Informed Consent
Informed consent is a way of prescribing hormones that treats you as the person best placed to decide whether you want them. A prescriber makes sure you understand what the hormones will do, what the risks are and which changes are permanent, checks that nothing in your health makes them unsafe, and if you understand and agree, writes the prescription. There is no separate assessment by a psychologist or psychiatrist first.
It is not a shortcut around safety. The medical checks are much the same as at any gender clinic: a health history, blood tests, and a plan for monitoring. What is missing is the gatekeeping step, where someone else decides whether your gender is established enough.
I am not a doctor, and I have not been through this myself. A lot of the patients I have coordinated through surgery in Bangkok started hormones this way, mostly in the US, Canada and Australia, and the questions they had going in were remarkably similar. This page answers those.
On this page
What informed consent means here
In ordinary medicine, informed consent just means agreeing to a treatment after it has been explained to you. In trans healthcare it has come to mean something more specific: a model where that conversation is enough, and no letter or diagnosis from a mental health professional is required.
The WPATH Standards of Care, version 8, moved in this direction for adults. They recommend that a single health professional with the right experience can assess readiness for hormones, and that professional can be the prescriber. Many informed-consent services work within that. Others go further and treat the consent conversation itself as the assessment.
What the prescriber is checking is capacity and understanding. Do you know what the hormones will change, roughly how fast, which changes stay if you stop, and what the medical risks are? Can you make the decision for yourself? If the answer is yes, most informed-consent prescribers will not ask you to prove anything else about your gender.
Who offers it
In the US, the main providers are community health centres with a focus on LGBTQ+ care, many Planned Parenthood locations, some university and hospital clinics, a growing number of family doctors and nurse practitioners, and telehealth services. What is available depends heavily on your state, both in which services operate there and in what state law allows.
In Canada, many family doctors and nurse practitioners prescribe on an informed-consent basis, and several provinces publish primary-care guidance that supports it. Waits depend on whether you have a family doctor at all.
In Australia, GPs can initiate hormones, and informed consent has become more common in general practice and in specialist sexual health services. Subsidy rules for some medicines differ, which affects cost more than access.
In the UK, NHS hormone prescribing still runs through the gender clinic route. Some private providers work on something close to an informed-consent basis for adults, and a few GPs are willing to take over prescribing from them.
None of this is a recommendation of a particular service. Quality varies within every category, and the right question to ask any of them is the same: who will be monitoring my bloods, and how often?
Before you book
Ask the service whether they prescribe on the first visit or need a second appointment, whether baseline blood tests must come back first, and who you contact between appointments if something goes wrong. The answers tell you a lot about how the service runs.
What happens at the first appointment
The details differ, but the shape is consistent. Expect roughly an hour, sometimes split over two visits.
Your health history. Current medicines, past illnesses, smoking, blood clots in you or your family, liver problems, heart disease, migraine with aura, mental health. These are the things that change which medicine or which form is safest, not whether you get one.
Your goals. What you are hoping for, and whether you want the full effect, a lower dose or only some of the changes. A good prescriber asks this rather than assuming, and it shapes the plan. Non-binary and low-dose HRT covers that conversation.
The consent conversation. The expected changes and their timeline, which are permanent, the risks, the effect on fertility, and what monitoring involves. Many services give you a written consent form listing all of this to read and sign. Read it properly. It is the most useful document you will be given.
Blood tests. Most prescribers want a baseline before they start, typically covering hormone levels, kidney and liver function, and a blood count. Some prescribe the same day and ask for bloods before the first refill; others wait for the results.
The plan. Which medicine, which form, what dose to start at, and when the next blood test and review are due.
What they still check
People sometimes hear "informed consent" and expect no questions. There are plenty of questions; they are just medical ones.
A prescriber will want to know about anything that raises the risk of a particular hormone. For estrogen that mostly means blood clots (DVT), smoking and some heart and liver conditions, which may point towards a transdermal patch or gel rather than tablets. For testosterone it is mostly blood count, because testosterone raises hematocrit, and some heart and liver conditions.
They will also check you can consent. That is not a test of your gender; it is a check that you understand the decision and are making it yourself. Mental health conditions do not rule anyone out, and a prescriber who treats them as if they do is not working on an informed-consent basis. If something is severe and unmanaged, a prescriber may want to make sure support is in place alongside hormones.
Age matters. Informed-consent services are for adults, and the rules for anyone under 18 are different almost everywhere and changing fast.
Telehealth
A lot of hormone prescribing now happens over video, with blood tests at a local lab and medicine posted or sent to a nearby pharmacy. For people far from a clinic, or in a place where local doctors will not prescribe, it has changed what is possible.
Two practical limits. First, the prescriber usually has to be licensed where you are, so in the US a telehealth service can only treat you if it covers your state. Second, testosterone is a controlled substance in the US, and the rules on prescribing controlled substances without an in-person visit have been in flux, with temporary extensions renewed more than once. Estrogen and most anti-androgens are not controlled, so this bites harder on masculinizing care.
State laws on gender-affirming care for adults also affect telehealth, including where the prescriber must be and what insurers will pay for. All of this changes, sometimes quickly. Check the current position with the service before you rely on it.
If you use a telehealth service
Find out which lab they use for blood tests and whether there is one near you, and what happens to your prescription if the service stops covering your state. Ask for copies of your results each time so your history goes with you.
If you are already on hormones
Some people arrive at an informed-consent service already taking hormones, prescribed elsewhere, bought privately or self-sourced. Most services will see you. Tell them what you have been taking, at what dose and for how long, and bring any blood results you have. Nobody competent will judge you for it; they need the information to prescribe safely.
If you have been taking hormones without medical supervision, getting blood tests and a prescriber involved is the single most useful thing you can do. Self-sourced medicines can vary in strength and purity, and without bloods there is no way to know whether your levels are too low to work or high enough to cause harm. A prescriber can usually continue what you are on or move you to something more predictable, often without a break.
In the UK, a GP may sometimes issue a bridging prescription to someone already self-medicating while they wait for specialist care. Gender clinics explains when.
Frequently asked questions
Do I need a therapist's letter to get hormones?
Not at an informed-consent service. The prescriber explains the effects and risks and checks your health, and your understanding and agreement are enough. See what informed consent means here.
Can I get hormones on my first appointment?
Sometimes. Some services prescribe the same day and ask for blood tests before the first refill; others want baseline results back first. See what happens at the first appointment.
Will they turn me away because of my mental health?
Mental health conditions do not rule anyone out. A prescriber checks that you can consent and may want support in place if something is severe and unmanaged. See what they still check.
Can I get testosterone over telehealth?
Often, but testosterone is a controlled substance in the US and the rules on prescribing it remotely have been changing. Check the current position with the service. See telehealth.