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
 . 
10
 MIN READ

This article was clinically reviewed by Michelle Forcier, MD.

TL;DR:

  • Accessing gender-affirming hormone therapy (GAHT, sometimes known as HRT) with FOLX is an easy, seamless experience, so you don't have to know everything beforehand to start your gender affirmation journey or transfer your care.
  • Getting hormone therapy at FOLX is simple and fast.
  • First, you'll sign up for a FOLX membership to access our expert-led care with trans-specialist clinicians.
  • After your appointment, you'll get your meds delivered discreetly and directly to your door or sent to a pharmacy of your choice.
  • When do you have to have labs? Just once or twice a year for most people!

We are thrilled you are considering starting your gender-affirming hormone therapy with FOLX! We know that it is an extremely personal journey to begin your transition, and we're here to help by meeting you exactly where you're at.

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? First off, you get support from a trans-care specialized team, start to finish. Your care team supports you the entire way, from your first appointment about starting hormone therapy to gender-affirming consults for surgery and other affirming procedures. Plus, you get access to accurate medical information in our Library as well as queer community support and care 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 gender affirmation is central to you. We all agree there is not one way, and no "right" way, to affirm your gender.

Over 80% of our clinicians identify as LGBTQIA+, and 36% identify as transgender, nonbinary, genderqueer, gender diverse, or two-spirit. 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). Over half of FOLX clinicians are members of LGBTQIA organizations and almost a fourth hold leadership positions in LGBTQIA+ organizations.

While many LGBTQ clinics have waiting lists of 6 months or more, you can be seen by a FOLX clinician within a few days. For people who don't feel safe visiting their local pharmacy, FOLX makes it easy to deliver your meds directly and discreetly to your door. Since FOLX provides gender-affirming care in almost every state, you can continue your care with FOLX from anywhere, even if you move. You don't have to live in a city where LGBTQ-affirming clinics might be. Wherever you might live, you can rely on getting expert and up-to-date medical care.

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, follow up with labs a couple of times a year, and get as much support as you want or need throughout your membership.

Signing up for your first appointment

To get started, you'll sign up for a FOLX membership. If you want to focus on GAHT initially, learn more about our offerings before signing up. You can always add appointments for other concerns, including sexual health, STI testing or prevention, and primary care if you want to down the line. We offer full telehealth services, all of which are specific to the LGBTQIA+ community.

After you sign up for membership, schedule a virtual gender-affirming care visit with a clinician. Your options for clinicians and appointments are based on where you live and the FOLX clinicians with medical licenses in that state. If you need to cancel or change your appointment, please do so within 24 hours or more of your appointment so that you will not be charged for a no-show. For instructions on how to cancel an appointment, visit this FAQ page.

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. While this might seem invasive or like a disclosure of sensitive information, having an accurate and up-to-date medical history is important to us. It helps us provide the most safe and effective care possible for you. As with any medical information, your privacy is protected only shared with those directly involved in your care.

During your first appointment, your clinician will go over a few key things.

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

  • Name and birthdate.
  • Your medical history with GAHT. 
  • If you have taken GAHT/HRT before, your clinician will ask questions about what worked or what 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.
  • Your gender goals and goals for taking GAHT.

They also will ask about social support and community support you have. Booking your first appointment is super easy, and you can get an appointment with a FOLX LGBTQ-expert clinician within just a few days.

After your first visit

After your visit, you'll get your medications or prescription, and more information about when to get your labs or schedule follow up visits.

Getting your medications

FOLX makes getting your hormones a breeze with a few simple steps to getting your meds. This is how it goes for most FOLX members.

How it works

Once you meet with your clinician, you'll review your medication, route, dosing, and pharmacy choice. If you choose to get your GAHT through a FOLX-affiliated pharmacy, GAHT medications can be shipped directly to your door. As medically appropriate, FOLX offers 3-month prescriptions of estrogen, testosterone, and other gender-affirming medications.

The FOLX partner pharmacy will send your prescriptions directly to your door, so you don't have to deal with an in-person pharmacy. For injection prescriptions, we include alcohol swabs, bandaids, gauze pads, and syringes/needles in each injection kit. We have discounted pricing on medication from our partner pharmacy.

If using insurance, options might include using the Capsule pharmacy or a local in-person pharmacy near you. You can also get your prescription sent to a pharmacy of your choice. We will ask you about your choice of pharmacy in the GAHT intake questionnaire.

Routes and types of GAHT medications offered

FOLX offers estrogen and testosterone for GAHT hormone replacement therapy. We also offer several different routes. Your clinician will work with you to determine which dose and route fits best for your gender or transition goals.

Dosages

Dosage is the amount and increment of GAHT taken over a period of time. This varies depending on the hormone, method of dosage, and where someone is at in their journey. FOLX provides helpful resources in understanding what high and low doses of each type of GAHT look like for both testosterone and estrogen.

