Duke Health provides gender-affirming hormone therapy to transgender and nonbinary people (ages 18 and older) who want gender-related characteristics -- such as breasts, beards, muscularity, and fat distribution -- to match the gender with which they identify. Our trained, compassionate specialists offer comprehensive consultations to help you understand if hormone therapy is right for you. We also connect you with specialists to address every aspect of your physical and mental health. We are dedicated to helping you achieve your goals.

What Is Gender-Affirming Hormone Therapy?

Gender-affirming hormone therapy can help anyone who feels uncomfortable with the physical aspects of their gender. It can be taken as pills, patches, gels, or by injection. Hormone therapy can be given alone or as preparation for gender-affirming surgery. We prescribe gender-affirming hormone therapy according to the World Professional Association for Transgender Health (WPATH ) Standards of Care; however, we also individualize regimens to help you reach your personal goals.

Male-to-Female Transition
Feminizing hormone therapy includes estrogen to promote feminine characteristics and anti-androgens to block the production and effects of testosterone. The goal of therapy is to attain a more feminine appearance, including breasts, softer skin, and rounder, wider hips.

Female-to-Male Transition
Masculinizing hormone therapy uses testosterone to achieve more masculine characteristics. These include a deeper voice, a more muscular appearance, and more facial and body hair. It also stops menstrual cycles.

Gender Fluid
Hormone therapy may also be taken in small doses by individuals who don’t identify as either male or female. It can result in a more androgynous or more feminine appearance that is somewhere between both genders.

Medical Supervision Is Needed
It is important to work with a gender care specialist if you are interested in this therapy because it can cause weight gain, acne, mood changes, and increased risks of serious medical conditions, such as heart disease, blood clots, and diabetes. Hormone therapy can be a lifelong commitment. Our transgender specialists work closely with you to minimize the side effects of hormone therapy and connect you with specialists who may also be part of your care. This ensures you have a positive, healthy experience.

In the First Year

During your initial consultation, your doctor will conduct a medical history, review the risks and benefits of gender-affirming hormone therapy, and set expectations for your treatment goals. Lab work will also be performed.

Injection Education
If your therapy includes injections, our pharmacist will teach you how to perform self-injections safely and effectively.

Follow-Up Visits
During the first year of therapy, you will attend follow-up appointments about every three months so we can monitor your treatment. This will ensure your provider can identify possible complications and adjust your therapy as needed. Lab tests may be performed.

Call for an Appointment

We Are Partners in Your Care

Long-Term Follow-Up
Taking hormone therapy is a lifelong commitment to maintain the changes you seek. While your follow-up visits will be less frequent after the first year, you will need to maintain a regular schedule of appointments.

Insurance Coverage
Gender-affirming hormone therapy is typically covered by insurance. Check with your health plan to confirm how and if it is a covered treatment. If needed, your provider can provide written authorization before starting treatment.

Participate in Research to Help Future Generations
Because gender-affirming hormone therapy is a relatively new treatment, research is needed to study its long-term effects. As a Duke patient, you can choose to participate anonymously in research that is studying the long-term risks of hormone-affirming therapy. The information, which is collected anonymously, will help doctors better understand how to treat future generations safely and effectively with hormone therapy.

LGBTQ+ Equality Leader

Duke University Hospital, Duke Regional Hospital, and Duke Raleigh Hospital are recognized as LGBTQ+ Healthcare Equality Leaders by the Human Rights Campaign Foundation. This recognition is evidence of our commitment to eliminate discrimination and promote equality and standing with the lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) community in all aspects of care.

Additional Services

Our gender medicine specialists can direct you to additional transgender care throughout Duke. This may include:

Our social workers can help you access community resources and get connected to mental and behavioral health care. They also run a support group for patients ages 40 and older.

This page was medically reviewed on 03/25/2022 by