What gender-affirming care can include
Gender-affirming care supports a person to live in ways that align with their gender. It may include names and pronouns, clothing, voice support, mental-health support, document changes, hormones or surgery. None is mandatory. Not using hormones or having surgery does not make a transgender or nonbinary identity less valid.
WHO moved gender incongruence out of the mental-disorders chapter in ICD-11, reflecting that transgender identities are not mental illnesses. A health classification can still support access for people who want care. Services should therefore reduce distress and expand informed choices—not require people to prove that they are “trans enough.”
Before starting hormones
A qualified provider should discuss your goals, current medicines, smoking, cardiovascular and clotting history, liver or kidney conditions, migraines, bone health, relevant cancers and fertility plans. Assessment should make treatment safer, not create unnecessary barriers.
- Review expected changes, variable timelines and changes that may be difficult to reverse.
- Discuss side effects, limitations and symptoms that need urgent care.
- Check blood pressure and arrange tests that match the medicine and health history.
- Discuss sperm, egg or embryo preservation before treatment if genetic parenthood may matter.
- Review every medicine, including ART, PrEP, supplements and products bought without a prescription.
Monitoring during hormone use
Follow-up depends on the medicine, route, age, health conditions and local guidance. Visits are often more frequent during initiation and dose adjustment. Monitoring may include goals, effects, blood pressure, mental wellbeing and relevant laboratory tests such as hormone levels, blood count, electrolytes, lipids or glucose.
Chest pain, difficulty breathing, one-sided leg swelling, a severe new headache, weakness, jaundice or a severe allergic reaction need urgent assessment. Acne, mood changes, breast tenderness or unexpected bleeding should be discussed rather than managed by automatically stopping or increasing treatment.
Long-term screening should follow the organs a person has and their treatment history, not only the gender marker in a record. A person with a cervix may need cervical screening; breast tissue and prostate tissue may require assessment according to age and individual risk.
Routine health should not disappear behind gender care
Gender-affirming care is one part of health. Blood pressure, vaccinations, dental care, sleep, nutrition, movement, smoking support and age-appropriate cancer screening still matter. A clinic should not attribute every symptom to hormones. New fatigue may involve sleep, anaemia, thyroid disease, infection, depression, medicine effects or other causes and deserves an ordinary clinical assessment.
Screening should be based on organs, age, exposure and family history. A person who has had chest surgery may still have residual breast tissue; the appropriate plan depends on the procedure and risk. A person with a cervix can discuss cervical screening techniques that reduce distress, including a smaller speculum, self-collected options where validated, stopping signals and more time. A person with a prostate may still develop prostate conditions even when testosterone is suppressed.
Bone health may require attention when sex-hormone levels remain low for a prolonged period, after gonad removal without adequate replacement, or when other risk factors are present. Cardiovascular risk should be addressed through the same evidence-based factors used for everyone—blood pressure, lipids, diabetes, smoking, family history and activity—while considering the individual hormone regimen. The goal is not to frighten people away from care but to manage modifiable risks.
Everyday gender affirmation and safer body practices
Not every affirming intervention uses medicine. Voice and communication training can help a person find a voice that feels congruent without damaging the vocal folds. A qualified speech professional can address pitch, resonance, pacing and communication style. Persistent pain, hoarseness or voice loss should be assessed rather than pushed through.
Chest binding should allow comfortable breathing and movement. Use a properly sized garment made for binding, take breaks, keep the skin dry, and stop if there is numbness, severe pain, skin injury, shortness of breath or dizziness. Elastic bandages, plastic wrap and extremely tight or layered binders can restrict breathing and damage skin or ribs. Binding while sleeping or during intense exercise can increase strain.
Tucking should never require severe pain or loss of sensation. Use skin-safe materials, take breaks and check the skin. Avoid adhesives directly on delicate genital skin unless a product and method are designed for that purpose. Genital pain, swelling, discoloration, urinary difficulty or persistent numbness needs prompt assessment. For padding, prostheses and wigs, attend to heat, friction, allergies and cleaning.
Hair removal can involve shaving, waxing, laser or electrolysis. Results, cost and suitability vary with hair and skin characteristics. A trained provider should discuss burns, pigment changes and preparation, especially before surgery where a surgeon may require treatment in a specific area and timeline.
Fertility, contraception and pregnancy
Hormones may reduce ovulation or sperm production but are not always reliable contraception. A transgender or nonbinary person with a uterus and ovaries may become pregnant even when periods have stopped. A person producing sperm may still cause a pregnancy while using estrogen.
Separate three conversations: whether pregnancy is wanted now, whether genetic parenthood may be wanted later, and how HIV/STIs will be prevented. Each goal needs different tools.
Gender-affirming surgery
Procedures may involve the chest, face, voice, reproductive anatomy or other individualized goals. Decision-making should include likely outcomes, scars, sensation, sexual function, fertility, complications, cost, recovery and support after surgery. Ask about qualifications, experience, follow-up and what happens if complications occur.
