How many sessions until I can start HRT?

If you’re 18 years or older…


Many people are anxious to start HRT (aka cross-sex hormones), and think they need a letter from a therapist to begin. If you are an adult, this may not be the case, depending on where you live.

Many places provide cross-sex hormones on an informed consent model (the same model for most surgeries. Just like you don’t need a therapist’s note to get a nose job, you don’t need a therapist’s note to start cross-sex hormones at these places).

If you live in Western North Carolina (WNC), planned parenthood and Western North Carolina Community Health Services (aka WNCCHS) provide transgender support.

If you are an adolescent…

…many endocrinologists only ask that you are currently seeing a therapist in order to start working with you.

Many adolescents don’t start on cross-sex hormones, but begin first on puberty blockers. (You can read more about puberty blockers here). This is a discussion between you and your doctor.

If you don’t already have a referral, your therapist can provide you a list with endocrinologists who work with transgender issues. There are multiple doctors who work with transgender adolescents, including WNCCHS.

While support for adults starting HRT isn’t required, it’s often helpful to have a clinician help guide you through the different steps. Starting your physical transition can be scary, intimidating, and exhilarating all at the same time, and you don’t have to go through it by yourself.

If you or a family member would like some support during gender transition, you can schedule a time to talk here.


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