Getting Started with Gender-Affirming Hormone Therapy at FOLX

GAHT (gender-affirming hormone therapy) at FOLX, also known as HRT, or hormone replacement therapy, means you get access to LGBTQIA-expert clinicians and more. Check out how signing up for GAHT works at FOLX.

August 8, 2023
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This article was clinically reviewed by Michelle Forcier, MD.

Here’s what’s included in this article:

  • What to expect when starting gender-affirming hormone therapy at FOLX
  • What to expect at your first visit
  • Medication routes and dosages
  • Estrogen and testosterone labs
  • Other support from FOLX

Whether you are new to starting gender-affirming hormone therapy (GAHT, also known as HRT) or want to transfer existing care over to FOLX, we make it easy to get started. We know that everyone has their own personal transition journey, and our LGBTQIA+ expert clinicians can help make a plan that is right for you.

After 6 months, 99% of FOLX members on GAHT are satisfied with their progress toward their goals, including goals like gender euphoria, sexual satisfaction, hair changes, changes in body fat, emotional benefits, and more.

Gender-affirming hormone therapy at FOLX

GAHT, or gender-affirming hormone therapy (also known as HRT or hormone replacement therapy), is seamless and easy at FOLX. What makes gender-affirming care and hormone replacement therapy at FOLX different? We offer holistic care, which means you not only have access to your clinician—you have an entire team there for you to help you navigate your care. From nurses who can help with your injection training to Member Navigators who can provide referrals and answer any questions you might have. Plus, you get access to community support, resources, events, support groups, and more through our FOLX Community Platform.

You've probably done your research, but you don't have to know everything beforehand to start your gender-affirming journey. FOLX clinicians understand that there is not one way, and no "right" way, to affirm your gender, and they’ll help you make a plan that’s right for you.

Over 80% of our clinicians identify as LGBTQIA+, and 36% identify as transgender, nonbinary, genderqueer, or gender diverse. Clinicians at FOLX are trained to provide best-in-class gender-affirming care, and over 40% of FOLX clinicians have presented at regional and national medical conferences (like WPATH, USPATH, and others). While many LGBTQ clinics have waiting lists of 6 months or more, you can be seen by a FOLX clinician within a few days. If you don’t want to use your local pharmacy, FOLX can deliver your meds directly and discreetly to your door. Since FOLX provides gender-affirming care in every state, you can continue your care with FOLX from anywhere, even if you move (some restrictions apply for testosterone). 

What to expect when you start GAHT/HRT at FOLX

When you sign up for GAHT at FOLX, you'll: 

  • Sign up for a FOLX membership
  • Have an appointment with your clinician
  • Receive your medications
  • Get lab work one to two times a year
  • Access as much support as you want or need throughout your membership

Signing up for your first visit

To get started, you'll sign up for a FOLX membership. See everything that’s included in a FOLX membership here

After you sign up for membership, schedule a virtual gender-affirming care visit with a clinician. You can generally get an appointment within a few days.

You will get an appointment confirmation emailed to you with the Zoom link for your telehealth visit. You'll also be asked to fill out a health history form before your appointment. As with any medical information, your responses are only shared with those directly involved in your care.

During your first visit

Your clinician will confirm your identification as required by law and ask you a series of health questions, including:

  • Your medical history 
  • Your transition goals or goals for taking GAHT

If you have taken GAHT/HRT before, your clinician will ask questions about what worked or didn't work for you previously. Be prepared to answer questions about your dosing, how long you were on GAHT prior, and if there were any interruptions in care.

They also will ask about the social and community support you have. You’ll be able to ask any questions you have as well. You can learn more about preparing for your first FOLX appointment in this article.

After your first visit

After your visit, if you were prescribed any medications, they will be sent to the FOLX pharmacy or a pharmacy of your choice. You can then schedule follow-up visits as needed for GAHT or any other care you might need.

You can also message your care team with questions at any time.

As part of your membership, you also get access to the FOLX Community Platform where you can connect with peers on a similar journey, attend support groups and events, get live injection training, view resources, ask questions, and more. It’s a place to find ongoing support from our community. 


Prescription Pick Up or Delivery

When you meet with your clinician, you'll review your medication, route, dosing, and pharmacy choice. If you want to use your insurance, you can get your prescription sent to a pharmacy of your choice (e.g. a local in-person pharmacy). As medically appropriate, FOLX offers 3-month prescriptions of estrogen, testosterone, and other gender-affirming medications.

If you choose to get your prescriptions through the FOLX partner pharmacy, GAHT medications can be shipped directly to your door. (Note that insurance cannot be used with the FOLX partner pharmacy at this time, pricing can be found here.)

For injection prescriptions, we include alcohol swabs, bandaids, gauze pads, and syringes/needles in each injection kit from the FOLX partner pharmacy. 

Routes and types of GAHT medications offered

FOLX offers estrogen and testosterone for gender-affirming hormone therapy. We offer several different routes and dosages depending on your preferences and goals. Your clinician will work with you to determine which dose and route is best for you.


