Informed Consent Considerations for Testosterone HRT

Everything to know to make an empowered decision with testosterone HRT.

Testosterone injectable HRT kit

FOLX uses an informed consent model to provide our members with hormone replacement therapy (HRT). We know that folx starting HRT have been thinking about this decision for a while. Many have done their own research and discussed this with other folx on HRT.

Our responsibility is to  provide as much clear information on the benefits, risks, alternatives, and explanations as possible before someone makes a decision. With an informed consent model, there is no requirement that a mental health provider assess whether or not a patient is a candidate for hormone therapy.

When signing up for a FOLX testosterone HRT membership, we need our members to understand and acknowledge the information below to get started. But don’t worry: no one needs to make these decisions on their own if they don’t want to. Your membership includes the option to talk with a FOLX clinician about the information below, and more.

Testosterone is a controlled substance because it was being trafficked for body enhancement (mainly sports). Therefore, FOLX has to follow certain requirements, such as scheduling a video visit with every new member. We hope that you take advantage of this appointment to discuss anything important to you!

When starting testosterone with FOLX, members agree that they understand the following:

Permanent changes

If any of the following changes occur for you, they are permanent and will likely not go away even if you stop taking testosterone:

  • Bottom growth/external genital growth/larger clitoris
  • Deepened voice
  • Facial hair
  • Hair loss from the scalp
  • Thicker/more body hair growth

Reversible changes

If any of the following changes occur for you, they usually go away or lessen if you stop taking testosterone:

  • Increased libido/sex drive
  • Changes in where your body stores fat
  • Changes to your strength/muscle definition
  • Faster hair growth over your body
  • Changes to your bleeding pattern/menstrual cycles

Health risks

The biggest concerns associated with testosterone are increased risk for heart attacks and strokes. Testosterone might also:

  • Increase your red blood cell count which can lead to higher risk of clots
  • Increase the amount of fat and/or cholesterol in the blood 
  • Increase the chance of diabetes 
  • Harm the liver (although there is recent research that disputes this)

There isn't a lot of research on the risks of testosterone for HRT so there may be other consequences that we don't know about yet.

Side Effects

The following are side effects that may happen when you start taking testosterone:

  • Acne: If you get acne after you start testosterone, let us know and we can help. There are some medications we can prescribe to you that may be able to help with acne.
  • Thicker and more oily skin
  • Head hair loss/balding (permanent): If you start noticing hair loss while you are on T, let us know. There are medications we can prescribe to you that can help minimize hair loss.
  • Mood changes, including increase in irritability. If you notice mood changes, let us know. Most folx notice that their mood improves because they’re getting the hormone that affirms them. Some folx notice that they become more irritable, and this usually gets better with time. When you’re on the right dose, testosterone should NOT cause anger problems. If you do notice anger problems, this is a sign that you might need a lower dose and you should contact us.
  • Vaginal/front hole dryness. Taking testosterone may cause irritation, discharge, odor, pain with urination, or pain during sex. If you notice any of these symptoms, let us know. Your clinician can discuss available options.
  • Bleeding irregularities (period/menstrual cycle changes). Some folx stop having bleeding completely soon after they start testosterone. Other folx have irregular bleeding for a while. Some folx decide to take forms of birth control in order to faster regulate bleeding.

Length of time it takes hormones to work

This depends on your starting dose. If you start with a low or average dose, it can take about three months to notice a change. Each change takes varied amounts of time to start and to reach maximum effect. Some changes take years to reach maximum effect. This is dependent on many factors--your dosage, the age you started hormones, your genetics. For instance, if you start hormones later in life, you may not see the same kind of changes as a younger person, since sex hormones affect tissues of older folx in more subtle ways. 

How long do I need to take testosterone?

This is your decision. To keep the non-permanent changes to your body, you will need testosterone for life. For folx who get their ovaries removed or for older folx whose bodies need less testosterone, you may use a lower dose.

Testosterone and fertility

We know that testosterone most likely decreases fertility, but it won’t make it go away completely. Pregnancy is possible while you are on testosterone, even if you haven’t had regular bleeding (period). We recommend birth control for you and/or your partner, if you are having the type of sex that could lead to pregnancy and you do not want to become pregnant. 

If it is important for you to use your own eggs to make a pregnancy, it’s best to store them before starting testosterone or as early as possible. If you would like to become pregnant, please talk to your clinician. It may be hard to become pregnant, even if you stop testosterone. If you take testosterone while you are pregnant, it can have dangerous effects on the health of the pregnancy.

And that’s that.

With the different routes and dosages of testosterone, there are a lot of ways to find the one that fits best for each individual body. For those ready to get started with FOLX for testosterone, the process begins here. And for those who’ve got some more questions about our informed consent approach or getting started, reach out to support@folxhealth.com.