Hormone therapy is often the beginning of a transgender person’s physical transition to their desired gender. However, hormone therapy is a big step and patients must be certain that they want to follow this path.

Before hormone therapy starts, most transgender people consult with specialists. Usually, one of two scenarios takes place:

• The transgender person is assessed by a mental health professional (such as a psychiatrist or psychologist). The mental health clinician must approve hormone therapy before it can be started.
• Another healthcare provider, usually a general practitioner (GP) counsels the transgender person on the risks and benefits of hormone therapy, and shares decision making with the transgender person. This is called the informed consent model.

With the informed consent model, transgender people can still see a mental health professional if they choose to, but approval from a clinician is not required to start hormone therapy.

The GP might refer patients to a mental health professional for further evaluation if they think the patient may not be capable of providing informed consent.

In a 2020 Journal of Sexual Medicine paper, researchers explained the informed consent model as follows:

The informed consent model of [gender-affirming hormone therapy] prescription emerged in the early 2000s with the intention of depathologizing gender diversity and reducing barriers to medical care for [transgender (including gender diverse and non-binary)] individuals. Its hallmark is a shift from the requirement for formal psychiatric approval before accessing [gender-affirming hormone therapy] to a shared decision-making process between the patient and their treating clinician.

In the paper, the authors described how the informed consent model was implemented at the Equinox Gender Diverse Health Centre in Melbourne, Australia.

They worked with data from 309 transgender individuals seeking hormone therapy.

Eight percent of the group were referred to mental health clinicians for further assessment. These individuals were more likely to have posttraumatic stress disorder (PTSD) or schizophrenia.

The rest of the group was assessed by their GP, following the informed consent model.

Individuals in the GP-assessed group started hormone therapy sooner than those who had mental health referrals.

A satisfaction survey was completed by 43 patients – 33 who had followed the informed consent route to hormone therapy and 10 who had been evaluated by a mental health clinician beforehand. Among all the participants, 80% said they were extremely or moderately satisfied with the protocol they had followed.

In addition, 80% of the people in the informed consent group decided to see a mental health provider at some point during their transition.

If you are interested in transitioning, your provider can give you more details about the informed consent model and the process used at your chosen clinic.

Resources

• The Journal of Sexual Medicine - “The Informed Consent Model of Care for Accessing Gender-Affirming Hormone Therapy Is Associated With High Patient Satisfaction”
  Spanos, Cassandra, MD, et al.
  (Full-text. Article in press. Published: November 26, 2020)
  https://www.jsm.jsexmed.org/article/S1743-6095(20)30995-4/fulltext
  
  
• TransHug.org.au - “Informed Consent”
  https://www.transhub.org.au/clinicians/informed-consent
  
  
• World Professional Organization for Transgender Health - “Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People – 7th Version”
  (Approved: September 14, 2011)
  https://www.wpath.org/media/cms/Documents/SOC%20v7/SOC%20V7_English.pdf