Dosage is the amount of GAHT taken over a period of time. This varies depending on the hormone, kind of medication, health needs, and your goals. How quickly changes happen and what changes happen depends on your dose, and also on your genetics. You can read more about changes expected for testosterone and estrogen in our Library.

If you’re interested in microdosing or starting with a lower dose, you can check out more information here for testosterone and estrogen.

Estrogen route and types

There are three routes for estrogen we can prescribe:

  • Estradiol pills taken sublingually (under the tongue) or swallowed
  • Injections
  • Patches

‍Expected changes from all forms of estrogen include permanent changes such as growing new breast tissue, as well as increased hip, butt, and other body fat redistribution. Other physical changes include muscle mass decrease, skin softening, and slowed face and body hair growth. You may experience changes to your mood, like emotions feeling bigger or more expansive. Estrogen mood changes are often beneficial and can include improved emotional and mental health.

a timeline for expected physical changes on estrogen HRT

Anti-androgens (T receptor blockers)

Many transgender and nonbinary folks on E also take anti-androgens, also known as T blockers. Anti-androgens work to block the effects of androgens on skin and hair receptors. Anti-androgens include:

  • Spironolactone: a daily pill that can contribute to mild decreases in testosterone levels and blocks T effects on skin and hair
  • Finasteride/Dutasteride: block conversion of available T to another more potent androgen hormone affecting hair, especially male pattern head balding

Testosterone route and types

There are two routes for testosterone we can prescribe 

  • Injections
  • Gel

‍Expected changes from all forms of testosterone include permanent physical changes such as a deepening voice, facial and body hair growth, and bottom growth. Other common physical changes are increased lean muscle mass and coarse, oily skin. Testosterone mood changes and benefits can include improved emotional and mental health. Some people may better access a full range of emotions more easily, especially as dysphoria lessens (though not all trans folks experience dysphoria).

a timeline for expected physical changes on testosterone hrt

Getting lab work

When it comes to labs, goals are way more important than exact numbers. Labs and levels are not always accurate measures, nor are they direct indicators of how much and what effects you get from your estradiol or testosterone. Many things can impact labs, and we expect them to be imperfect estimates.

To manage GAHT at FOLX, we perform specific lab tests based on which medications you're taking and your unique health needs. You likely only need to have labs once or twice a year. Once you are on a stable dose, labs generally remain relatively stable after one year.

You generally won't need labs right away, as changes typically occur between 6-12 months. We take an approach that accounts for the whole picture when it comes to your gender-affirming hormone therapy. Your care team will discuss any risks versus benefits of hormone therapy for your goals and health.

Estrogen labs

When folks take estrogen (estradiol), we may check estradiol and total testosterone levels. We may also check creatine (Cr) and potassium (K+) for folks taking anti-androgens, like Spiro (Spironolactone). For many people on stable doses, labs might only be recommended once a year.

Testosterone labs

For folks taking testosterone, we check total testosterone and hemoglobin levels.

What if I'm not sure GAHT is right for me?

If you're unsure about gender-affirming hormone therapy, you can still book a consultation with one of our LGBTQ-expert clinicians.

In that visit, you can get answers to any GAHT-related questions you may have. Our clinicians are happy to discuss anything from bottom growth to hair loss and sexual health issues surrounding GAHT. Our clinicians are dedicated experts on the most up-to-date information on GAHT practices.

We know that hormones may only be a part of your journey or even something you never choose to take. FOLX clinicians can support all kinds of journeys and wellness goals. You can meet with a clinician and decide not to start hormone therapy, or consider it later on. You can also meet with a clinician to discuss other elements of your transition, like gender-affirming surgeries, hair removal, fertility preservation, and social transition.

Additional support

At FOLX, we provide so much other support for your journey as well, including:

  • Expert clinicians who can discuss other aspects of your gender transition
  • Member Navigators who can support you in finding resources
  • A nationwide network of LGBTQIA referrals and resources
  • The FOLX Community Platform where you can connect with the community, join events, or view resources and take classes
  • Support groups
  • Letters for name or gender marker change or surgery

In summary

‍We make it easy to get gender-affirming hormone therapy, whether you are starting your medical transition or transferring your care to FOLX. We provide you with access to LGBTQIA+ specialized care with clinicians who care for your whole self. Most importantly, we believe no one-size-fits-all for gender-affirming care and hormone replacement therapy. We work with you to figure out the best approach to gender-affirming hormone therapy for you. Get health care where you are finally heard, seen, and empowered. Join today to get the joyful and affirming care you deserve.


FOLX Health is the first digital healthcare company designed by and for the LGBTQIA+ community. Our services include virtual primary care, gender-affirming hormone therapy including estrogen and testosterone (HRT), mental health care, sexual and reproductive health care, preventive care, and fertility consultations. FOLX memberships give you access to LGBTQIA+ expert clinicians, peer support, thousands of LGBTQIA+ resources, and more. Whether you’re lesbian, gay, bisexual, transgender, queer, gender non-conforming, or nonbinary, you can find LGBTQIA+-specialized health care that helps you meet your wellness goals. FOLX Health is health care that's queer all year. Get all the benefits of becoming a FOLX member and sign up today!