Informed consent HRT is a model for accessing gender-affirming hormone therapy where your prescribing clinician explains the risks, benefits, and alternatives, and you give consent to begin treatment, just like you would for most other medications. It skips the traditional requirement of getting a referral letter from a mental health professional before starting hormones. The approach treats hormone therapy as a standard medical decision between you and your doctor rather than something that requires outside gatekeeping.
How the Informed Consent Model Works
In the informed consent model, a clinician sits down with you and walks through what hormone therapy will do to your body, what the medical risks are, what changes are reversible and which ones aren’t, and what alternatives exist. You discuss all of this together, and then you give your consent to start treatment. That consent can be verbal (the clinician documents the conversation in your chart) or written (you sign a form that covers the same information). Both approaches are recognized in clinical practice.
The key idea is that you, as the patient, are the authority on your own gender identity. The clinician’s job is to make sure you have all the medical information you need to make a fully informed decision, not to evaluate whether your identity is “real enough” to justify treatment. Many clinicians who use this model say they do so because they view hormone therapy as comparable to other medications, where standard consent practices are sufficient. This aligns with the seventh edition of the WPATH Standards of Care, which listed verbal informed consent as an acceptable form of consent for adults seeking hormone therapy.
How It Differs From the Referral Model
The traditional pathway to hormone therapy requires you to first see a mental health professional, receive a formal assessment, and obtain a referral letter confirming a diagnosis of gender dysphoria. Only then can you see an endocrinologist or prescribing clinician to start hormones. This process can take months or longer depending on wait times and insurance requirements.
The informed consent model removes that mandatory step. You go directly to a prescribing clinician, have the consent conversation, and can begin treatment at that visit or shortly after. Research has shown that adults who access hormone therapy through non-referral models report greater satisfaction compared to those who were required to get a mental health referral first. That said, the informed consent model doesn’t discourage therapy or mental health support. It simply means those services are offered rather than required as a condition for treatment.
Some clinicians and ethicists have argued that psychological assessment still has value, particularly because the transgender population experiences higher rates of co-occurring mental health conditions. Others counter that requiring assessment as a gatekeeper to hormones is ethically inconsistent with how medicine treats other comparable decisions, including elective procedures like cosmetic surgery, where psychological support is recommended but not mandatory.
What You’ll Be Told About Risks
Regardless of which consent model a clinic uses, the prescribing clinician is responsible for making sure you understand the potential health risks. These differ depending on whether you’re starting feminizing or masculinizing hormones.
Feminizing Hormone Therapy
Estrogen-based therapy carries risks including blood clots (especially dangerous if they form in deep veins or travel to the lungs), stroke, heart problems, elevated triglycerides, weight gain, high blood pressure, and type 2 diabetes. If you have a personal or family history of blood clots, taking estrogen in pill form is generally discouraged, though other delivery methods like patches or injections may be safer. Breast cancer risk increases compared to cisgender men, though it does not appear to exceed the baseline risk for cisgender women. You’ll need regular blood tests to monitor cholesterol, potassium, blood sugar, blood count, and liver function.
Masculinizing Hormone Therapy
Testosterone therapy consent forms typically cover the risk of ovarian cancer, though much of that language is framed with significant uncertainty since long-term data is still limited. Consent documents also explain changes in sexual organs and functioning, pregnancy and fertility considerations, and general cardiovascular risk. One point that consent forms stress clearly: testosterone is not birth control. Even after your periods stop, pregnancy remains possible if sperm can reach the uterus, so barrier contraception is recommended if that applies to you.
Irreversible vs. Reversible Changes
One of the most important parts of the consent process is understanding which changes will reverse if you stop hormones and which ones won’t. Consent forms lay this out explicitly.
For feminizing hormones, changes considered potentially irreversible include breast growth, decreased bone density, fat redistribution, genital changes (smaller testes and penis), and reduced sperm production that could cause permanent infertility. Sperm banking before starting therapy is recommended if you want biological children in the future.
For masculinizing hormones, irreversible changes typically include voice deepening, facial hair growth, and clitoral growth. Body fat redistribution and menstrual changes generally reverse if testosterone is stopped, but the timeline varies.
Consent forms use the word “potentially” for many of these effects because individual responses differ. Some people experience changes faster or more permanently than others. The clinician’s role is to ensure you understand this uncertainty before you begin.
Fertility Preservation
Both the Endocrine Society and WPATH recommend that all transgender individuals be counseled about how treatment may affect their ability to have biological children, and that fertility preservation options like egg freezing or sperm banking be discussed before hormones are started. The American Society for Reproductive Medicine emphasizes that patients should receive information “material to their decision-making,” including the reality that there are still gaps in knowledge about the long-term reproductive effects of hormone therapy.
If fertility preservation is something you’re considering, it’s worth raising this at your first visit, because some preservation methods work best before hormones have had any effect on your reproductive system. Clinicians should also be prepared to discuss what discontinuing hormones to pursue pregnancy would look like, both physically and emotionally, since stopping treatment can intensify gender dysphoria for some people.
Age Requirements and Adolescents
The informed consent model as described above applies primarily to adults. For adolescents, the process looks different. The Endocrine Society recommends that hormone therapy for adolescents begin only after a multidisciplinary team of medical and mental health professionals has confirmed persistent gender dysphoria and sufficient mental capacity to consent. Most adolescents meet that threshold by age 16, according to their guidelines, though there may be compelling reasons to begin earlier in some cases.
For minors, parental or guardian consent is typically required alongside the adolescent’s own assent. Genital surgeries involving removal of reproductive organs are recommended to wait until at least age 18 or the legal age of majority. The rules vary by state and country, so the specifics depend on where you live.
Finding an Informed Consent Clinic
Informed consent clinics exist across the United States, often run by community health centers, Planned Parenthood locations, and LGBTQ-focused healthcare organizations. Some primary care doctors also use this model in private practice. At these clinics, you can typically schedule an appointment specifically for hormone therapy, complete the consent process, have baseline blood work drawn, and receive your first prescription within one or two visits. Wait times vary by location, but the process is substantially faster than the traditional referral pathway, which can involve months of appointments before hormones are prescribed.