gendr
Step 5 of 8Hormones

Hormone options.

A balanced overview of the three broad approaches used in adult care, and of the option to wait. This step describes; it doesn't recommend. Hormones are prescribed and monitored by clinicians.

Team talk

This is the step many people come to gendr for.

It is also the most consequential. The options below carry real benefits, real risks, real timelines, and real uncertainty. The right decision is the one you make with a clinician, gendr's job is to make sure that conversation is yours, not theirs.

Before you read this step, a word on fertility. All medical hormone approaches can affect fertility, sometimes irreversibly. Step 6 covers fertility preservation and is intentionally placed before any hormone decision is finalised. You may want to read it in parallel.
About the evidence. Most of what we know about adult gender-affirming hormones comes from observational studies, not large randomised trials. Recent systematic reviews suggest hormones can improve depression, quality of life and suicidality for many people, with no substantive harms identified, but the certainty of the evidence is rated low to moderate. Where ranges exist, gendr gives them. Where a number is contested, it says so.

Option talk

Four broad options, presented equally.

Approach A

Feminising hormones

Usually oestradiol with an androgen blocker (anti-androgen or GnRH analogue). Routes vary: tablet, patch, gel, injection.

Possible benefits (months to years): breast development; softer skin; redistribution of body fat; reduced body hair growth; reduced libido and erectile function.

What is permanent once established: breast tissue.

What stays the same: bone structure, voice, beard growth (electrolysis or laser can help).

Risks: venous thromboembolism (blood clots), cardiovascular considerations, changes in lipids and prolactin. Risk is influenced by route (transdermal often lower-risk than oral) and personal factors. Regular blood monitoring is required.

Fertility: impaired, extent variable, discuss preservation first.

Approach B

Masculinising hormones

Usually testosterone, by gel or injection.

Possible benefits (months to years): periods stopping (usually within ~6 months); voice deepening; facial and body hair; muscle mass and fat redistribution; clitoral growth.

What is permanent: voice deepening, facial hair, clitoral growth.

What is reversible: menstruation typically returns if testosterone is stopped.

Risks: raised haematocrit (thicker blood), changes in lipids and acne; vaginal atrophy may need local oestrogen for comfort. Regular blood monitoring is required.

Fertility: affected, extent variable; some people have conceived after stopping, discuss preservation first.

Approach C

Individualised / non-binary

Lower-dose, partial, monotherapy or intermittent regimens aimed at specific changes rather than a binary endpoint. Recognised by international standards (WPATH SOC-8) and used by many adult clinicians.

Possible benefits: some of the changes above, in a partial form, allowing more control over which effects you do and don't pursue.

Risks: the same physiological risks as full-dose regimens, with the same monitoring requirements. Evidence is more limited and outcomes are less predictable.

Fertility: still potentially affected, discuss preservation first.

Approach D

Wait, defer, or decline

Choosing not to start hormones, for now, or at all, is a real option, treated here with equal weight.

Possible benefits: no medication, no monitoring burden, no medication-related risks; more time to be sure; flexibility to start later (the door doesn't close).

Possible downsides: continuing dysphoria for some people; missed time for changes you may later want.

You can revisit this decision at any time. Some people choose Approach D long-term; some choose it for now.

For your appointment

Ask each option through the BRAN lens.

  • BWhat are the benefits, for me specifically, given my health and goals?
  • RWhat are the risks, and how often do they happen at my age and circumstances?
  • AWhat alternative regimens or routes are available?
  • NWhat happens if I wait, for a few months, for a year, indefinitely?

Values

What matters most to you when you weigh these?

Move the sliders. You can come back and change them. There's no right pattern.

3
Doesn't matterVery important
3
I can waitSooner the better
3
ReluctantComfortable
3
Not a priorityVery important

Your words

If a clinician asked you today, what would you say you'd like to consider, and what would make you want more time?

Decision talk

Bring these to your appointment.

One safety note. Hormones are prescribed and monitored by clinicians for a reason, the monitoring catches problems early. If you are currently obtaining hormones from outside the NHS, please tell your GP or clinic, without fear of judgement. They want to support your safety, not police your choices. If shame or worry is in the way, the peer support organisations on our Resources page can help you find words.