How to Start Hormone Therapy (HRT) in British Columbia: A Step-by-Step Guide

For many trans, non-binary, and gender-diverse people, starting hormone replacement therapy (HRT) is an important step in affirming their gender. While the process can feel overwhelming at first, accessing hormone therapy in British Columbia is often more straightforward than many people expect.

I frequently hear clients and prospective clients say they aren't sure where to start or what assessments are required. Because of this, I wanted to create a simple guide explaining how to access gender-affirming hormone therapy in BC.

1. Connect With a Healthcare Provider

The first step is connecting with a healthcare provider who can prescribe hormone therapy or help coordinate your care.

This may include:

• A family doctor

• A nurse practitioner (NP)

• A walk-in clinic physician

• An endocrinologist

• A gender-affirming care clinic

If your provider does not offer gender-affirming hormone therapy, they may refer you to someone who does. If you do not have a provider, feel free to send me a message, and I may be able to provide a recommendation.

2. Complete a Hormone Readiness Assessment

Most healthcare providers, like an endocrinologist, will require a hormone readiness assessment before prescribing HRT.

A readiness assessment is an opportunity to ensure you have the information needed to make an informed decision about hormone therapy and allows you to ask any questions you may have. It also provides the documentation required by some prescribing providers.

As a provider trained by Trans Care BC, I offer hormone readiness assessments for individuals seeking gender-affirming hormone therapy in British Columbia.

The assessment typically involves discussing:

• Your gender history and goals

• Your understanding of hormone therapy

• Relevant physical and mental health considerations

• Fertility considerations

• Any questions you may have

Once completed, your assessment can be sent directly to the healthcare provider who will be prescribing your hormones, such as your family doctor, nurse practitioner, or endocrinologist.

If you do not currently have a healthcare provider who can prescribe HRT, your assessment can be sent to a walk-in clinic physician to support a referral to an endocrinologist. Alternatively, your family doctor or nurse practitioner can also provide a referral to an endocrinologist if needed.

3. Meet With the Prescribing Provider

After reviewing your readiness assessment, the prescribing provider will discuss:

• Your goals for treatment

• Expected effects of hormone therapy

• Potential risks and benefits

• Medication options

• Any recommended blood work

The goal is to ensure you have the information needed to provide informed consent before starting treatment.

4. Start Hormone Therapy

Once any required assessments and medical reviews have been completed, your provider can prescribe hormone therapy.

Depending on your goals, treatment may include:

Feminizing Hormone Therapy

• Estrogen

• Testosterone blockers (if needed)

Masculinizing Hormone Therapy

• Testosterone

Your provider will explain what changes to expect, how long they may take, and which effects are reversible or permanent.

5. Attend Follow-Up Appointments

Hormone therapy is an ongoing process. Regular follow-up appointments allow your provider to:

• Monitor hormone levels

• Review physical changes

• Adjust dosages when needed

• Address any concerns

These appointments help ensure treatment remains safe and effective over time.

Key Things to Keep in Mind

Do I Need a Mental Health Diagnosis to Start HRT?

No. In British Columbia, a mental health diagnosis is not generally required to access gender-affirming hormone therapy. Care is typically based on an informed consent model.

Is HRT Covered by MSP?

Appointments with physicians and nurse practitioners are generally covered by MSP. Prescription medications may be covered through extended health benefits, Fair PharmaCare, or other programs, depending on your circumstances.

Final Thoughts

Starting hormone therapy can feel like a big step, especially if you're navigating the healthcare system on your own. The good news is that there is a clear pathway to accessing gender-affirming care in British Columbia.

If you're looking for a hormone readiness assessment or have questions about the process, feel free to reach out.