Hi Apollo!

Thank you for reaching out to AlterHéros!

So, you have your first appointment at a clinic to start testosterone. You’re wondering how a first appointment like that usually goes and how many appointments you will need to get your prescription.

First, I’d like to say how sorry I am that you had to wait 4 years to get an appointment! It’s really not fair that trans people have to wait so long to have access to medically necessary and life-saving medication. 

Second, let’s look at how these appointments usually go. I don’t know if you are going to a clinic that uses the “informed consent” model to prescribe hormones or if you are going to an endocrinologist that uses more of an old-school model. There are some differences between the two approaches. 

In either case, it’s possible that you will experience attempts at gatekeeping your access to hormones. The medical professional might ask questions such as “Since when do you know you are trans?” and “Are you out to your family, friends or at work?” or even questions that have nothing to do with being trans like “What’s your sexual orientation?”. 

If the doctor uses the informed consent model, it’s less likely that you will be asked a lot of questions about your identity and transition. In any case, I’d rather you be prepared for this possibility instead of being surprised. Some providers do not actually have much training to respectfully assess trans people who want to medically transition. Even more of them have little to no knowledge about non-binary identities. 

For example, my endocrinologist asked me at my first visit “How long have you wanted to become a man?” He assumed that my being assigned female at birth meant that I was a trans man. I’m actually non-binary, but I didn’t feel like I could safely talk about that with him, so I answered that I had always wanted to be a boy. In any case, you don’t have to answer questions you are not comfortable with. You can deflect questions or lie if you want to. 

After that, the medical professional might talk to you about the effects of testosterone or ask you what changes you expect from beginning hormonal therapy. This is to assess if you understand the effects, the risks and the limits of HRT, and to make sure you have realistic expectations. They will also talk about administration methods (injections, gel, patches) and ask you if you have a preference. It’s better to do your own research before your appointment to demonstrate that you have good knowledge about testosterone and to be able to ask questions if you have some. I figure that in the 4 years of waiting you’ve had more than enough time to gather all the info you need! Still, here are some good resources if you need them:

• Information on Testosterone Hormone Therapy
• Masculinizing Hormone Therapy

Then, the medical professional might want you to sign paperwork that lists all of these effects and risks, to make sure you consent to taking this medication. This is more common at informed consent clinics, and less common with endocrinologists. 

Most providers will do a short physical exam to make sure you are healthy. Usually, that will mean taking your blood pressure, listening to your heart, weighing you and palpating organs such as the thyroid gland (which is in the throat) and the liver (in the belly). 

Usually, it takes one or two appointments to get a prescription. A lot of providers will want to check your hormone levels and other health indicators via a blood test before you start taking testosterone. This might mean that they’ll write you a prescription for a blood test and schedule another appointment to prescribe the testosterone after they get the results. Sometimes, they will write a prescription for both a blood test and the hormones at the same time, and ask you to do the blood test before you take your first dose. 

After you start taking testosterone, the medical professional will want you to do another blood test in 3 to 6 months and to see you again to do another short physical exam, see how you’re doing and adjust the dosage if needed. After that, you’ll have follow up appointments every 6 to 12 months. 

I hope that this answer gives you all the info you need! If it’s not the case or if you have any other questions, don’t hesitate to reach out to us again.

I wish you all the best!

Séré, outreach worker for AlterHéros