FOLX uses an informed consent model to provide our members with gender-affirming hormone therapy (GAHT, sometimes known as HRT). We know that many people starting GAHT have been thinking about this decision for a while. Many have done their own research and discussed this with other folx on HRT.
Our responsibility is to provide as much clear information on the benefits, risks, alternatives, and explanations as possible before someone makes a decision. With an informed consent model, there is no requirement that a mental health provider assess whether or not a patient is a candidate for hormone therapy.
When getting started with testosterone at FOLX, we need our members to understand and acknowledge the information below to get started. But don’t worry: no one needs to make these decisions on their own if they don’t want to. Your first appointment is a chance to talk with a FOLX clinician about the information below, and more.
Overview:
Gender affirmative care is tailored to each individual and their unique gender development and identity. Gender affirmative hormone therapy (GAHT), or hormone replacement therapy (HRT), is one aspect of many options used to affirm a person’s internal gender identity and gender expression in the world. Over the almost 100 years that HRT hormone replacement therapy has been around, there is a growing body of medical evidence that consistently, persistently, and insistently demonstrates their usefulness, effectiveness, and safety.
The testosterone used in GAHT is the same testosterone that testes make. You can choose the route by which you “deliver” this testosterone to the bloodstream, where it begins to circulate throughout the body to find tissues and cells with androgen receptors. When the hormone testosterone connects with an androgen receptor, it starts a whole series of changes that begin the cell, tissue, physical and neurologic changes that are a part of hormone therapies.
The following consent materials are based on current medical evidence that we use when patients elect to start testosterone GAHT at FOLX. Medical evidence changes over time, and the medical care we provide at FOLX will stay aligned with these evidence based updates. Individuals who want to receive a prescription for testosterone from FOLX agree that they have read, understand, and consent to the following:
- Some changes caused by testosterone are permanent, while others are reversible and require people to continue to take the medicine to get those desired effects.
- The effects of testosterone vary from person to person and are affected by genetics, age, and other factors.
- Testosterone is very safe when you work with a provider to prescribe and follow up on your care. In rare instances, it may increase certain health risks. Working with a provider helps avoid these risks and minimize potential more common side effects that are important to consider.
Our clinicians are happy to answer any questions you have related to GAHT during your video visits.
- By checking this box, I consent to gender-affirming hormone therapy and confirm that I have read and understand the benefits, risks, and alternatives of taking testosterone as outlined below.
Benefits
Permanent changes
Most permanent changes take some time to occur. If any of the following changes occur for you, they are permanent and would not go away even if you stop taking hormones.
- Deepened voice
- Facial/ body hair growth
- External genital (bottom) growth/ enlarged clitoris
- Potential for ovarian dysfunction and decreased fertility
Reversible changes
Many changes go away or lessen if you stop taking hormones. Most of these changes are desired and well tolerated. If you have questions or concerns about any changes, you can discuss directly with your clinician in your video visit.
- Changes in body fat and fat redistribution (more fat in torso, upper body, less in buttocks, hips and thighs)
- Increased lean body mass, muscle mass, strength, and muscle definition
- Coarser, darker, more noticeable body and facial hair (especially if lots of face, body hair runs in the family)
- More oily skin, possible acne
- Changes in libido (sex drive); changes in sexual function
- Menses may become irregular or stop altogether; Genital area may become more easily irritated and uncomfortable due to lack of estrogen effects; Pelvic discomfort or pain
- Changes in moods or emotions (contact our clinicians if these are disruptive to your daily life)
- Subtle changes in cholesterol panel (LDL increase, HDL decrease); higher risk for problems with blood pressure and cardiovascular disease
Length of time it takes hormones to work
The effects and outcomes for testosterone take time and vary from person to person. Changes start in the first three months but may continue for 2-3 years. Different changes take different amounts of time to start and to reach maximum effect. Both the rate and degree of changes depends on many factors such as: how you take your hormones (do you take them regularly and as instructed, dosage); age you start hormones; general health and genetics. Testosterone does not change height or other bone/skeletal structures.
Risks
Most people take these medications because they need them. We find that for most people the benefits far outweigh the theoretical and actual risks or bad outcomes. All medications might have some risks. Below are the more serious but much less common risks seen when taking these medications.
- Gender hormones are metabolized and broken down by the liver. Severe liver failure might cause problems with hormone metabolism.
- Cause small increases in red blood cell count that are usually not clinically significant. You may benefit from additional iron to create healthy red blood cells. We check hemoglobin in order to assess for continued safety. It is unlikely testosterone will change your red cell count or hemoglobin enough to put you at risk for blood clot, stroke, or cardiovascular event. It might even improve anemia.
- Over time, contribute to head hair loss/ balding. Balding cannot be reversed, but can be prevented with finasteride or dutasteride.
- Frequent or heavy bleeding is not expected on testosterone and could be a sign that your dose is either too low or too high. People in their more mature years with a uterus may need to seek medical evaluation for new or changes in bleeding to make sure there are no concerns about uterine cancer. Uterine cancers appear to be rare in people on testosterone.
Testosterone and fertility
Taking testosterone over time could lead to dysfunctional ovaries and eggs, and infertility. If you want to use your eggs to have genetic children, we recommend saving eggs while you are young and before using testosterone. Taking testosterone does not work like birth control. If you do not want a pregnancy, even if you do not have periods, you should use birth control when needed to prevent pregnancy.
Additional Medications & Considerations
Testosterone is the single most important masculinizing hormone, changing your body inside and out. Some people use other medicines to support their gender care: birth control; acne medicine; anti-balding medications.
Mood changes
All of the medications can actually impact how you think and feel. Taking GAHT usually leads people to feeling "relief," "happier,'' more confident, and more congruent with who they know themselves to be. Testosterone can lead to flatter emotions or moods, difficulty with crying, and a different sex drive and sexuality. GAHT does not cause rage or aggression. Know that you can discuss these changes any time with your clinical team if you have questions or concerns.
Allergic reactions
People do not have allergic reactions to estrogens or testosterones. They exist in all bodies. But, people can have allergic reactions to the substances in the vehicle which delivers the medication. Minor foreign body or local allergic reactions can happen because of the sesame or cottonseed oil bases. These present as small, red, irritated bumps at the site of injection. They can be managed with ice, benadryl, or ibuprofen. Do not use injectables if you have allergic reactions to benzoate preservatives. Please contact us if you notice a rash or skin swelling. If you experience lip or tongue swelling, trouble breathing, or feel like your throat is closing up, this is a medical emergency and you should contact 911. Stop taking any new medications that could be the source of the allergic reaction.
Alternatives
For some people, gender is a fluid and changing aspect of their identity. There are many ways to affirm your individual gender identity. There are alternative methods not currently provided by Folx Health that you may want to explore. Alternatively, there may be a time when you choose not to continue taking testosterone. We respect that you know your body, your identity and your needs better than anyone. Please feel free to talk with a member of the Folx team if you have any questions or concerns.
And that’s that.
With the different routes and dosages of testosterone, there are a lot of ways to find the one that fits best for each individual body. For those ready to get started with FOLX for testosterone, the process begins here. And for those who’ve got some more questions about our informed consent approach or getting started, reach out to support.folxhealth.com.
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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!
