What are the best steps to ensure continuity of hormone therapy for transgender patients if their current healthcare provider is unable to continue their care?

Ensuring Continuity of Hormone Therapy During Provider Transition

You must immediately provide your transgender patients with sufficient hormone prescriptions to bridge them to their next provider, ideally 3-6 months of refills, and expedite warm handoffs to qualified providers who can continue their gender-affirming hormone therapy without interruption. 1

Immediate Actions to Prevent Treatment Interruption

Bridge Prescriptions Are Critical

• Provide 3-6 months of hormone refills immediately to prevent any gap in therapy while patients establish care elsewhere 2, 3
• The National Commission on Correctional Health Care explicitly states that transgender patients who received hormone therapy before any transition in care should have therapy continued without interruption 1
• Abrupt discontinuation of gender-affirming hormone therapy significantly worsens gender dysphoria, depression, and anxiety, which can be life-threatening given the elevated suicide risk in this population 1, 4

Specific Prescriptions to Write Now

For transgender women on feminizing therapy:

• Continue current estradiol regimen (oral, transdermal, or injectable) at established doses 2
• Continue anti-androgens (spironolactone, cyproterone acetate, or GnRH agonists) at current doses 2
• Provide 3-6 months of refills for all medications 2

For transgender men on masculinizing therapy:

• Continue testosterone cypionate or enanthate at established doses (targeting 300-1,000 ng/dL) 3
• Provide sufficient vials/prescriptions for 3-6 months 3
• For patients with needle phobia on transdermal gel, continue current formulation 3

Referral Strategy and Warm Handoffs

Identify Appropriate Providers

• Contact local LGBTQ health centers, university medical centers, or Planned Parenthood clinics that provide gender-affirming care 5, 6
• Approximately 50% of primary care providers are willing to continue hormone therapy for transgender patients, so multiple referral options may be needed 6
• Prioritize providers with documented experience in transgender medicine to avoid further delays 6

Execute Warm Handoffs

• Call the receiving provider directly to facilitate immediate appointment scheduling 5
• Transfer complete medical records including current hormone regimens, dosing history, and recent lab values (testosterone, estradiol, CBC, liver function, lipids) 2, 3
• Document that hormone therapy is medically necessary and should not be interrupted 1, 7

Critical Clinical Context to Communicate

Mental Health Implications

• Gender-affirming hormone therapy reduces depression by 20% and significantly improves quality of life in transgender individuals 1, 4
• Hormone therapy has no adverse mental health outcomes and is considered medically necessary for many transgender people 1, 4, 7
• Interruption of therapy can precipitate severe psychological distress, including increased suicidality 1, 4

Medical Safety of Continuation

• Both feminizing and masculinizing hormone regimens are safe when used within established protocols 8, 7, 9
• Continuing established therapy poses minimal risk compared to the significant harm of interruption 1, 7
• Recent literature demonstrates that concerns about hormone therapy have been overly cautious, and the data are largely reassuring 9

Common Pitfalls to Avoid

Do Not Taper or Discontinue Hormones

• There is no medical indication to taper or stop established hormone therapy during provider transitions 1
• Abrupt cessation causes rapid reversal of physical changes and severe psychological distress 1, 4

Do Not Require Psychiatric Clearance for Continuation

• Continuing established therapy does not require new psychiatric evaluation 7
• The receiving provider can address any monitoring or adjustment needs 2, 3

Recognize the Consequences of Inadequate Access

• 49% of transgender women report using non-prescribed hormones when unable to access healthcare 5
• Non-prescribed hormone use is associated with safety risks and inconsistent dosing 5
• Your bridge prescriptions prevent patients from resorting to unregulated sources 5

Documentation for Receiving Provider

Include in transfer records:

• Current hormone regimen with specific doses and formulations 2, 3
• Most recent hormone levels (testosterone, estradiol) and dates 2, 3
• Recent monitoring labs: CBC, liver function, lipid profile, glucose 2, 3
• Duration of therapy and any adverse effects experienced 2, 3
• Statement that therapy is medically necessary and should continue without interruption 1, 7