How you prepare

Before starting feminizing hormone therapy, your doctor will evaluate your health to rule out or address any medical conditions that might affect or contraindicate treatment. The evaluation might include:

• A review of your personal and family medical history
• A physical exam, including an assessment of your external reproductive organs
• Lab tests measuring your lipids, blood sugar, blood count, liver enzymes, electrolytes and the hormone prolactin
• A review of your immunizations
• Age- and sex-appropriate screenings
• Identification and management of tobacco use, drug abuse, alcohol abuse, HIV and other sexually transmitted infections
• Discussion about sperm freezing (sperm cryopreservation)
• Discussion about use of potentially harmful treatment approaches, such as unprescribed hormones, industrial-strength silicone injections or self-castration

You might also need a behavioral health evaluation by a provider with expertise in transgender health. The evaluation might assess:

• Your gender identity and gender dysphoria
• The impact of your gender identity at work, school, home and social environments, including issues related to discrimination, relationship abuse and minority stress
• Mood or other mental health concerns
• Sexual health concerns
• Risk-taking behaviors, including substance use and use of nonmedical-grade silicone injections or unapproved hormone therapy or supplements
• Protective factors such as social support from family, friends and peers
• Your goals, risks and expectations of treatment and your future plans for your care

Adolescents younger than age 18, accompanied by their parents or guardians, also should see doctors and behavioral health providers with expertise in pediatric transgender health to discuss the risks of hormone therapy, as well as the impact and possible complications of gender transition in that age group.