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This isn’t gatekeeping — it’s a safety check. Starting HRT without baseline labs is like driving blindfolded.

The following baseline tests are recommended by international guidelines^[1]^[2].

§ 1.1 Baseline Lab Work

The following tests should be completed before starting HRT. Most can be ordered through your primary care provider, an informed consent clinic, or services like Planned Parenthood:

§ 1.2 Absolute Contraindications

Crucial Red Line

Active thromboembolic disease (e.g., deep vein thrombosis, pulmonary embolism)
Confirmed or suspected hormone-sensitive malignancy (e.g., breast cancer, prostate cancer)
Severe hepatic or renal impairment in acute phase
Unexplained vaginal bleeding (for transmasculine individuals)
Known severe allergy to drug components

§ 1.3 Relative Contraindications

Medical Caution

Uncontrolled hypertension or cardiovascular disease
Poorly controlled diabetes mellitus
Tobacco use (especially age 35+, significantly increases VTE risk)
History of gallbladder disease
Migraine with aura (requires careful risk assessment)
Severe obesity (BMI > 30)

§ 1.4 Setting Realistic Expectations

HRT is not magic. Changes happen over months and years — don't expect overnight transformation.
Some changes are irreversible (e.g., breast growth, voice deepening, clitoral growth). Understand what you're signing up for.
HRT may reduce or permanently eliminate fertility. Consider gamete preservation (egg/sperm freezing) before starting.
Mood fluctuations are a normal side effect. Make sure you have a stable support system in place.