Hi,
I am considering HRT and am looking for guidance. What are the guidelines (requirements) before my psychiatrist would consider writing me the scripts? I am currently in therapy and I presume she would have to write a letter to my psychiatrist.  That would not be much of a problem since they both work in the same complex, and I am a patient of both. So what else? Would I HAVE to come out? I am very much still in the closet and have only recently told my therapist. I have been racking my brain to share my "condition" with a friend, but I can't for the life of me think of anyone. And finally...do I have to live full time while undergoing HRT?  Thank you in advance for your input.

It all depends on where you live. Some places make it really difficult, some very easy with informed consent (no psych).

The WPATH Standards of Care is the usual guide to these things, but there's heaps of variations from it.

http://www.wpath.org/site_page.cfm?pk_association_webpage_menu=1351

The standards of care are in the Wiki here, just look up WAPATH Standards of Care.

Or www.WPATH.org and down load SOC7.

No you do not have to be full time or in RLE to be on HRT, that was phased out a long time ago.

Basically the psychiatrist or mental health professional ( who can be anyone with the training) clears you that:

You are competent to make a decision, which means you understand the consequences fully.
You do not have co-morbidities that prevent you from making a clear decision.

You do not suffer a physical ailment that would worsen on HRT, usually this is related to high blood pressure or clotting conditions. These may be worsened by smoking or obesity and the medics may not allow HRT unless these factors are under control.


You are over the age of consent for your country. If you are not there are legal matters that need to be dealt with.

After being on HRT many, but not all surgeons, want at least 12 months RLE before they will accept a psychiatrists letters for you to have surgery. If you don't want surgery that is irrelevant.

These rules do vary a little from country to country and some medics impose their own variations but that is not indicated in the SOC 7.

I would download SOC 7, read them and make sure you have the information to hand when you need it.

Depending where you live, there are two options:

Informed Consent - which does not require a letter from a therapist. You pretty sign a piece of paper which states that you understand the treatment and the risks associated with taking hormones. In the US, some planned parenthood centers and a few other places accept Informed Consent. Some Doctors also work with Informed Consent.

Finding an Endocrinologist (or other doctor) with knowledge about HRT. Most of them would like to see a letter from your therapist or counselor.

If you have insurance covering HRT, most of them require "the letter" to cover HRT.

HRT is a lot easier than surgery. Usually a letter from one professional (counselor, psychiatrist or psychologist) is sufficient. Surgery may require two letters.

Usually a therapist tries to establish that you are affected by Gender Dysphoria. I have heard different numbers in terms of how many sessions they would like to see. I did get my letter after three month of therapy.

Unfortunately all may depend on where you live and it may be different in other countries.

It am thinking it might be a good idea to ask your psychiatrist what her thoughts are on how hormones mind fit into your therapy?