Hormone Readiness Assessments in BC and Beyond
Hormone Readiness Assessments
What this is
A hormone readiness assessment is a written letter from a mental health professional confirming that you are able to give informed consent to gender-affirming hormone therapy. Some prescribers and some surgical programs require one.
Many prescribers in BC do not. Hormone therapy is increasingly available through an informed consent model with a family doctor or nurse practitioner, with no mental health assessment involved. If nobody has told you that you need a letter, check with your prescriber before booking. You may not need this service.
We know that obtaining a Hormone Readiness Assessment can be a barrier for many trans people. We aim to make this experience supportive, helpful, and we will advocate for your needs.
What happens
Before our session, we will send you an intake form and a Release of Information form which will allow us to send your assessment to your provider after our session. You do not have to have a provider to get an assessment. We will provide you a copy regardless.
Everyone is different. If you are needing more support, your session may go longer. They typically last 50 to 90 minutes.
There are no wrong answers, we aim to advocate for the care you need. During the assessment, we may discuss:
- Your gender history and how you understand your identity
- What you are seeking from hormone therapy and what you expect it to change
- Your understanding of the effects — which are reversible, which are permanent, and the expected timeline
- Fertility and its implications, including options if that is relevant to you
- Your current health, including any conditions or medications
- Your mental health history and current supports
- Your social circumstances, including housing, income, and who knows about your transition
The purpose is to establish informed consent. You never need to justify your identity with us. There is no correct way to answer these questions, and uncertainty about some parts of transition does not disqualify you. We do not want to gatekeep – you have every right to receive gender affirming care! Our main goal is to provide you with support if there are aspects of your experience that you would like help navigating alongside whatever medical treatment you need. You always have the option of continuing individual therapy if you want ongoing support.
The letter
The letter is drafted within one week of the session. You review it before it goes anywhere. If something is inaccurate or you are uncomfortable with how something is described, tell us and we will change it.
The letter includes your counsellor’s credentials and registration number, confirmation that we met and when, a statement about your capacity to consent, and any specific language your prescriber requires. It goes directly to you and your prescriber or just to you if you do not have a prescriber yet.
We will also advocate that you receive the most accessible and cost-saving form of the medication you need. In the letter, we normally request that your doctor submit a special authority request so that you can receive testosterone or certain testosterone blockers (Cyproterone) at reduced or no cost. Estrogen and Spironolactone are normally covered by MSP.
Fees
$300 total. This is not covered by MSP. Many extended health plans cover counselling with a Registered Clinical Counsellor — check your plan for RCC coverage.
Our Hormone Readiness Assessment Counsellors
The Last Best Place Counselling is an online counselling clinic. We work with people who are physically located in British Columbia, Saskatchewan, Manitoba, Newfoundland and Labrador, Yukon, the Northwest Territories, or Nunavut, and who are looking for ethical, affirming, and supportive care.
We work with adults who are physically located in one of the regions we serve.
Our work centres queer, trans, and gender-diverse people. Many of the people we see are also navigating disability, neurodivergence, racism, migration, or other systemic pressures.
We do not currently work with children, and we are not a crisis or emergency service.
If this sounds like the kind of counselling you are looking for, we would love to hear from you. Not sure we are the right fit? Just ask!