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Gender-Affirming Hormone Therapy 101
What exactly is gender-affirming hormone therapy (GAHT)? Learn about the different types of treatments, who it's for, and how to access it in Ontario and Alberta.
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If you’re looking for information about hormone therapy, it can be hard to know where to go and what information to trust. Things can be overwhelming, especially if you’re just starting out.
This article will explain what hormone therapy is, who might use it, and the types available in Canada. It will also guide you through your care options in Ontario and Alberta, including Foria’s virtual program. If you’re stuck between a doctor who doesn’t get you and relying on Reddit, don’t panic! We’ve got you covered.
What is hormone therapy?
Hormones are naturally-occurring chemicals in your body. There are many kinds of hormones produced by your body, affecting everything from digestion to sleep. Sex hormones are largely produced by your reproductive organs - they affect your physical appearance, sex drive and mood. For most people, these changes reflect the sex you were assigned at birth.
Hormone therapy is a type of gender-affirming care. It’s when a licensed clinician prescribes sex hormones, like testosterone or estrogen, to help your physical appearance better reflect your gender identity and/or expression. It can be distressing when your body doesn’t reflect your gender or how you see yourself, and this is known as “gender dysphoria”. Hormone therapy is one way to ease this and help you feel more comfortable.
For many trans, non-binary and gender diverse people, hormone therapy is life-saving.
Who is gender-affirming hormone therapy for?
Hormone therapy can be taken by anyone who wants to align their body with their gender, including non-binary people. There’s no one way to be trans, and you can choose whatever journey feels authentic to you.
This might include hormone therapy and gender-affirming surgeries, or it might include surgeries without hormones. It might not include medical treatments at all. Not every trans, non-binary or gender diverse person uses hormone therapy – it’s a decision that’s yours to make.
Is hormone therapy for me?
Hormone therapy may be for you if changes to your body would better reflect your gender identity. You might want to take hormones to feel more comfortable with yourself. There can be different reasons to choose hormone therapy, and all of them are valid.
Is hormone therapy permanent?
There’s a lot of variation with hormone therapy. Everyone’s body responds in different ways, and many effects - like changes to your skin or body fat levels and distribution - are reversible. This can feel frustrating, because you have to keep taking hormones to keep these effects, but it’s also a good thing! If you’re having any health issues or you are considering pregnancy, you can come off treatment and over time, some effects may reverse. How quickly or how much this happens will depend on how long you were on hormones.
Some effects of hormone therapy, like voice changes while on testosterone or breast growth while on estrogen, are permanent. This means that if you stop or change your dose, these will stay with you. Some people may go on hormones for a limited time until they’ve had these permanent changes, while other people may choose to stay on treatment for the rest of their lives.
If you’re feeling confused or unsure about your long-term plans with hormones, that’s ok! You might also feel excited about some changes from hormones, but less so about others. Your clinician can walk you through what treatment could look like and help build a plan that works for you. At Foria, we know your gender journey is unique. Whatever your path, we’re ready to help you reach your goals.
Types of hormone therapy
There are two main types of hormone therapy that can produce different effects: testosterone and estrogen/androgen blockers.
The type of treatment you have will depend on your assigned sex at birth and the changes you’d like to see. Testosterone will produce masculinizing effects, while estrogen/androgen blockers will produce feminizing effects. Hormone therapy can also be taken by intersex people who would like these kinds of body changes.
For someone assigned female at birth, testosterone can produce facial hair and make your voice deeper. It can also change your body fat distribution, sex drive and mood.
Testosterone can be taken topically - as a gel you apply to your skin every day - or as an injection. You administer these injections yourself every one or two weeks. See our guide to testosterone for more information on these changes and the timeline you could expect with them.
Estrogen and androgen blockers
For someone assigned male at birth, estrogen and androgen blockers can produce breast growth and make your skin softer. They can also affect your body fat distribution, sex drive and mood.
Estrogen is a hormone with feminizing effects and androgen blockers* reduce your natural testosterone. Estrogen can be taken topically as a gel or patch, as a daily pill or as an injection. Androgen blockers are taken as a daily pill. See our guide to estrogen and androgen blockers for more information.
*If you’ve had bottom surgery, you won’t need androgen blockers.
Some people might follow a standard treatment plan, while others might opt for lower doses of hormones. This is often called “microdosing” and can produce more gradual effects.
Options for gender-affirming care
When it comes to gender-affirming care in Ontario and Alberta, you have four options: your primary care provider, an endocrinologist, specialty clinics and Foria.
