Arrow Health provides gender affirming hormone therapy for trans men and trans women — personalized protocols, affirming providers, and the clinical expertise to help you become fully yourself.
Arrow Health uses an informed consent model for gender affirming hormone therapy. We believe you are the expert on your own identity. Our providers are here to partner with you medically — not to evaluate whether you deserve care.
You don't need a therapist's letter. You need a provider who listens and acts.
Every Arrow Health patient receives a comprehensive consultation, a full hormone panel, and a protocol built around their goals — whether that's full feminizing or masculinizing effect, or a more individualized approach for non-binary patients.
Book a ConsultationTestosterone drives the physical and emotional changes that help trans men and transmasculine individuals align their body with their identity — building the masculine features that reflect who you are.
Explore Trans Men's CareFeminizing hormone therapy combines estrogen with anti-androgen medications to reduce testosterone's effects and allow estrogen to gradually feminize the body on your timeline.
Explore Trans Women's CareTestosterone therapy raises levels to typical male ranges while suppressing estrogen — driving gradual, ongoing masculinization that brings your physical self into alignment with who you are. Arrow Health offers testosterone as injections (IM or subcutaneous) or topical gel.
Injected weekly or bi-weekly for consistent, controllable levels. The most common and cost-effective delivery.
Applied daily — a needle-free option delivering steady testosterone absorption through the skin.
Testosterone naturally suppresses estrogen. Some patients also use progesterone to halt menstruation sooner.
Physical Changes Over Time
Begins within 3–6 months. One of the most significant and valued changes for most trans men.
Enlargement (bottom growth) typically begins within the first few months of testosterone.
Fat shifts from hips and thighs toward the abdomen over 6–12 months.
Develops over 1–5 years. Pattern depends heavily on genetics and family history.
Most trans men stop menstruating within 3–6 months of starting testosterone.
Once voice deepens and facial hair grows in, these changes remain even if therapy stops.
ⓘ Note: Some changes associated with testosterone therapy may be irreversible. Please discuss the full scope of expected changes with your Provider before beginning treatment.
Feminizing therapy combines estrogen with anti-androgen medications. Estrogen drives feminizing changes while anti-androgens block testosterone — allowing feminization to proceed fully on your timeline. Arrow Health offers patches, gels, injections, and sublingual options.
The primary feminizing hormone — available as patches, gels, injections (valerate or cypionate), or sublingual tablets.
The most common US anti-androgen — blocks testosterone receptors and reduces testosterone production.
Bioidentical progesterone may enhance breast development, improve mood, and support sleep in some patients.
Physical Changes Over Time
Typically begins within 3 months. Final size develops over 2–3 years, shaped by genetics.
Skin becomes softer, smoother, and less oily within 3–6 months of starting estrogen.
Fat redistributes to hips, thighs, and buttocks — a more feminine silhouette over 6–24 months.
Body and facial hair grows more slowly and softens over time with estrogen therapy.
Spontaneous erections decrease and libido shifts as testosterone is suppressed by therapy.
Breast development is permanent even if therapy is stopped. Other changes may partially reverse.
ⓘ Note: Some changes associated with estrogen therapy may be irreversible. Please discuss the full scope of expected changes with your Provider before beginning treatment.
Your first visit is $100. Meet your Provider, discuss your goals and health history — no gatekeeping, no judgment, no letters required.
A comprehensive hormone panel through Quest Diagnostics before starting any protocol. Labs are $25–$50.
Your Provider designs your personalized protocol — hormones, delivery method, dosing — based on your labs, goals, and health profile.
Follow-up HOT visits ($150) and labs every 3–6 months keep your levels optimized and your protocol evolving with you.
Gender affirming hormone therapy is safe for the vast majority of trans and non-binary individuals when properly monitored. Understanding the risks empowers you to make fully informed decisions alongside your Provider.
Testosterone increases red blood cell production. Elevated hematocrit raises clotting risk and requires regular CBC monitoring. Managed through dose adjustment or therapeutic phlebotomy when needed.
Testosterone suppresses ovulation but is not guaranteed contraception. If preserving fertility matters to you, we strongly recommend discussing egg freezing before starting therapy.
Increased oiliness and acne are common, especially in the first year. Usually manageable with topical treatments and improves as your body adjusts to stable testosterone levels.
Low estrogen from testosterone can cause vaginal dryness and discomfort. Topical estrogen (which doesn't affect masculinization) or lubricants effectively address this.
Testosterone can affect cholesterol and blood pressure. Routine cardiovascular monitoring is standard. Most trans men on testosterone maintain good cardiovascular health with proper care.
Testosterone can accelerate male-pattern baldness in those genetically predisposed. This may be a welcomed change — or something to discuss managing with your provider.
Oral estrogen carries a small elevated risk of venous thromboembolism. Transdermal estrogen and injections have a significantly lower risk — which is why Arrow Health prefers non-oral delivery for most patients.
Estrogen and anti-androgens significantly reduce or eliminate sperm production — often permanently. If biological parenthood is a future goal, sperm banking before starting therapy is strongly encouraged.
Spironolactone can cause increased urination, dizziness, and elevated potassium. Regular potassium and electrolyte monitoring is required throughout treatment.
High-dose estrogen and certain anti-androgens affect lipid profiles. We monitor lipids, blood pressure, and glucose at regular intervals to keep cardiovascular health in check.
Estrogen can raise prolactin levels over time. Very rarely this leads to a benign pituitary adenoma. We monitor prolactin annually as a standard safety measure.
Trans women on long-term estrogen have a breast cancer risk above cisgender men but below cisgender women. Regular screening is recommended after 5–10 years of therapy.
Important: This information is educational and does not replace a clinical consultation. All Arrow Health protocols are managed by licensed Nurse Practitioners following WPATH Standards of Care v8, UCSF Transgender Care Guidelines, and Endocrine Society guidelines.
No therapist letters required. We believe you understand your own identity. Our role is to provide expert medical care — not to gatekeep your access to it.
Your chosen name and pronouns are used in every interaction — appointments, records, and all communications. Always. No exceptions.
Every Arrow Health provider has specific training in gender affirming care and follows current WPATH v8 and Endocrine Society guidelines.
All patient information is HIPAA-protected. We never share your information beyond what's required for your care. Your privacy is non-negotiable.
We provide individualized care for non-binary and genderqueer patients who may want partial or non-standard hormone protocols tailored to their specific goals.
All consultations and follow-ups are available via telehealth — removing geographic barriers and keeping affirming care accessible wherever you live.
We target male physiological ranges (400–900 ng/dL) and adjust dosing based on your response and goals, not just a number on paper.
We target premenopausal female ranges (100–200 pg/mL) and adjust based on feminization progress and symptom response over time.
Complete blood count monitors red blood cell production. We keep hematocrit below 52% to safely manage polycythemia risk.
Required when taking spironolactone, which affects potassium balance. Monitored at every lab draw to prevent hyperkalemia.
Hormone therapy can affect cholesterol and triglycerides. We monitor cardiovascular risk markers at baseline and annually.
Certain hormone preparations are processed by the liver. LFTs are checked at baseline and periodically to confirm healthy liver function.