Gender Affirming Hormone Care

Planned Parenthood Columbia Willamette uses an informed consent model. This means we do not require a mental health assessment or a referral from another doctor before scheduling a visit. At your first visit, you will meet with a provider to go over your health history and to discuss your hormone care options. We are able to prescribe hormones after that first visit for most patients.

Most initial appointments are about an hour and a half, and you’ll have shorter follow-up appointments every 3 to 9 months, depending on your individual plan with your provider.

If you plan to use your insurance to cover your care, or change your insurance, we advise you to check with your insurance provider to confirm that your plan covers the care you’ll receive. If you do not have insurance or cannot use your insurance for your care, we offer payment plans and discounts to make your care more affordable. For more information about insurances, costs or discounts, please call us at 1-888-875-7820

Why do folks on hormones need to have labs drawn?

Checking labs helps us to optimize hormone regimens and ensure safety. Checking hormone levels also helps to guide dosing changes in line with an individual’s embodiment goals. 

Specifically, by medication, these are some of the labs we follow:

• Spironolactone: Spironolactone should only be used by people with normal kidney function, and in rare cases people taking it can develop high potassium levels. Use requires monitoring of kidney function (creatinine) and potassium levels. 
• Hemoglobin, hematocrit: Testosterone can increase red blood cell counts; when red blood cell counts are very high, there could be an increased risk of blood clots. Use requires monitoring of red blood cell count levels (hemoglobin, hematocrit).
• Estradiol: For people taking estradiol (estrogen), we follow estradiol levels; for most individuals 100–200 pg/mL is an appropriate estradiol level for hormone therapy. We do not follow estriol or estrone levels.
• Testosterone: For people taking testosterone, we follow testosterone levels; for most individuals 320–900 ng/dL is an appropriate level for hormone therapy. At higher levels, extra testosterone is converted by the body into estradiol. For people using medications to block testosterone production, the goal testosterone level is typically less than 55 ng/dL.
• Additional labs such as an A1C (diabetes screening), lipid panel (cholesterol screening), or liver function testing may be recommended.

When should I have labs drawn?

Labs work is usually done more frequently in the first year of hormone therapy and less frequently as time passes. You can expect labs every three months when starting hormones; some health conditions and circumstances require more frequent bloodwork.

How should my lab draws be timed?

After your initial baseline lab tests, we recommend that you use your medications consistently for at least 4–6 weeks before having hormone levels drawn. Your clinician will make a recommendation for when your next lab testing should be performed based on whether you are starting on a new regimen, making adjustments, or maintaining a stable regimen.

For folks using hormone injections, labs should be drawn approximately halfway between injections; if you desire to have labs drawn at your in-person Planned Parenthood appointment, please consider the timing of your injections when booking your appointment.

How will I get my results?

After having your labs done, unless there is an abnormal result, we will not be contacting you with lab results. But, if desired, you can view your own results on your MyChart portal.

Choosing the route of hormone therapy that is right for you. Learn about the various methods used in Estrogen-based and Testosterone-based hormone therapies, ranging from injections to pills or even patches, that can be found here.

We put together a chart that breaks down effects of estrogen-based hormone therapy

We put together a chart that breaks down effects of testosterone-based hormone therapy.

If you are prescribed hormones at your visit, you will fill your prescription at a pharmacy of your choice and administer the prescription at home.

Special considerations for testosterone

Testosterone is a controlled substance. Based on current law, clinicians must rewrite testosterone prescriptions every 6 months. While individuals on stable testosterone regimens usually only require clinic visits and labs annually, a clinician is required to electronically resend your prescription for testosterone every 6 months when you are on a stable regimen.

*Please note that testosterone is undergoing changes with the ending of the PHE. It is also possible that a person will need an in-person visit to get a testosterone prescription.

Injectable medications

We will provide prescriptions for needles and syringes with injectable medications. For those who use syringes and needles, please ensure the needle length, gauge, and syringe volume are accurate for you prior to leaving the pharmacy. The pharmacist will be the most helpful person in resolving any issues with this. If you are prescribed two different needle sizes for one syringe, it is important that you are able to attach and detach each of the needles to the syringe.

If you are having trouble finding your needles or syringes in stock at a pharmacy, please be aware that syringes and needles can also be purchased over the counter at suppliers like Amazon, Bulk Syringes, or cost-free from the non-profit Trans Needle Exchange. If you do intramuscular (IM) injections, look for a 23–25g needle that is 1 inch in length; if you do subcutaneous (SubQ) injections, look for a 23–25g needle that is 5/8 inch in length. The length of the needle you use to draw does not matter if you switch it out for one of the above, but generally a 18–20g works best to draw out medications with less resistance. Sharps disposal bins can also be purchased at the pharmacy, or sharps can be disposed of in hard plastic containers (like a laundry detergent container) labeled “Sharps” with a sealed and taped lid.

Prescription directions

Gel and injection medication prescriptions may be written to reflect a range of dosing (i.e., inject 50–100mg into the muscle each week as directed) to ease the process of dose adjustments. If your prescription is written in this way, please use the dose recommended by the clinician and speak with a clinician before making adjustments.

Prescription lengths and refills

Our clinicians typically send 3-month prescriptions with or without refills to your pharmacy. It is important to keep track of when your lab draws are due. Depending on your medical situation (the labs you have previously had, and the medications you are on), clinicians may or may not be able to provide refills when labs are overdue. Most people who have been on hormones for a year and are on a stable regimen will require annual labs. 

Changing pharmacies

You can update your pharmacy in our system using your MyChart portal or at your next appointment. 

How can I get a refill and how to transfer my medication?

The best way to get a refill is by calling the call center (503-788-7273) or sending a MyChart message when you have about 1 month of medications left.

You can call your pharmacy to transfer existing prescriptions to a new pharmacy with the exception of testosterone. Because testosterone is a controlled substance, we will need to resend testosterone prescriptions to your new pharmacy.

Learn how to properly perform an intramuscular (IM) or subcutaneous (SQ) self injection through these informative videos created by our friends at Planned Parenthood of Greater Texas.

Intramuscular Injection (English)
Subcutaneous Injection (English)

Inyección Intramuscular (Español)
Inyección subcutánea (Español)

Our friends at Planned Parenthood of Michigan give real information about gender affirming care and bust some common myths

• We are excited to be a part of your healthcare! Here are some things we’d like to share with you before your visit:
  • Planned Parenthood Columbia Willamette is not contracted with all healthcare plans
  • We encourage our patients to reach out to their insurance by calling the number on the back of their insurance card to ask about coverage.  

For your initial extended appointment we run a benefit check. This does not guarantee full coverage. If required, we will submit a prior authorization¹. It is important to call us with your insurance information before your appointment: 503-788-7273. We can also discuss possible funding and payment plan options with you

_{1. ‘Prior Authorization’ is when your insurance company requires your doctor to be granted permission before your plan will cover the care or medicine you receive. It can take up to two weeks to receive an approval or denial of coverage. If your insurer denies coverage for your care you have options, including advocacy and making appeals. PPCW may be able to help you appeal denials. Also, if you are denied coverage you may pay out of pocket for your visit and for your medications. The Good Rx coupon can help reduce the costs of medications: www.goodrx.com}

*If you are concerned about medical costs, we encourage you to bring this up before your visit by calling 503-788-7273 or at your visit when you are making a plan; we can talk about different resources that may be available.

Learn more about Paying For Your Visit.