Real Life Experience for Transgender Hormone Therapy? Not Anymore.


You don’t need Real Life Experience (RLE) for your HRT letter.

You heard me correctly.  If you are transgender, you don’t need real life experience for your hormone replacement therapy letter.  Real life experience in your actual gender harks back to a time when it was required in the WPATH standards of care and in some cases, can have a potential for harm to people due to safety concerns.

As of today, the current guide a lot of physicians use  is the WPATH (World Professional Association of Transgender Health), standards of care, version 7.  In time, the standards of care 8 will be out. In the current standards of care, the requirements for hormone replacement therapy state:

“1. Persistent, well documented gender dysphoria.

2. Capacity to make a fully decision and to consent for treatment

3. Age of majority in a given country (if younger, follow the standards of care outlined in section VI).

4. If significant medical or mental health concerns are present, they must be reasonably well controlled.”

(Quoted from the World Professional Association of Transgender Health, Standards of Care, version 7)

I thought Georgia required this?

There is no longer a requirement for “real life experience” in your gender before starting HRT.  A progressive, well trained clinician should be able to assess for these requirements in a time frame that does not unnecessarily increase the amount of time you have to experience life without beginning your transition.

Some people have the availability of the Informed Consent Model within access, which is another option for beginning hormones.   In this model, a provider talks to you at the doctor’s office about informed consent. They review possible psychosocial changes and surpass the need for a letter from a mental health therapist for consent for treatment.

What is the value of therapy for my transition?

Mental health therapy by a knowledgeable, trained provider can be beneficial and sometimes crucial to make these positive changes in your life. You may be experiencing depression, anxiety, body shame, disassociation or other concerns during your transition.  It’s best to have a therapist to guide you through difficult emotions that you may have.

Therapy has its value in people’s life.  Finding a therapist that is a good fit for you can be helpful when navigating social change and  coming out at work. It can be helpful with difficult relationships with family, feelings of depression, low self-esteem, anxiety or thoughts of self-harm.

Therapy can teach you how to have a good toolbox for surpassing difficult emotions and seeing clearer meaning and value within yourself. Therapy can provide a safe place to explore emotions, challenges and joys with a trusted provider.

Real life experience has value as well in people’s lives.  This experience can be a process to increase self esteem and build confidence in your true self. It can open the ability to experience emotions and change without medically transitioning.  It can be a beautiful, growing experience for people beginning their transition.  But, it is no longer required before you start hormone therapy.

How many sessions does it take to get my letter?

When you are transgender and starting the process of hormone therapy, it’s best to have upfront expectations about getting a letter written.  Or, know the availability of an informed consent clinic in your area.  There are fantastic doctors at both options, but your therapist should be able to let you know how an estimate of how long it takes to write a letter.  It can be written without real life experience, unless you choose that’s the path you want and need to take.

I offer individual, family and couples therapy in person and via video tailored to your needs.  I do write letters, as requested, but don’t have a minimum number of sessions you must attend for a letter.  If you need or want therapy on an ongoing basis, I am excited to collaborate with you for those needs.  You can contact me here for more information or to set up an appointment.

4 thoughts on “Real Life Experience for Transgender Hormone Therapy? Not Anymore.”

  1. Angelina Grewen says:

    Thank you. Information you can send me will be a great help to me!

    1. Edward Carlson says:

      I like that real life experience is optional now because as was mentioned it may cause harm to the individual. Some have experience great hostility from co workers and even termination of employment. This also requires a wardrobe change which may end with having to buy even more clothing to accommodate the physical changes that HRT and surgeries will produce. Impoverished people such as myself may find it difficult to comply with the real life experience criteria.

  2. zoey gerbrandt aka doug gerbrandt says:

    thank you I been locked up for 36 or more years as a boy at the time I did not want to tell my parent due to mental state so I withheld info now I meet a really good person doctor friend that made me see the light and now I have open right up I want the letter for sure but I also want the surgery and I was told in order to get the surgery you need to be a year on the hormon thanks again for this news

Comments are closed.

Sign Up for the Newsletter

118 E. Maple Street
Decatur, GA 30030

Schedule an Appointment Online

Schedule an Appointment

Send A Message