Staying Healthy on HRT
Starting hormones gets most of the attention. Staying on them is the part that lasts decades, and for most people it settles into a simple routine: blood tests roughly every three months in the first year, then once or twice a year, a prescriber who reads the results and adjusts the dose, and the same screening and check-ups anyone your age would have, adjusted for the body you actually have.
The risks that matter most are well known and show up on a blood test or a blood pressure reading long before they cause symptoms: blood clots on estrogen, thickened blood (a high hematocrit) on testosterone, and a few medicine-specific ones such as potassium on spironolactone. Feminizing hormone risks and masculinizing hormone risks cover those in detail. This section covers the routine that keeps them in check, and the decisions that come up along the way.
Who does what
Most people end up with more than one clinician involved, and it helps to know which one to ask.
Your prescriber, whether a gender clinic, an endocrinologist, an informed consent service or a GP under shared care, owns the hormones: the dose, the form, the blood tests that check them, and any change to them.
Your GP or primary care doctor owns the rest of your health: blood pressure, cholesterol, blood sugar, vaccinations and screening invitations. In many systems they also do the blood draws your specialist asks for.
A surgeon, if you have one, owns the instructions around the operation, including whether your hormones pause. They need to hear from your prescriber, and your prescriber needs to hear what they said. Passing information between them yourself keeps everyone working from the same plan.
Three habits that make all of it easier
- Keep your own copy of every result, with the units, the reference range and when you last dosed before the blood was taken.
- Keep a current list of what you take, the form and who prescribes it, on your phone. Every new doctor, pharmacist and surgeon will ask.
- Ask for your targets in writing, in the units your lab uses, so you can follow your own results without guessing.
This is general information, not medical advice. Nothing here should prompt you to change a dose; take it to your prescriber, who has your results in front of them.
Guides
The guides fall into three groups. Monitoring is the routine that runs for as long as you take hormones: the blood tests, the decades view of bones, heart and screening, and mood. Planning ahead covers the decisions that are easier made early, fertility before the first dose, what happens to your prescription around surgery, and how to change, pause or stop hormones with a plan rather than by accident. Day to day is the practical end: injecting, and keeping your supply steady through travel, moves, shortages and changes in access.
If you've just started, read blood tests and monitoring first; it explains what every other page means when it says "your levels". If you haven't started yet, fertility is the one that can't wait. And if you already have a lab sheet in front of you that makes no sense, how to read your hormone blood results goes through it line by line.
Hormones and surgery is where I have the most first-hand ground. Almost everyone I help plan gender-affirming surgery in Bangkok is on hormones, and whether to pause them before an operation, and what changes after the testes or ovaries are removed, comes up in nearly every case.
Monitoring
Blood Tests and Monitoring
What gets measured on each kind of HRT, how often, and which results lead a prescriber to change something.
Long-Term Health on HRT
Bones, heart health, screening for the organs you have, and ageing on hormones, and where research is still building.
Mental Health on HRT
What hormones do and do not do to mood, how to work out what is behind a change, finding a supportive therapist, and the low patch after surgery.
Planning ahead
Fertility and HRT
What each direction of hormones does to fertility, what is and isn't known about reversibility, and the options to consider before your first dose.
Hormones and Surgery
Pausing or not pausing hormones before an operation, how surgeons manage clot risk, and how your prescription changes after gonad removal.
Changing, Pausing or Stopping Hormones
Why doses and forms change, when people pause, what happens when you stop for any reason, and what to plan if you restart.
Day to day
Injecting Hormones
Under the skin or into muscle, where on the body, picking a day and interval, sharps and supplies, and which reactions are normal.
Travel, Moving and Keeping Your Supply
Flying with hormones and needles, crossing borders, moving to a new prescriber, shortages and losing access, without a gap in your supply.
Clinics that do staying healthy
Frequently asked questions
How often will I need blood tests on HRT?
Commonly about every three months in the first year, then once or twice a year once your dose is stable, plus a check after any change. See blood tests and monitoring.
Who should I ask about my hormones, my GP or my prescriber?
Your prescriber owns the dose, form and hormone blood tests; your GP or primary care doctor owns the rest of your health, including screening and vaccinations. The section on who does what, above, sets out the split.
Can I stop hormones if I want to?
Yes, and it's best done with your prescriber so you know what to expect and whether you need anything for bone health. See changing, pausing or stopping hormones.
Can I travel abroad with my hormones?
Usually, in hand luggage with the prescription or a letter, though testosterone is controlled in many countries. See travel, moving and keeping your supply.
Do I still need cancer screening on hormones?
Yes, for the organs you have, whatever your gender marker says. See long-term health.
Not sure where to begin?
The Start Here guide covers what hormones change, how people get a prescription, what the blood tests are for and what it costs.
start here →