The best time to start hormone replacement therapy (HRT) depends on your individual circumstances and goals. There are a few key factors to consider:
Age - Many experts recommend starting HRT before age 35 if possible. The younger you start, the better the effects on physical changes like breast development, body fat redistribution, and facial changes. However, HRT can still be very effective even if started later in life.
Menopause status - If you are peri- or post-menopausal, starting HRT can help alleviate symptoms like hot flashes, vaginal dryness, and sleep disturbances. The longer you've been post-menopausal, the less effect HRT will have on breast development and reversal of male pattern hair growth and baldness.
Medical conditions - Certain medical conditions may make earlier initiation of HRT advisable, like a family history of osteoporosis or heart disease. Discuss your specific risks with your doctor.
Mental health - Some individuals find starting HRT improves gender dysphoria, anxiety, and depression. If you are struggling with mental health issues, it may make sense to start sooner.
Social transition status - Many providers recommend living in your authentic gender role for at least 3 months before starting HRT. However, this is not an absolute requirement, especially if your dysphoria makes delaying treatment difficult.
Readiness and life circumstances - Make sure to consider your preparedness for physical and social changes. Do you have social support? Are you able to make adjustments at work or school if needed? Take your time and don't rush into HRT before you're ready.
Fertility preservation - If preserving fertility for future biological children is important, take steps for egg/sperm freezing before starting HRT. HRT can cause irreversible sterility.
Now, let's discuss some key factors in deciding when to start HRT:
- Get any necessary medical tests beforehand, like blood work, heart/bone health scans, cancer screenings, etc. Your doctor will advise on needed testing.
- Talk to your doctor about your goals, expectations, and overall health to determine the right starting dose and schedule. Follow their monitoring recommendations to keep levels in the proper range.
- Start low, go slow. It's generally best to start with a lower hormone dose and increase gradually over months. This allows your body to slowly adjust and reduces side effects.
- Be consistent with dosing to keep hormone levels stable. Take oral doses at the same time each day and do not skip. With injected hormones, maintain a regular injection schedule.
- Monitor changes and side effects. Keep note of physical and emotional changes and report anything concerning to your provider. They may adjust your dosage/regimen if needed.
- Get follow up blood work done per your doctor's recommendations to ensure your hormone levels are in the ideal therapeutic range. Expect dose adjustments over the first year.
- Consider adding other medications like 5-alpha reductase inhibitors to augment feminizing effects if progress stalls after adequate time on HRT alone. Discuss options with your provider.
- Be patient. Maximal effects take 2-5 years. Trust the process and try not to become discouraged. Your body needs time to re-learn processes. Periodic evaluations with your provider can help you stay confident you're on track.
The key is finding the right time that fits your unique needs and situation. While it's ideal to start HRT earlier, you can still achieve excellent results whenever you start. The most important thing is being ready to take this step and having proper medical guidance.
At Balance Hormone Center, we specialize in gender-affirming hormone therapy and are dedicated to helping our patients start HRT at the optimal time for their individual needs. Our compassionate providers will take the time to understand your goals and circumstances and work with you to create a customized treatment plan. We offer everything from therapy and labs to onsite injections so you get comprehensive transition care all under one roof. Contact us today to schedule your first appointment and get started on your path to becoming your true self. We're here to support you every step of the way.