Preparation may include stopping smoking, managing health conditions, adjusting selected medicines and arranging transport and caregiving. Written aftercare should cover wounds, infection, movement, medicines and urgent warning signs.
Can hormones be used with PrEP or ART?
Gender-affirming hormones are generally not a reason to deny PrEP, PEP or HIV treatment. Specific medicines may require interaction review or additional monitoring. Do not stop ART or change hormones on your own because of assumed interactions. Share a full medicine list and ask the sexual-health and hormone teams to coordinate with your consent.
HIV and STI testing should follow sexual practices and sites of exposure, not identity. Seek PEP urgently after a possible HIV exposure within 72 hours; consider PrEP when exposure may recur.
Continuity of care during travel, relocation or service interruption
Running out of hormones or other medicines can be physically and emotionally difficult. Before travel, confirm how much medicine can be supplied, keep prescriptions and a brief clinical summary, and check transport rules for needles or controlled medicines. Carry medicine in labelled packaging in hand luggage where permitted. Climate can affect storage, so ask about temperature requirements.
When changing clinics, request a record of the regimen, dose, route, relevant laboratory results, allergies, previous complications and future monitoring plan. Do not rely only on photographs of tablets because products can look similar. If a gap occurs, contact a qualified service rather than restarting at a higher dose to “catch up.” The safest restart depends on the medicine, duration of the gap and health history.
Privacy during travel may be a concern where documents, appearance and gender markers do not align. Research entry and medication rules from official sources, keep emergency contacts and decide what information you are comfortable showing. For surgery away from home, plan who will provide aftercare and how complications will be managed after returning. A low package price is not a substitute for a clear continuity plan.
Choosing respectful and safer services
A good service uses the correct name and pronouns, protects confidentiality, explains options and costs, avoids irrelevant examinations, supports refusal and informed consent, and has a referral and follow-up pathway. Before booking, ask which populations the clinic serves, what monitoring it offers and what costs to expect.
Find clinics and sexual-health services Read more about hormone care
Record goals, choices and questions before each appointment
Gender-affirming care is easier to personalize when the conversation begins with the person’s goals rather than a standard pathway. Write down which changes matter most, which changes would be unwelcome, how quickly change is desired and what practical limits exist. Work, sport, caregiving, privacy, cost and travel can all affect the plan. A person may want one aspect of care without wanting another, and goals can change over time.
Bring a current list of medicines, supplements, allergies, previous doses, laboratory results and relevant family history. Include nicotine, alcohol or other substances without fear of punishment; the purpose is to identify interactions and reduce harm. Ask the clinician to explain the expected timeline, which changes may be reversible, which may be permanent, how follow-up will work and whom to contact between visits.
After the appointment, keep a simple record of the agreed dose, route, next test and review date. Note changes in mood, energy, bleeding, pain, sleep and any symptom that interferes with daily life. A record helps a new clinician continue care safely and prevents decisions from depending on memory alone.
Understand what a test result can—and cannot—tell you
Laboratory ranges printed on a report may be selected from a sex marker in the registration system rather than from the clinical question being assessed. Some results need interpretation in relation to organs present, hormone exposure, treatment goals, age and other health conditions. Do not change a dose only because a value is highlighted by the laboratory. Ask which reference range the clinician used and why the result matters for your plan.
Monitoring is not limited to hormone concentrations. Depending on the medicine and the person’s health, a clinician may consider blood pressure, blood count, liver or kidney function, potassium, lipids, glucose, bone health or other measures. More testing is not always better; the useful schedule is the one linked to a decision. Ask what will change if a result is high, low or unchanged.
Seek prompt assessment for chest pain, severe shortness of breath, sudden weakness, a painful swollen leg, a severe new headache, fainting, signs of a serious allergic reaction or thoughts of self-harm. These symptoms have many possible causes and cannot be safely diagnosed from a general webpage.
Plan for long-term health, ageing and changes in circumstances
Long-term care should include the same foundations recommended for everyone: vaccinations, sleep, movement, nutrition, dental care, mental-health support and management of blood pressure, diabetes and cholesterol. Screening should be based on the organs and tissues a person has, relevant exposures, age and family history—not on assumptions from a name, appearance or gender marker.
Needs may change after surgery, menopause, gonad removal, illness or a long interruption in treatment. Bone health and cardiovascular risk deserve particular attention when hormone levels are low for a prolonged period or when other risk factors are present. Discuss any planned pause rather than rationing medicine silently. A clinician may be able to adjust the route, dose, monitoring or cost plan.
Prepare for continuity before moving, travelling or changing insurance. Ask for a concise clinical summary, generic medicine names, recent results and enough notice for referrals. Store documents securely but accessibly. If a service closes or a prescriber changes, avoid purchasing products of uncertain strength as the only response; contact an affirming clinic or community organization early.
