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. Version 7 of the Standards, which were published in 2011, is used in BC.
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.
- If you need help finding health professionals who conduct hormone readiness assessments, contact Trans Care BC.
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. Some primary care providers may prefer to refer to an endocrinologist or other clinician rather than being the prescribing clinician. We hope that as more primary care provides receive basic hormone therapy education, this will occur less frequently.
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. A few visits to your health care provider, over the course of 2 to 6 months, is usually needed before hormone therapy is started.
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.
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 feminize or masculinize their body, while others wish to appear more androgynous. This may impact your medication dosage
- the effects you expect to see from feminizing or masculinizing medications
- 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 younger youth seeking puberty blockers or hormone therapy, you will typically receive a hormone readiness assessment with a qualified mental health professional, such as a psychiatrist or psychologist. Then you will be referred to a pediatric endocrinologist who prescribes and monitors the treatment. In some cases a primary care provider such as a pediatrician may be involved in your assessment and treatment.
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 and hormone treatments
- what puberty blockers and hormone treatments won’t do
For recommendations of mental health professionals who work with trans youth, contact Trans Care BC.
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.
The four criteria for hormone therapy for adults are:
- persistent, well-documented gender dysphoria
- capacity to make a fully informed decision and to consent to treatment
- being of the age of majority (in BC, the age of majority is 18).
- significant medical or mental health concerns, if present, must be reasonably well-controlled
For children and youth under the age of 18, the criteria for hormone therapy are:
- a long-lasting and intense pattern of gender non-conformity or gender dysphoria
- gender dysphoria emerged or worsened with the onset of puberty
- any coexisting psychological, medical, or social problems are stable enough to start treatment
- the adolescent having given informed consent. The consent of your guardian 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 health care provider may prescribe hormones as an alternative to illicit or 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 removes this requirement.