Getting Hormones

By Nick Peplow·Founder and editor

Last reviewed 27 September 2026· How this site is researched

Getting a prescription for hormones can take one appointment or several years, and the difference is mostly down to where you live and who is paying. The medicines themselves are old, cheap and widely available. What varies is the route to them: who is allowed to prescribe, what they want to know first, and how long the queue is.

There are two broad models, and almost every service sits somewhere between them.

The two models

Informed consent. A prescriber explains what the hormones do, what the risks are and what is and is not reversible, checks your health, and if you understand and agree, prescribes. No separate psychological assessment is required. This is how many US community health centres, some family doctors and a growing number of telehealth services work, and it is common in parts of Canada and Australia.

Assessment-led gender clinics. A specialist service assesses you, often over more than one appointment, before recommending hormones. In the UK this is the NHS gender identity clinic route, where the assessment is thorough and the wait for a first appointment is measured in years. Many people in the UK go private for part or all of it, and then ask their GP to take over the prescribing.

Neither model skips the safety checks. Both will want baseline blood tests, a picture of your general health and a plan for monitoring. The difference is who decides you are ready: you, with a prescriber making sure you understand what you are agreeing to, or a clinic that assesses you first.

Paying for it

For most people the ongoing cost is small compared with surgery, but it is ongoing. Generic estrogen tablets and testosterone injections are among the cheapest medicines on any pharmacy shelf, while patches, gels and some anti-androgens cost a good deal more, and the blood tests and appointments add up. Cost and insurance covers what people typically pay in the US and UK, how insurance and prior authorisation work, and where the hidden costs sit.

When the default is not what you want

Most services have a standard starting plan built around a full transition in one direction. Plenty of people want something else: a lower dose, slower change, or only some of the effects. Non-binary and low-dose HRT explains what a lower dose actually does, what "microdosing" means and does not mean, and how to put that to a prescriber.

The rules change

Access to hormones is more politically exposed than most medicine, and the rules move. US states have passed laws on prescribing, insurance coverage and telehealth, the federal position on insurance has shifted more than once, and in the UK the rules for under-18s have changed significantly in recent years. These guides describe how things generally work for adults and flag where they are in flux. Check the current rules where you live before relying on anything here.

What these guides are

I am not a doctor and I have not taken hormones myself. I spend my working life coordinating trans patients through surgery in Bangkok, and almost every one of them arrives having been on hormones for years, by every route on this page. What follows is what that has taught me about the routes in, written down plainly. It is information, not medical advice, and the prescriber who has your blood results is the one to decide anything about your dose.