Endocrinologist

An endocrinologist is a doctor who specialises in hormones and the glands that make them: the thyroid, the pituitary, the adrenals, the ovaries and testes. Some gender clinics have them on staff, and in some countries they are the people who prescribe gender-affirming hormones.

Where you'll meet it

At gender clinics, in hospital systems where hormones have to be started by a specialist, and in referral letters when a GP or nurse prescriber wants a second opinion on something unusual. In the US, many hospital gender programmes route hormones through endocrinology. In the UK, NHS gender identity clinics may have an endocrinologist advising on the hormone plan, which your GP then prescribes under shared care. In Canada and Australia, GPs start most people and refer on when something is complex.

What they actually do

Their training covers the whole hormone system, which is why they are the people other doctors call when results do not add up. For someone on HRT that can mean working out why estradiol will not rise on a dose that works for most people, why testosterone keeps coming back, or what to do when a prolactin result keeps climbing. They also manage the conditions that can complicate hormone therapy, such as diabetes and thyroid disease.

What they usually do not do is assess your gender identity. At an assessment-led clinic that is the job of a psychologist, psychiatrist or specialist clinician; the endocrinologist comes in afterwards to set the hormone plan. Gender clinics explains who does what.

Do you need one

Often not. In many places gender-affirming hormones are started and managed by GPs, nurse practitioners, sexual health clinics or informed-consent clinics, and routine monitoring is well within what they do. An endocrinologist becomes more useful when something is out of the ordinary: a prolactin level that keeps climbing, a thyroid problem, diabetes, a history of clots, a hematocrit that will not come down, or levels that will not settle however the dose is changed.

Common questions

A specialist is always better. Endocrinology is a broad specialty, and plenty of endocrinologists see few or no trans patients. A GP or nurse practitioner who manages hundreds of people on HRT may know the everyday questions better than a hospital specialist who sees a handful a year.

You have to see one to start. That depends entirely on where you live and which route you take. Informed-consent clinics and many GPs start hormones without any endocrinology referral.

An endocrinologist will be stricter. Some are cautious; some are the most flexible prescribers you will meet. It depends on the person and their experience.

Waits and cost

Specialist appointments often carry longer waits than a GP, and in the US an endocrinologist may need a referral for insurance to pay. Privately, a specialist visit costs more than a GP visit; cost and insurance has typical figures.

What to ask

If you are referred to one, it is fair to ask whether they have experience with gender-affirming hormones, and how many trans patients they see. Ask who will do your routine blood tests and prescribing after the first visit: the endocrinologist, or your GP. And ask what would bring you back to them, so you know which results are routine and which are a reason to call.

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