There are pros and cons to all these options, and multiple factors could determine which works best for you. These include where you live, the urgency of your situation and your finances.
Primary care providers
In the public system, primary care providers like nurse practitioners and family doctors can provide gender-affirming care. If you’ve spoken to your provider and they’re unsure about gender-affirming care, you can direct them to clinical guidelines like the Rainbow Health guide.
The pros of this option are that, if you’re registered with a provider, wait times are usually short. Because this is covered by the public system, you also won’t have to pay.
On the other hand, these providers could be less educated about gender-affirming care. This means you might have to advocate for yourself when it comes to treatment. Unfortunately, some primary care providers may refuse to provide gender-affirming care – if this happens to you, then you have other options in the public system (see below).
Endocrinologists are experts in hormones. Not every endocrinologist has training or experience in gender-affirming care, but some do. You’ll need a referral to see one, so you can ask your primary care provider to refer you to one. You might want to do this if you’re not comfortable with your primary care provider, or if they’re not confident about providing gender-affirming care.
These appointments are covered by the public health system, so you won’t have to pay. A downside is that they can have long wait times.
Some clinicians are comfortable providing gender-affirming care, but many of them will refer people to specialty clinics. The pros of this option are cost – public healthcare is free to patients – and the high quality of care you’ll receive. Specialized clinics focus on gender-affirming healthcare, so they are very experienced with providing care to gender-diverse people. Unfortunately there aren’t many of these clinics and they can have long waiting lists (one to two years).
At the time of writing, specialized clinics and clinics with experience providing gender-affirming care are:
Foria is a private option for gender-affirming care in Ontario and Alberta.
The benefits of Foria are that you can access care wherever you are – we can connect you with expert and affirming clinicians virtually, which means you’ll only need to visit a lab for your blood work and a pharmacy to check your vitals (e.g. blood pressure).
You can also get your appointments faster than the public system, and the care you’ll get through us is specialized (like at specialty clinics).
Since Foria is private, we charge a fee to cover the cost of care.
Informed consent & Foria Clinic
Foria uses an informed consent model. Informed consent is when you and your clinician work together to see if hormone therapy is right for you. Informed consent is recognized by the World Professional Association of Transgender Health (WPATH) as an appropriate way to start treatment.
You might have heard stories of doctors getting to decide if someone is “trans enough” for treatment. Thankfully, this is becoming a thing of the past! At Foria, we let you lead the way – you don’t need to prove your gender to us.
How much does it cost?
In Ontario, most hormone therapy is covered by public drug programs (i.e. OHIP+, OW, Trillium, ODSP), if you qualify. In Alberta, most hormone therapy is covered by public drug programs (i.e. AISH, Alberta Works), if you qualify. The amount you pay depends on your income and the program. For some medications, your provider may have to submit paperwork to get coverage approved.
Hormone therapy is usually also covered by private insurance, but this can vary by company and insurance plan. If you’re exploring hormone therapy but are unsure of your coverage, Foria’s patient care coordinators can help you navigate this.
If you’re paying out of pocket, this is roughly how much you can expect to pay for medications. These are based on average doses for a period of 4 weeks and don’t include pharmacy fees:
Estrogen (pills): $39
Estrogen (patch): $53
Estrogen (injectable): $40
Androgen blocker (Spironolactone): $18
Androgen blocker (Cyproterone): $13
Testosterone (gel): $67
Testosterone (injectable): $14-29
In the public system, your appointments at in-person clinics are covered.
With Foria’s virtual service, you pay an appointment fee to cover the cost of care. For more information on our fees and why we charge them, see our FAQ.
What is it like starting hormone therapy?
After deciding to begin hormone therapy, you’ll usually have a series of appointments to plan this process with your care provider. In these you’ll explore your goals and medical history, screen for relevant health issues and discuss topics like fertility and side effects. This planning period is an important step in your care journey - it confirms that you’re able to consent and that treatment is right for you. For more information about starting hormones with Foria, see our FAQs.
In some cases – like if someone’s been self-medicating without a prescription – the planning period can be fast-tracked. This is to keep you healthy by prescribing reliable and safe medications as quickly as possible.
This content has been reviewed by Foria’s Medical Director, Dr. Kate Greenaway and our community advisory team. Medical sources include Rainbow Health Ontario’s Guidelines for Gender-Affirming Primary Care with Trans and Non-Binary Patients.