You can get feminizing hormone therapy (HRT) through several types of providers: Planned Parenthood clinics, LGBTQ+ community health centers, telehealth platforms, university gender clinics, or a local doctor such as an endocrinologist or family medicine physician. The best option depends on where you live, whether you have insurance, and how quickly you want to start.
Planned Parenthood and Community Health Centers
Planned Parenthood is one of the most accessible starting points, especially if you don’t have a regular doctor. Many of their health centers offer gender-affirming hormone care on an informed consent basis, meaning you don’t need a therapist’s letter or a formal diagnosis before starting. They can also help with insurance navigation, name and gender marker changes, and referrals to specialists like voice coaches or surgeons. Not every Planned Parenthood location offers HRT, so check your local clinic’s services page before booking.
LGBTQ+ community health centers operate similarly. Organizations like Fenway Health in Boston, Callen-Lorde in New York City, and Howard Brown Health in Chicago have dedicated gender-affirming care programs with staff experienced in feminizing hormone therapy. If you’re in a smaller city or rural area, these may be harder to find, but many now offer telehealth visits across state lines.
Telehealth Platforms
If there’s no in-person provider near you, or you prefer the privacy and convenience of virtual care, telehealth services designed specifically for transgender patients are a strong option. The two largest are FOLX Health and Plume, and they differ mainly in pricing structure.
Plume charges a flat $99 per month (or about $750 for the year), which includes up to five provider visits per month and lab work. They don’t accept insurance. FOLX has a lower base membership of $39.99 per month (around $25 per month if you pay annually), but visits are billed separately: $159 for your first appointment and $79 for follow-ups if you’re paying out of pocket. FOLX does accept insurance, which can bring visit costs down to a typical copay of $15 to $30. Lab work through FOLX runs about $50 out of pocket or can be billed to insurance.
Both platforms write your prescriptions and let you fill them at a local pharmacy or have medications delivered. The main tradeoff is simplicity versus flexibility: Plume bundles everything into one predictable monthly cost, while FOLX can be cheaper if you have insurance or don’t need frequent visits.
University Gender Clinics and Specialists
Major university hospitals often have comprehensive gender services programs. The University of Michigan, for example, runs a program that provides hormone therapy through its family medicine, endocrinology, and gynecology departments for patients 19 and older. Similar programs exist at institutions across the country, including UVA Health, Mount Sinai, and UCSF. These clinics tend to have multidisciplinary teams, which can be helpful if you want surgical referrals, fertility counseling, or mental health support all in one place.
The downside is that university clinics sometimes have longer wait times for new patients, and you may need a referral depending on the hospital system. If you’d rather see someone in private practice, an endocrinologist or family medicine doctor with experience in gender-affirming care can prescribe and monitor HRT just as effectively.
How to Find a Provider Near You
The OutCare Health OutList directory is one of the most useful tools for locating affirming providers. It’s a searchable international database where you can filter by specialty (like endocrinology), location, and whether the provider offers telehealth. You can search by state to find providers who practice remotely if nothing is available locally. The directory includes providers who offer hormone therapy, surgical services, and reproductive health care specifically for LGBTQ+ patients.
Your insurance company’s provider directory is another practical starting point. Many major insurers now cover gender-affirming hormone therapy, and searching for in-network endocrinologists or family medicine doctors, then calling to confirm they have experience with transgender care, can save significant money compared to cash-pay options.
What Happens at Your First Appointment
Your first visit will typically involve a review of your medical history, a discussion of your goals, and baseline blood work. The blood tests establish your starting hormone levels and screen for conditions that might affect how safely you can take certain medications. Results usually come back within a couple of days. If nothing concerning shows up, you can often start hormones at that same visit or very shortly after.
Under current clinical guidelines, providers look for a few key things before prescribing: that your experience of gender incongruence is consistent and sustained, that there aren’t other medical explanations for what you’re experiencing, and that any mental or physical health conditions that could affect treatment outcomes have been discussed. You’ll also have a conversation about how hormone therapy can affect fertility and what your options are for preserving reproductive capacity if that matters to you. Many informed consent clinics cover all of this in a single visit rather than requiring multiple appointments.
Common Medications for Feminizing HRT
Feminizing hormone therapy typically involves two components: estrogen to develop female secondary sex characteristics and an anti-androgen to suppress testosterone’s effects.
The standard estrogen is estradiol, available in three forms: pills (the most commonly prescribed), skin patches or gels, and intramuscular injections. Each has tradeoffs. Pills are the simplest but carry a slightly higher risk of blood clots compared to patches or injections. Patches deliver a steady dose but can cause skin irritation. Injections are typically given every one to two weeks and provide consistent levels, but you or someone else needs to administer the shot.
The most common anti-androgen in the United States is spironolactone, prescribed at doses of 100 to 300 mg daily. It blocks testosterone from binding to its receptors and may also have mild estrogen-like effects. If spironolactone isn’t a good fit, alternatives include GnRH agonists, which suppress testosterone production through a different mechanism. In Europe, a medication called cyproterone is widely used, but it’s not available in the U.S. due to clotting risks.
Ongoing Monitoring and Lab Work
Once you start HRT, expect follow-up visits every three months during your first year, then every six to twelve months after that. Each visit includes blood work to check that your hormone levels are moving into the target range: estradiol below 200 pg/mL and testosterone between 30 and 100 ng/dL. Your provider will also monitor prolactin and triglycerides, since estrogen can affect both. If you’re taking spironolactone, potassium levels get checked regularly because the medication can cause potassium to rise.
These appointments are also when your provider tracks the physical changes you’re experiencing, adjusts dosages if needed, and screens for any side effects. Most people notice breast tenderness and softer skin within the first few months, with more significant changes developing over one to three years.
What It Costs Without Insurance
The medications themselves are relatively affordable. Generic estradiol pills typically cost $10 to $30 per month at major pharmacies, and generic spironolactone runs roughly the same. Using discount programs like GoodRx can bring prices even lower. The bigger variable is the cost of provider visits and lab work, which is where telehealth platforms and community health centers can help keep things manageable. Planned Parenthood and similar clinics often use sliding-scale fees based on income.
If you have insurance, check whether your plan covers gender-affirming care. Most state Medicaid programs and many employer-sponsored plans now cover feminizing hormone therapy, including the medications, lab work, and provider visits. Calling your insurer’s member services line and asking specifically about coverage for gender dysphoria or gender-affirming hormone therapy will give you the clearest answer.