Gender-affirming hormone therapy (GAHT) using testosterone is a medical treatment sought by many transmasculine individuals, including transgender men (FTM), to align physical characteristics with their gender identity. Masculinizing hormone therapy involves introducing external testosterone to suppress natal hormones and induce secondary sex characteristics, such as a deeper voice and facial hair growth. Because testosterone is a controlled substance regulated by federal and state laws, access requires a formal prescription from a licensed healthcare professional. Understanding which providers are authorized to prescribe is the first step in starting this process.
Licensed Healthcare Professionals Who Prescribe
The authority to prescribe testosterone rests with licensed medical professionals who possess prescriptive rights. The most common prescribers include Medical Doctors (MDs) and Doctors of Osteopathic Medicine (DOs), who hold the broadest scope of practice. These physicians are fully authorized to prescribe controlled substances, including the Schedule III anabolic steroid, testosterone.
Advanced practice clinicians, such as Nurse Practitioners (NPs) and Physician Assistants (PAs), also serve as major access points for gender-affirming care, frequently managing hormone therapy in primary care and specialized gender health clinics. Their ability to prescribe controlled substances like testosterone varies significantly depending on state-specific regulations.
In states granting full practice authority, NPs and PAs can prescribe independently, often without physician oversight. Other states may enforce restricted or reduced practice, requiring a collaborative agreement with a supervising physician before they can issue prescriptions for controlled substances. Regardless of their specific license, any prescribing provider must register with the Drug Enforcement Administration (DEA) to legally dispense a Schedule III medication such as testosterone.
The Informed Consent Model Versus Traditional Care
Testosterone therapy initiation often follows one of two procedural models, reflecting different philosophies of patient autonomy. The Informed Consent model is the most common and accessible pathway for adults seeking gender-affirming hormones. In this approach, the patient meets directly with the prescribing provider, who thoroughly explains the risks, benefits, and alternatives of testosterone therapy, including its permanent and reversible effects.
The patient confirms their understanding and capacity to consent, and if the provider determines the treatment is appropriate, the prescription can be initiated without delay. This streamlined process focuses on patient self-determination and removes the requirement for external validation of gender identity. The Informed Consent model operates on the premise that an adult capable of understanding the medical implications is the primary decision-maker.
This modern approach contrasts with the older, Traditional model associated with earlier versions of the World Professional Association for Transgender Health (WPATH) Standards of Care. The Traditional model historically required a letter of readiness or a formal psychological assessment from a mental health professional before starting hormone therapy. This requirement was intended to ensure a diagnosis of gender dysphoria and confirm the patient’s psychological stability and readiness for irreversible physical changes.
While the WPATH Standards of Care now recognize the validity of the Informed Consent model, the Traditional pathway is still sometimes used by individual providers or required by certain insurance policies. The key distinction is that the older model inserts a mental health professional as a gatekeeper, whereas the Informed Consent model places the decision-making authority and responsibility primarily with the patient and the prescribing medical provider.
Specialized Settings and Provider Roles
The specialty or location of the prescribing provider often influences access to testosterone therapy. Many individuals find care through their Primary Care Physicians (PCPs), who are increasingly comfortable managing GAHT as part of routine health maintenance. PCPs offer comprehensive, long-term care, integrating GAHT with preventative health screenings and management of other medical conditions.
For complex cases or those with pre-existing conditions like endocrine disorders, specialists such as Endocrinologists may be involved, offering deeper expertise in hormone management and monitoring. A growing number of transmasculine people also access care through specialized LGBTQ+ Health Clinics and Community Health Centers. These settings often operate on an Informed Consent basis and are designed to be affirming and knowledgeable about gender-specific healthcare needs.
Telemedicine and Virtual Care
Telemedicine significantly expands access to prescriptions, especially for those in rural areas or places with few experienced providers. The ability to prescribe testosterone virtually is governed by federal regulation because it is a Schedule III controlled substance. Historically, the Ryan Haight Act required an in-person evaluation before a controlled substance could be prescribed.
During the COVID-19 public health emergency, the Drug Enforcement Administration (DEA) temporarily waived this requirement, allowing providers to prescribe testosterone via telehealth. These flexibilities have been repeatedly extended, demonstrating the importance of virtual access to care. As of late 2024, these temporary extensions remain in place, but future regulations may reintroduce an in-person visit requirement for the initial prescription.
Required Steps Before Starting Testosterone Therapy
Regardless of the model of care, certain medical steps are mandated to ensure patient safety before starting testosterone therapy. The process begins with a comprehensive baseline physical examination to assess overall health and identify any pre-existing conditions that might affect treatment. This is followed by a thorough discussion of expected effects, including permanent changes like voice deepening and clitoral enlargement, and the associated risks.
The provider will order comprehensive bloodwork, which serves as a crucial safety check and baseline for future monitoring. This typically includes:
- A lipid panel.
- Liver function tests.
- A complete blood count, which helps monitor for potential side effects such as erythrocytosis (an increase in red blood cells).
- Baseline levels of sex hormones, including testosterone and estradiol, to guide the initial dosing strategy.
After the initial prescription, the patient is scheduled for follow-up visits, usually within the first three months, to monitor physical changes and manage potential side effects. Repeat bloodwork is performed at these visits to ensure testosterone levels are within the target male physiological range (typically 300 to 1000 ng/dL). This monitoring ensures the therapy is safe, effective, and aligned with the patient’s goals.