Considering HRT? Here's What to Think About Before You Start

Starting gender-affirming hormone therapy (HRT) is a significant and empowering step for many trans people. It’s a path toward aligning your body with your gender identity, and it can have profound positive effects on your well-being. And, if you already understand the effects of HRT and have decided it's right for you, you might be eager to start the process.

The physical changes that HRT brings also means that other people will notice them too, which can impact various aspects of your life. This article is here to help you think through some important considerations before you start HRT, so you can take this step with confidence and a solid plan in place.

Your Safety Comes First

Safety is key. The physical changes brought on by hormones will make your trans identity more visible to others, which might affect your relationships, living situation, and employment. It’s essential to evaluate these areas of your life and think about how you will navigate them once you begin HRT.

Housing: Is your living situation stable?

Consider your current housing situation. Do you live with family, roommates, or in a community that may not be supportive of your transition? Are you out to them, or do you plan to come out? Even if you don't think there's a risk you could be asked to leave or face hostility from those you live with (but especially if you do think there's a risk!) it's important to have a realistic plan.

• Alternative Housing: Start exploring other housing options, such as LGBTQ+ friendly shelters or housing programs. Research average rent costs and housing availability in your area, and if you're thinking about relocating to a new place, do the same research for those potential locations. Now is also the time to reach out to supportive friends or family members to discuss the possibility of staying with them, and what that arrangement might look like.
• Emergency Funds: If possible, start saving for emergency housing and living costs. Even a small amount of savings can provide a temporary buffer if you need to find a new place to live and/or support yourself unexpectedly.
• Legal Protections: Familiarize yourself with tenant rights in your area. In some places, discrimination based on gender identity is illegal, and knowing your rights can help you navigate any challenges that arise.

Employment: Is your job secure?

Unfortunately, not all employers are supportive of trans employees, and there may be risks to your employment as you socially and/or medically transition.

• Job Security: Reflect on how supportive your workplace is. Are there clear policies protecting LGBTQ+ employees? If you’re unsure, now might be the time to look for a more inclusive employer or to learn about your legal rights in the workplace.
• Job Alternatives: Consider updating your resume and networking within LGBTQ+ friendly circles, both in person and online. It’s also a good idea to start running job and career searches periodically to keep your options open and stay informed about potential opportunities. If your current job becomes untenable, you will have a head start on a search for a new one.
• Know Your Rights: Learn about workplace discrimination laws in your area. In some places, it's illegal to fire someone for being trans, and knowing this can empower you to advocate for yourself as necessary.

Health Insurance: Are your benefits secure?

If your benefits are tied to your employer, parent, or partner, now is the time to consider what alternatives might be available to you if you lose your job, need to switch your job, or lose your family support. This is especially important if you manage other health conditions: the potential loss of health insurance coverage may make it harder to navigate other non-HRT healthcare needs.

• Explore Alternative Coverage Options: Research whether you might qualify for government-sponsored health programs like Medicaid, or if you could access health insurance through the Affordable Care Act (ACA) marketplace. Understanding these alternatives in advance can help you avoid a gap in coverage if your situation changes.

Social Support: Building a network

Social support is vital as you start HRT. Having people in your corner who understand and support your journey can make all the difference.

• Identify Allies: Who in your life supports your transition? Make a list of these people and consider how they can help you if you encounter challenges. It may be helpful to reach out to them now to discuss your plans and how they might be able to support you emotionally, financially, or practically.
• Join Communities: Online and local LGBTQ+ groups can provide valuable support and resources. Connecting with others who have gone through similar experiences can offer guidance and reassurance. Centerlink’s LGBT Center Directory is a great tool to find organizations near you.

Health and Well-Being: Prepare for the changes

HRT brings both physical and emotional changes. Preparing for these in advance can help you navigate them more smoothly.

• Medical Care: Ensure you have access to a primary healthcare provider who is knowledgeable about HRT and trans health. Regular check-ins with your doctor will be crucial as you begin hormone therapy. (If you're considering HRT with a telehealth provider or are applying for Point of Pride's HRT Access Fund, primary medical care is sometimes an included benefit with your membership. Reach out to the telehealth provider's customer service department to learn more about what additional services or care is included.)
• Mental Health: Consider speaking with a therapist who has experience with trans issues. HRT can be an emotional journey, and having professional support can help you manage any mental health challenges that arise. (Again, some HRT telehealth providers also offer mental health services or support groups. Reach out to the telehealth provider's customer service department to learn more.)
• Routine, Well-Being, and Self-Care: Consider your movement, nutrition, and sleep practices and how you might be able to adjust them to support your overall well-being. Establishing a routine that includes self-care activities, such as meditation, journaling, or hobbies you enjoy, can help you stay grounded and manage stress during periods of change.

Plan for the Unexpected

Once you start HRT, it's not advisable to stop suddenly due to the risk of adverse health and mental health effects. Therefore, it’s important to generally plan for any scenario that might disrupt your ability to continue HRT, such as losing your job or housing, a change in your health insurance coverage, a change in benefits programs, or needing to move to another place.

• Emergency Resources: Identify local resources, such as LGBTQ+ health clinics and support organizations, that can help you access HRT even if you face financial or logistical challenges.
• Health Insurance: Review your health insurance coverage to understand what’s covered and what’s not. Consider what you would do if you lost your coverage and explore options like sliding scale clinics or medication assistance programs.

Final Thoughts

Starting HRT is a powerful step toward living authentically, and when we know it's right for us, we may feel eager to begin immediately. However, it's sometimes necessary to slow down and carefully plan before starting. For some, as difficult as the decision may feel, this might mean temporarily pausing on HRT to first make sure our housing, employment, and support networks are stable and safe.

Remember, you deserve safety. By preparing now—considering your safety, housing, employment, wellness, social support, and other factors—you can enter this new chapter of your life with confidence and resilience, ready to face any challenges that arise and to celebrate your experiences of trans joy!