For more information on expected changes depending on dosages of GAHT, talk with your FOLX clinician or read more in the Library.

Estrogen route and types

We prescribe estradiol pills that people can take sublingually (under the tongue) or swallow; via a self-injection; or transdermally via the skin (a patch).

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

FOLX can prescribe testosterone via an injection or transdermally via gel through the skin.

Testosterone cypionate and enanthate are injected weekly subcutaneously (sub Q) or intramuscularly (IM). IM T can also be spaced out to injections every two weeks but is a deeper, somewhat more painful injection.

T gel can be applied on the shoulders and back or areas with less body hair, such as the thighs, arms, and belly.

Getting your labs

We may check labs and levels of estradiol, testosterone, creatine, and potassium-depending on what meds you take. For most people, labs are only done once or twice a year.

Labs and levels

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 don't run a full panel but instead perform the specific lab tests based on which medications you're taking. You only need to have labs once or twice a year. Most changes are minor, and changes occur between 6-12 months. Once you are on a stable dose, these labs generally remain relatively stable after one year.

And no, you don't need labs right away. Labs are tools, and we aim to not gatekeep life-saving, gender-affirming care. For example, our clinicians know there is a low clinical risk (for VTE or blood clots) when starting E. 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.

FOLX's patient-centered, consent-based approach to labs is based on the growing evidence and clinical standards of care. Members are at the center of decision making; FOLX providers empower members in their own health care journeys. Our approach is to improve access to gender-affirming care and provide education and resources to support you along the way while keeping you safe.

Estrogen labs

Expected changes from 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.

When folks start estradiol (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.

Expected physical changes on estrogen GAHT/HRT.

Testosterone labs

Expected changes from 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 more coarse and 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).

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

Expected physical changes on testosterone GAHT/HRT.

With GAHT, physical and emotional changes are part of the goals you will discuss with your clinician and care team. Transgender and gender-diverse folks often experience a better quality of life and well-being with affirming hormone therapy and care.

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

Even if you're unsure about being ready to jump into gender-affirming hormone therapy, you can still book a consultation with one of our LGBTQ-expert clinicians.

Get answers to GAHT-related questions you may not feel comfortable asking a typical PCP. Our clinicians are happy to discuss anything from bottom growth to hair loss and sexual health issues surrounding GAHT. Plus, whatever else you may be wondering about or experiencing related to GAHT.

Many of our clinicians are LGBTQ themselves and, most importantly, 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 transition support

We can also help with surgery referrals or letters and have support groups! Transition support at FOLX includes:

  • Expert clinicians who can discuss options beyond GAHT for your transition
  • Member Navigators who can support you in finding resources, many of whom are in the community themselves
  • Access to a nationwide network of LGBTQIA referrals and resources
  • The FOLX Community Platform
  • Peer-led support groups
  • Letter writing services

Get FOLX

FOLX supports all gender identities. It doesn't matter how you identify on the gender spectrum–nonbinary, gender-variant, transmasculine, transfeminine, female-to-male, male-to-female, genderqueer, gender non-conforming, butch, femme, or something else–FOLX will always respect your gender identity.

 

At FOLX, we believe in informed consent, meaning you choose how you want to move through this journey with your body. Your body, your choice. So at any point during this process, if you want to change your dosage, add medication, or take a pause, know that you are in control.

How pricing works

Get FOLX today and pay a low-cost membership fee of $39.99 per month. If you pay annually, it's only $299 for the whole year. Pay our low-cost cash pay rates for medications, labs, and visits with your clinician and care team. You pay for the services you use separately from your membership.

You will pay for your appointment at the time you schedule it.

  • If you want to use your insurance, you can do that too. FOLX accepts some insurance for labs and medications. If you have in-network insurance, you'll be billed a copay.
  • If you are paying without insurance, you'll pay a cash pay rate of $159 for your initial visit, then $79 for each subsequent visit with your clinician.

If you miss an appointment, you will be billed. If you cancel more than 24 hours prior to your scheduled appointment, you will be refunded within 5-10 business days. Should you have any issues, please reach out to our Member Navigators via the Help Center.

What you get with a FOLX membership

With a membership, you unlock any-time messaging with your trans-competent care team 24/7, referrals to LGBTQIA+ health centers and providers, and resources from our Member Navigators. You also get exclusive access to the FOLX Community Platform, a space where you can take courses and connect with other LGBTQ folks having similar experiences. We offer injection training, peer-led support groups, and more.

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. GAHT at FOLX is LGBTQIA+-expert-led gender care delivered via telehealth. 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!

Sign up to stay up to date on LGBTQIA+ healthcare

Newsletter sign up