(HRT) Hormone Letters and Informed Consent for the Transgender Community

By: Katie Leikam, MBA, LCSW, LISW-CP, BC-TMH

Can I use Informed Consent for Hormones?

The first thing to know about getting an HRT letter is that informed consent is possible and there are doctors’ offices that practice informed consent. Informed consent is when you give your consent to begin hormones after learning what happens to your body and the risks without having to get a letter from a mental health provider. Often though, the transgender community will decide they want to go to a doctor that does require an HRT letter and I fully understand that choice. If you have heard good things about the doctor, or they cover your insurance, that could be the way to go still. It can also be affirming for some people in the transgender community to receive a gender affirmation letter from a mental health professional.

What if I Need and HRT Letter?

If you decide you would like or need an HRT letter, please keep in mind that WPATH no longer requires real life experience to receive your letter. This means that you no longer must socially transition or dress in your affirmed gender before starting hormones, although some people still feel that’s what works best for them. You also don’t need to be in therapy for a minimum amount of time to receive a letter. However, your therapist is still assessing your mental health and ability to make an informed decision. Because of that, it may take more than one session depending on your therapist although I write my HRT letters in one session most of the time.

What to ask the Therapist?

When you start to look for a therapist to write your HRT letter, it’s a good idea to ask them a couple of questions first. You could ask them if they have written a letter before and if they follow the most recent WPATH standards of care. (Currently version 7) You can ask them what a reasonable amount of time to expect them to be able to write a letter assuming you are mentally stable and healthy. You can ask them how they will write your letter for you if you do have mental health concerns. We want you to be honest at our practice about your mental health concerns. I do not keep you from gender affirming care, but I want to treat you with respect and empathy and allow you to get help for mental health during your transition.

What is the Assessment Like?

When you do make an appointment, your therapist will probably want to get some history from you about your life and your recent emotions. They may ask if you have ever been in a mental health hospital or if you are feeling anxious. They may ask how you are eating. All these questions are for the therapist to get an idea of your mental health and they are not meant to be gate keeping, just to assess your mental health.

Your therapist will probably ask you about the history of your gender identity and what happened along the way to get where you are now. They shouldn’t be judging you, merely gathering information for writing your letter. Sometimes this can be hard to talk about and sometimes it’s a healthy process to talk about and discover more about yourself.

After you talk to the therapist about your gender history, they will need to review what happens to your body when you take hormones and the risks to you. They are not medical doctors, so any medical questions should be asked of your doctor. This is a great time to process if there are things about starting HRT that worry you or if you have questions about your mental health while on hormones.

Should I Continue Therapy After I get my Letter?

Therapy is certainly important during times of transition and just because you have received your hormone letter, doesn’t mean you should stop therapy all together. If you have a history of depression, anxiety, suicidal thoughts, family conflict or just want a professional to talk to while you are transitioning, staying in therapy is recommended. After you receive your HRT letter, you and your therapist can talk about changes that are taking place, people you want to come out to or relationships that aren’t going as you had hoped. Your therapist can process with you feelings of gender dysphoria if you have them or mood changes that may occur after you start HRT.

I do write hormone letters and I do support informed consent as well. It is a personal choice for my clients if they want to receive an HRT letter. I also welcome you to continue therapy with me throughout your transition, even if it is to check in with each other. There’s many concerns we can process in therapy including minority stress,internalized transphobia, relationships with your partner and other mental health concerns. Forming a relationship with a therapist can have positive effects and I want you to thrive. If you would like to make an appointment, please contact me here or call me at 404-948-6186.

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