Your first appointment

Before your first medical appointment

There are some things to consider before you come to your first medical appointment at the Gender Service.

1. Understand what your specific goals of hormones are

To make the most of your medical appointments, it is preferable if you have done some pre-reading or watched videos about gender affirming hormones before you see us. We will provide you with medical information before your appointment;  TransHub also has excellent information about medical affirmation

Not everyone who attends the Gender Service medical appointment starts gender affirming hormones straight away. This may because hormones are not suitable or safe for them, or because the medical doctor requires more information about their health before they can prescribe hormones

If a person is unclear about their gender goals, hormones or options for hormones, there may also be delays in prescribing gender-affirming hormones until this can be communicated clearly

2. Understand the risks and benefits of hormone treatment for gender-affirmation

The medical doctor needs to be sure you know enough about gender-affirming hormones and have thought about the risks, benefits, potential side effects, permanent changes and potential fertility impacts. The doctor also needs to think about your safety and can only prescribe hormones if it is appropriate to do so.

Some people change their minds about hormones after the doctor has counselled them on risks, potential side effects, permanent changes and impacts on fertility. This is completely fine; gender is a unique experience, and many people do not use hormones. The role of the medical doctor is to make sure you have a full understanding of the risks, benefits and alternatives of gender-affirming hormones and can make an informed medical decision for yourself.

We understand that it can be very disappointing not to be prescribed hormones. Please remember that the doctor’s foremost intention is your safety. You may wish to think about who can best support you, should you not begin hormones.

3. How will you manage the ongoing responsibility of taking hormones?

Think about how you will manage the ongoing responsibility of taking hormones, including who will continue to prescribe and monitor once you have been discharged from our service

If you are prescribed hormones, you will be given a pathology form for a blood test and instructions when to have this. Your GP and the Gender Service medical doctor will receive these results.

The blood test results are needed for your medical review appointment(s) and for further scripts. If you do not have your blood test done before your appointment, we will not be able to adjust your dose, and this may limit your progress towards your goals.

4. Read the information sheets

It is important that you have a preliminary understanding about gender-affirming hormones before your first Gender Service medical appointment,

This includes understanding and the ability to describe in your own words, the benefits, potential risks, side effects, permanent changes, reversible changes, and impact on fertility. of hormones and safety in pregnancy (if applicable)

Having an adequate knowledge about gender-affirming hormones is a requirement to be prescribed hormones. It will also let you ask us questions that are relevant to you.

Some people find written information more challenging to understand. If this applies to you, have a think about who could help you with this. This could be a partner, friend or family member, a counsellor, psychologist or your GP.

Can I have a support person come with me?

Yes. You are welcome to include a support person (including support workers, partner, family members or others) in your appointments. You should be comfortable sharing personal and confidential information with any support person, that may be discussed as part of your appointment.

What will happen?

The medical doctor will ask you about your gender-affirming hormone goals. This includes both the physical and emotional changes you may experience after you start hormones. It is important that you can clearly express your goals so that the doctors know you are ready for hormones.

The doctor will assess your health. This includes your physical and mental health and an individual risk assessment for starting gender-affirming hormones. This includes asking you questions about your family medical history, as well as certain questions about lifestyle (eg: smoking, alcohol consumption). You may need another medical appointment to obtain further information from your GP, mental health provider, other treating specialists, and may need to be referred to another specialist doctor if you have a complex medical history.

The doctor will discuss gender-affirming hormones (feminising or masculinising) in detail with you and answer any questions you may have.  The doctor will assess your understanding of hormones including the benefits, potential risks, side effects, permanent changes, reversible changes, impact on fertility and safety in pregnancy (if applicable).

As hormones can change fertility and the ability to have a biological child in the future, it is important that you have thought about this prior to your appointment. Some people will see their GP prior to their medical appointment for a referral to a fertility specialist to have their eggs or sperm frozen. Please note, we are not able to offer this as part of the Gender Service.

As testosterone is not safe in pregnancy, it is important that you are using an effective form of pregnancy prevention if you have the type of sex where you can become pregnant.

The doctor may start the informed consent process during your first appointment. Informed consent means that you can understand the information presented to you about the treatment, weigh up the information as part of a decision-making process, and clearly communicate your decision to the doctor about gender-affirming hormone therapy.