Do you need a therapist for HRT?

Hormone replacement therapy (HRT) is a medical treatment that supplements hormones when your body is not making enough on its own. The most common reasons people take HRT are for menopause symptoms or to affirm their gender identity.
HRT can involve taking estrogen, testosterone, or progesterone supplements. The right hormones and dosages are tailored to each individual based on factors like their age, symptoms, medical history, etc.

Do you need a therapist's approval to start HRT?

The short answer is - it depends.

• For menopausal HRT, you typically do not need a therapist's note. However, your doctor will want to discuss your symptoms and medical history in depth before prescribing anything.


• For gender-affirming HRT, a therapist's assessment is often required beforehand. The reasoning is that the therapist can assess if the patient fully understands this medical intervention and its psychological/social effects. They can also diagnose gender dysphoria and rule out other potential causes for the patient’s distress.

Below is more detail on the standard requirements for gender-affirming HRT:

Gender-Affirming HRT Requirements

• A diagnosis of gender dysphoria from a mental health professional. This usually requires several therapy sessions where you discuss your gender identity and transition goals.


• A referral letter from your therapist stating HRT is medically necessary for treating your dysphoria. This “approval” letter is usually required by the prescribing doctor.


• Being the legal adult age in your state/country (or having parental consent if you are a minor).


• Going through the informed consent process with your HRT prescriber. This covers topics like:
  
  
  • The types/dosages of hormones
  
  
  • Changes to expect on HRT
  
  
  • Timeline for effects
  
  
  • Health risks
  
  


• Consistently living as your gender identity for a period of time beforehand (such as 12 months). This is a controversial requirement that not all providers still use.


• Being evaluated by an endocrinologist or competent HRT provider before starting hormones.

So in summary - yes, you need a therapist's assessment to affirm you are ready for gender-related HRT, both emotionally and socially. The therapist cannot bar you from accessing hormones, but their evaluation is a common prerequisite used to protect the patient’s interests.

Seeking Therapy Support

Even after getting approved for HRT, staying in therapy can be extremely valuable for many transitioning patients. A good gender therapist provides support with:

• Processing expectations vs reality of transition


• Coming out to family, friends, and workplace


• Adjusting to social or biological changes


• Guiding you towards helpful medical interventions beyond hormones


• Managing mental health conditions like anxiety or depression


• Building confidence in your self-expression & gender identity

Summary

While a therapist's note is not always mandatory, having a gender dysphoria diagnosis and assessment of readiness for HRT is considered best practice. Going through counseling sessions first allows important self-reflection before this life-changing treatment. A therapist can catch potential issues the patient themselves might overlook or downplay. They also ensure the desire for transition is coming from the patient's core identity - not external factors like trauma or societal pressure.

Overall the therapist acts as an unbiased third party that protects the interests of a vulnerable population. With their stamp of approval, you can feel fully assured that hormone therapy is the wise next step in embracing your true self. Reaching out for their continued support after starting HRT is also highly recommended.