Testosterone therapy for female-to-male (FTM) individuals, often termed masculinizing hormone therapy, is a medical process intended to induce physical changes that align with a masculine gender identity. Accessing this treatment requires a prescription because testosterone is classified as a Schedule III controlled substance by the Drug Enforcement Administration (DEA). This designation means the medication has accepted medical use but also carries a potential for dependence or misuse. Understanding the healthcare professionals and pathways authorized to prescribe this therapy is the first step toward access.
Licensed Medical Professionals Who Prescribe
The authority to prescribe testosterone rests with licensed healthcare providers who possess the necessary DEA registration. The highest level of prescriptive authority is held by Medical Doctors (MD) and Doctors of Osteopathic Medicine (DO), who can prescribe all controlled substances. Physicians specializing in family medicine, internal medicine, or endocrinology are frequently the prescribers of choice for gender-affirming hormone therapy.
A growing number of prescriptions are written by Advanced Practice Providers, including Nurse Practitioners (NP) and Physician Assistants (PA). These professionals operate under varying degrees of autonomy depending on state laws. Some states grant full practice authority to NPs, allowing them to prescribe independently, including controlled substances.
In other states, NPs and PAs may have reduced practice, requiring a collaborative agreement or physician supervision for prescribing controlled substances. NPs and PAs are increasingly trained in gender-affirming care and often serve as primary prescribers in specialized clinics.
The Informed Consent Model of Care
Many FTM individuals utilize the Informed Consent (IC) model to streamline access to hormone therapy. This model shifts away from traditional methods that mandated a referral letter from a mental health professional certifying gender dysphoria. Under the IC model, the medical provider ensures the patient has the capacity to make an autonomous decision about their care.
The core of informed consent is a thorough conversation where the patient demonstrates a clear understanding of the treatment’s full scope. This includes the expected physical changes, both reversible and irreversible, the potential health risks, and the alternatives to hormone therapy. Once the patient demonstrates this comprehension and signs the required legal documentation, the clinician can initiate treatment, removing the requirement for psychological gatekeeping.
The IC model is recognized by major professional organizations and emphasizes the patient as the primary decision-maker regarding their medical transition. This patient-centered approach aims to reduce the barriers and lengthy wait times often associated with older, more restrictive models of care. The process focuses on medical readiness and the patient’s demonstrated capacity for consent, rather than requiring external validation of their gender identity.
Clinical Settings for Hormone Therapy Access
Prescribers who follow the informed consent model are often found in healthcare facilities dedicated to gender-affirming care. Specialized LGBTQ+ health centers and dedicated gender clinics were early adopters of the IC model and remain common access points. These facilities have providers who focus solely on this area, offering high levels of expertise and a culturally competent environment.
Primary Care Providers (PCPs) are also emerging as a major resource for initiating and managing FTM hormone therapy. Since gender-affirming care is increasingly viewed as a component of comprehensive primary care, many PCPs are obtaining specialized training to offer this service directly in their offices. This integration helps normalize hormone therapy and makes ongoing monitoring more convenient for the patient.
Telehealth has revolutionized access, particularly for individuals in rural areas or those facing transportation challenges. Virtual-only clinics allow patients to consult with a licensed prescriber, complete the informed consent process, and receive a prescription remotely. While initial physical exams and lab work may still require an in-person visit, virtual appointments for follow-ups have made care significantly more accessible.
Initial Requirements Before Receiving a Prescription
Before a prescription is issued, the healthcare provider must conduct a comprehensive medical evaluation to ensure patient safety. This begins with a thorough physical examination and a detailed review of the patient’s medical history to identify existing health conditions that could be complicated by testosterone use.
Baseline laboratory testing is mandatory to establish initial health metrics and screen for contraindications. This typically includes a complete blood count (CBC) to check for polycythemia, a condition where red blood cell count increases, and a comprehensive metabolic panel to assess liver and kidney function. Cholesterol and lipid panels are also commonly ordered, as testosterone therapy can influence cardiovascular risk factors.
The purpose of these initial requirements is to create a safe treatment plan and determine the appropriate starting dose. The provider also screens for potential interactions with other medications and discusses reproductive health, including the effects of testosterone on fertility.