Staying Healthy on HRT
Starting hormones gets most of the attention. Staying on them is the part that lasts decades, and it is mostly unglamorous: a blood test a few times 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.
None of that is complicated once someone explains it, and very little of it is dangerous for most people. The risks that do exist, blood clots on estrogen, thickened blood on testosterone, a few medicine-specific ones, are well known and largely manageable with monitoring. That is what the tests are for.
The guides in this section cover four things.
Blood tests and monitoring explains what gets measured, how often, why the time of day and the time since your last dose change the number, and how to read results that come back in units nobody told you about.
Fertility covers what each direction of hormones does to fertility, why nobody can promise it comes back, and the options for storing eggs or sperm before you start. It is the one decision on this site that is much easier to make before the first dose than after.
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 the question of whether to pause them before an operation, and what changes afterwards, comes up in nearly every case.
Long-term health covers bone density, heart health, cancer screening based on the organs you have, and getting older on HRT, including the parts where the evidence is still thin.
I am not a doctor and have not taken hormones myself. What I know comes from a decade of coordinating trans patients through hospitals and reading the clinical guidance they are treated under. Nothing here is medical advice, and nothing here should prompt you to change a dose. Take it to your prescriber, who has your results in front of them.
Guides
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, with a plain account of where the evidence runs out.
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.
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 →