Gender-Affirming Hormone Therapy (GAHT): Starting Safely, Step by Step

Most people who come to talk to me about gender-affirming hormones aren't starting from zero. Many have taken pills a friend recommended, some have bought injections online, and some have used contraceptive pills for years without ever having a blood test. I don't blame anyone, because I know that finding understanding services isn't easy. But I want you to know that using hormones with a plan and someone monitoring you is both safer and more effective.

What is GAHT, and how does it help?

GAHT stands for gender-affirming hormone therapy: using hormones to bring physical characteristics in line with gender identity for transgender and gender-diverse (TGD) people.

• Feminising hormones use estradiol, combined with an anti-androgen for some people. See details in feminising hormone therapy (MTF).
• Masculinising hormones use testosterone. See masculinising hormone therapy (FTM).
• Non-binary people may use individually tailored doses or forms.

Many studies have found that GAHT is associated with less distress from gender incongruence, better quality of life, and fewer symptoms of depression or anxiety. The WPATH SOC-8 guidelines therefore classify it as medically necessary health care, not cosmetic treatment.

1. 1Assess togetherUnderstand expected effects, risks, and discuss having children
2. 2Exam + blood testsMedical history, smoking, clots, and baseline values
3. 3Choose a regimenIndividual, by goals, health and blood results
4. 4Long-term follow-upCheck desired effects, mood, side effects and blood tests

Based on WPATH SOC-8 (2022) for adults; prior psychotherapy is not required.

Step 1: Assessment and shared decision-making

For adults, the SOC-8 guidelines (2022) emphasise assessment by a knowledgeable health professional and do not require psychotherapy beforehand. What your doctor will talk with you about:

1. Your gender incongruence is clear and persistent.
2. You understand the expected effects, the irreversible effects and the risks well enough to give consent.
3. Any physical or mental health problems that might affect treatment are being cared for at the same time.
4. You have discussed fertility and the option of storing eggs or sperm before starting, because hormones can reduce fertility.

For people under 18, care is more complex and needs a multidisciplinary team with parents or guardians involved, so it should be provided at a specialist service.

Step 2: Physical examination and blood tests before starting

Before you start, your doctor will ask about medical conditions, medicines you take, smoking and any family history of blood clots, check your blood pressure and weight, and order basic blood tests such as a full blood count, liver and kidney function, lipids, glucose and baseline hormone levels. Details are in blood tests before starting gender-affirming hormones.

If you have sexual risk, it's a good opportunity to test for HIV and STIs at the same time and talk about PrEP.

Step 3: Choosing a regimen and form of medication

Doses differ from person to person; your doctor chooses based on your goals, health and blood results. For a comparison of forms, see trans women's hormone regimens: tablets, gels and injections.

Step 4: Long-term monitoring

In general, following the Endocrine Society and SOC-8 guidelines:

• In the first year, follow-up about every 3 months to review desired changes, mood, side effects and blood results.
• After that, every 6–12 months if everything is stable.
• Screening based on the organs you have: trans men who still have a cervix still need cervical cancer screening, and trans women still have a prostate.
• Bone health, especially for people who have had their testes or ovaries removed but use hormones irregularly.

1. Before starting
   Baseline blood tests

   Blood count, liver, kidney, lipids, glucose and baseline hormones

2. First year
   Follow up about every 3 months

   Adjust for changes, side effects and blood results

3. After year 1
   Every 6-12 months if stable

   Blood tests and an overall health review

4. 1-3 years
   Full effects seen

   The body changes at its own pace; higher doses don't speed it up

5. Lifelong
   Screen the organs you have

   E.g. cervix, prostate, and bone care

Per Endocrine Society and SOC-8 in general. Actual frequency depends on your doctor's assessment.

Risks to know, and warning signs

On the estrogen side, the main risk is blood clots, which is higher in people who smoke, are older, or take high-dose oral tablets. On the testosterone side, the most common problems are thickened blood, acne and hair thinning (see testosterone side effects in trans men).

Go to hospital immediately (call 1669, Thailand's medical emergency number) if you have:

• Swelling, pain or redness in one leg
• Chest pain, sudden breathlessness, or coughing up blood
• A sudden severe headache, weakness in an arm or leg, a drooping face or slurred speech
• Yellowing of the skin or eyes

Coverage in Thailand, and care at Dr. Kris Clinic

Since 2025–2026, Thailand's National Health Security Office (NHSO), which runs the universal coverage scheme for Thai citizens, has approved gender-affirming hormone services as a benefit at registered facilities for people aged 18 and over. Details may change; ask the NHSO hotline 1330 (Thai language). Visitors and expats are generally not covered by this scheme and would use private care or their own insurance.

At Dr. Kris Clinic, I provide GAHT from consultation and blood tests to individually planned regimens and long-term follow-up, for trans women, trans men and non-binary people, including those who have previously used hormones on their own and want to make things safer. Care is available at the clinic in Surat Thani and online, with English-speaking consultations. If you are planning surgery in the future, read assessment and letters before gender-affirming surgery.