A hormone readiness assessment is an evaluation conducted by a healthcare professional to determine if a patient is ready to begin hormone therapy.
The World Professional Association for Transgender Health Standards of Care requires an assessment before hormone therapy is started. Care in B.C. is guided by Version 8 of the Standards (WPATH SOC-8), which were published in 2022.
Many primary care providers including family physicians, nurse practitioners and pediatricians have received training and are able to assist with readiness assessment for hormone therapy. Counsellors, psychologists and psychiatrists may also perform hormone readiness assessments and write letters of recommendation to clinicians who are able to prescribe.
For help finding healthcare professionals who conduct hormone readiness assessments, contact our health navigation team.
Not all primary care providers feel comfortable assessing for hormone readiness or initiating treatment and may prefer to refer on to other providers. Even experienced providers may involve other clinicians depending on your unique needs. In this case, you may see one provider (such as a mental health clinician) for a letter of recommendation and another provider (such as an endocrinologist) for your prescription.
Counselling is not typically required to get a prescription for hormones although it can be very helpful for some people. It 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
The length of the assessment period depends on the health care provider, clinic protocols and your needs.
Assessment may take longer if someone has physical health, mental health or substance use issues. These concerns are not barriers to hormone therapy, but need to be considered when making a plan for treatment.
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.
During the assessment, you will be asked about:
- your gender identity and feelings about your body
- your goals. Some people wish to reduce testosterone-related features, induce estrogen-related features, reduce estrogen-related features, and/or induce testosterone-related features. This may impact your medication dosage
the effects you expect to see from estrogen-based or testosterone based hormone therapies and effects you would rather avoid
your health history (current and past medical and mental health conditions, surgical history, medications, allergies, smoking status, exercise, nutrition, family history, etc.)
- your understanding of the 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
If you are a youth seeking puberty blockers or hormone therapy, you health care provider will need to consider additional factors because of your age and stage of development. Youth are typically living with parents or guardians who may also need additional information or support related to gender-affirming treatment.
For youth, when you visit your health care provider to talk about starting puberty blockers or hormones, they will likely want to discuss:
- how you understand your gender
- the way you express your gender
- 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 and hormone treatments
- what puberty blockers and hormone treatments won’t do
For recommendations of health care providers who work with trans youth, contact our health navigation team.
You do not have be trans to be eligible for hormone therapy. Hormone therapy can be medically necessary for a range of people, including those who are non-binary, genderqueer, or gender diverse.
WPATH SOC-8 Criteria for Hormone therapy for adults:
- Gender incongruence is marked and sustained;
- Meets diagnostic criteria for gender incongruence and other possible causes of apparent gender incongruence have been identified and excluded;
- Demonstrates capacity to consent for the specific gender-affirming hormone treatment;
- Mental health and physical conditions that could negatively impact the outcome of treatment have been assessed, with risks and benefits discussed;
- Understands the effect of gender-affirming hormone treatment on reproduction and they have explored reproductive options.
WPATH SOC-8 Criteria for hormone therapy for adolescents:
- Gender diversity/incongruence is marked and sustained over time;
- Meets the diagnostic criteria of gender incongruence and other possible causes of apparent gender incongruence have been identified and excluded;
- Demonstrates the emotional and cognitive maturity required to provide informed consent/assent for the treatment;
- Mental health concerns (if any) that may interfere with diagnostic clarity, capacity to consent, and gender-affirming medical treatments have been addressed; sufficiently so that gender-affirming medical treatment can be provided optimally;
- Informed of the reproductive effects, including the potential loss of fertility and the available options to preserve fertility;
- Reached at least Tanner 2 (applies more to puberty suppression but is listed in hormone criteria as well)
In some cases, health care providers may prescribe hormones even when these criteria are not met. For example, a health care provider may prescribe hormones as an alternative to unsupervised hormone use. Also, the presence of mental health concerns (such as depression or 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.
Note that “Real Life Experience” is no longer a requirement for hormone therapy. Version 7 of the Standards of Care removed this requirement and Version 8 maintains this change.