Monitoring is more than numbers
Once gender-affirming hormone therapy (GAHT) begins, follow-up is what keeps treatment safe and on track. WPATH Standards of Care Version 8 state that monitoring covers the person's goals, quality of life, side effects and general health, not hormone levels alone.[1]
Many people focus heavily on their estradiol or testosterone result and forget other things that matter just as much, such as blood pressure, mental health and screening based on the organs they have.
What follow-up achieves
Follow-up reviews whether changes are happening as hoped, how satisfied you are, and catches side effects early.[1] It is also a chance to adjust dose or route as life changes, for example with age or new health conditions.
People using hormones without monitoring may not know that their blood pressure has risen, their blood has thickened or their levels are unsuitable until a problem develops.
Care is individual
Using gender-affirming hormones is not a measure of mental illness, and care needs vary with goals and access.[4] Monitoring should therefore be tailored to each person, not a single formula for all.
Risks differ by regimen
Each hormone carries specific risks.[1],[2]
- Testosterone can raise haematocrit and cause acne, hair thinning and changes in blood pressure.
- Estrogen increases clot risk, especially oral estrogen and in smokers, and can affect liver tests in some people.
- Androgen-lowering medicines: spironolactone can raise potassium, and cyproterone acetate has specific side effects, so the lowest effective dose should be used.
A typical monitoring schedule
During the first year, while doses are adjusted, visits are usually about every three months. Once treatment is stable, they become less frequent, such as once or twice a year.[1],[2] Blood tests are chosen according to regimen and risk:
- On testosterone: testosterone level and haematocrit.
- On estrogen: estradiol and testosterone levels, and potassium if taking spironolactone.
- Everyone: blood pressure and weight, plus review of symptoms, side effects and satisfaction.
Other health care not to forget
Good follow-up covers the whole person: blood pressure, sleep, mental well-being, smoking, contraception, STI prevention and screening based on the organs you have.[1],[2] STI testing should match risk and exposure sites, in line with CDC guidance.[3]
Bone health. After removal of the testes or ovaries, the body no longer makes its own sex hormones. Stopping hormones for long periods can thin the bones, so any change should be planned with your care team.[1],[2]
The aim of treatment is well-being and the changes you want, not the highest possible hormone level.[1]
How we care for you at Dr. Kris Clinic
As family physicians, we monitor both your hormones and your overall health in one place, in English or Thai. At each visit we ask about changes you are happy with or worried about, run only the tests due, check blood pressure, and talk about sleep, mood and screening.
We use your chosen name and pronouns and discuss organ-based screening respectfully. If you would like support with stress or relationships, Kris Care Space is also available.
Frequently asked questions
How often do I need blood tests?
Usually about every three months in the first year, then once or twice a year once stable, depending on regimen and risk.
Should my levels match a friend on the same regimen?
Not necessarily. People respond differently, and your doctor interprets results with your symptoms and goals.
Do I still need hormones after surgery?
If the testes or ovaries have been removed, hormones are usually continued to protect bone and general health, although the dose may change.
What else should be checked besides hormones?
Blood pressure, mental health, STI testing according to risk, and cancer screening based on the organs you have.
The aim of GAHT monitoring is well-being and the changes you want, not the highest hormone level.[1] Good follow-up covers hormones, side effects and the health of the whole person.
Talk to a doctor about this
Confidential care in Surat Thani, the mainland gateway to Koh Samui, Koh Phangan and Koh Tao. Tue–Fri 17:00–20:00 · Sat–Sun 10:00–15:00 (UTC+7)
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Dr. Krida Uakridathikarn (Dr. Kris)
Board-certified family physician with certificate training in clinical sexology and sexual medicine. He works at Suratthani Hospital and provides sexual health, hormone and LGBTQ+ inclusive care at Dr. Kris Clinic. Profile and CV
References
- WPATH Standards of Care, Version 8 (2022)
- Endocrine Society: Gender Dysphoria/Gender Incongruence (2017)
- CDC STI Guidelines: Screening Recommendations
- WHO: Gender incongruence and transgender health in ICD-11
Keep reading
Main guide: Gender-affirming care
Preparing for Gender-Affirming Hormone Therapy (GAHT)
Testosterone for Trans Men and Transmasculine People
Hormones for Trans Women and Transfeminine People: Safe Regimens and What to ExpectThis article is general education, not personal medical advice or a promise of results. Diagnosis and treatment require assessment by a doctor. Content reflects the cited sources as of the update date.