

Assessment may take longer if someone has medical, mental health or substance use issues. These concerns are not necessarily barriers to hormone therapy, but should be reasonably well-controlled before starting. Another factor is age; assessors may wish to have several meetings with a youth before making a recommendation for hormones.

What questions will be asked during my assessment for hormones?

  • Your gender identity and feelings about your body.

  • Your goals. Some people wish to feminize or masculinize their body, while others wish to appear more androgynous. This may impact your dosage.

  • What effects you expect to see from feminizing/masculinizing medications

  • Health history (current and past medical and mental health conditions, surgical history, medications, allergies, smoking status, exercise, nutrition, family history, etc.)

  • Your understanding of long-term risks associated with hormone therapy

  • Your support network and strategies for thriving in your changing gender expression with family and friends, at work and at school.

Do I need to have a physical as part of the assessment?

Your health care provider will usually perform an exam. They will also likely ask you to do some laboratory work, such as a blood test.

What if I am a youth?

If you are a youth seeking puberty blockers or hormone therapy,  you will typically receive a hormone readiness assessment with a qualified mental health professional. Then you will be referred to a pediatric endocrinologist who prescribes and monitors the treatment. For recommendations of mental health professionals who work with trans youth, Contact Us.

For youth, when you visit your mental health professional to talk about starting puberty blockers or hormones, they will likely want to discuss:

  • How you understand your gender identity

  • The way you express your gender identity

  • How you feel about your body

  • How you are doing emotionally

  • Your relationships with peers and family

  • Your experiences at school and in the community

  • What to expect from puberty blockers/hormone treatments

  • What puberty blockers/hormone treatments won’t do

If I am not trans, am I eligible for hormone therapy?

Yes. Hormone therapy can be medically necessary for a range of people, including those who are genderqueer, gender variant, or gender non-conforming.

What are the criteria for hormone therapy?

The World Professional Association for Transgender Health sets the criteria for hormone therapy in a document called Standards of Care. The current Version 7 is now used in BC.

The four criteria for hormone therapy for adults are:

  1. Persistent, well-documented gender dysphoria.

  2. Capacity to make a fully informed decision and to consent to treatment.

  3. Age of majority (in BC, the age of majority is 18).

  4. If significant medical or mental health concerns are present, they must be reasonably well-controlled.

For children and youth under the age of 18, the criteria for hormone therapy are:

  1. A long-lasting and intense pattern of gender non-conformity or gender dysphoria

  2. Gender dysphoria emerged or worsened with the onset of puberty

  3. Any coexisting psychological, medical, or social problems are stable enough to start treatment

  4. The adolescent has given informed consent. The consent of your guardian(s) is preferred, but not absolutely necessary under the BC Infants Act.

In some cases, health care providers may prescribe hormones even when these four criteria are not met. For example, a healthcare provider may prescribe hormones as an alternative to illicit or unsupervised hormone use. Also, the presence of mental health concerns (like depression and anxiety) or addiction does not necessarily mean you do not meet the criteria. Instead, these concerns will need to be reasonably managed prior to, or during, hormone therapy.

Is “Real Life Experience” (RLE) a requirement for hormone therapy?

“Real Life Experience” is no longer a requirement for hormone therapy. Version 7 of the Standards of Care, which was published in 2011, removes this requirement.