Introduction:
Hormone therapy is a cornerstone of gender-affirming care, and regular blood tests are an important part of this process, helping to monitor hormone levels and adjust dosages accordingly. However, there might be circumstances where getting blood tests done is not feasible. This article explores how hormone therapy can be managed in the absence of regular blood monitoring, focusing on both feminising and masculinising hormone therapies.

Reasons for Inability to Access Blood Tests:

• Geographical Barriers: Individuals in remote or rural areas might not have easy access to healthcare facilities that can perform blood tests.
• Financial Constraints: The cost of blood tests can be prohibitive for some, especially in regions where healthcare is not universally funded.
• Healthcare System Limitations: Overburdened healthcare systems or those with limited resources may not be able to provide regular testing.
• Personal Circumstances: Factors such as mobility issues, chronic illnesses, or fear of needles can also limit an individual’s ability to undergo regular blood tests.

Risks of Proceeding Without Blood Tests:

• Unmonitored Hormone Levels: Without blood tests, it’s challenging to accurately gauge hormone levels, which can lead to ineffective dosing.
• Potential Health Risks: Some medications can impact liver function, lipid profiles, and other vital health markers. Without blood tests, these changes may go unnoticed.
• Increased Risk of Side Effects: Over- or under-dosing can lead to an increased risk of side effects so higher doses should not be prescribed without monitoring.
• Psychological Stress: The uncertainty regarding the effectiveness and safety of the hormone therapy can cause additional stress and anxiety.

Benefits of Continuing Therapy Without Tests:

• Psychological Well-being: Continuing hormone therapy can significantly improve mental health and quality of life for transgender individuals, reducing gender dysphoria.
• Physical Alignment: Hormones play a crucial role in aligning physical appearance with gender identity, which can be essential for the wellbeing of transgender individuals.
• Accessibility: In situations where blood tests are not feasible, continuing hormone therapy without them may be the only viable option for continuing gender affirmation.

Mitigating Risks:

• Clinical Monitoring: People can use patient-reported outcomes to monitor therapy progress.
• Standard Dosing Protocols: Using standard doses of hormones, as guided by clinical guidelines, can mitigate some risks associated with hormone treatments and blockers.

Feminising Hormone Therapy Without Blood Tests:
When blood tests are not accessible for those undergoing feminising hormone therapy, care providers may opt for a standard starting dose of estrogen. This approach typically involves:

• Standard Starting Dose: The equivalent of a 2mg estrogen tablet is recommended as this dosage aims to promote feminisation effects while avoiding potential risks.
• Blockers without Monitoring: In addition to estrogen, medications that don’t require monitoring, such as Finasteride or Gonadotropin-Releasing Hormone antagonists (GnRH), can be recommended. These medications help in reducing testosterone levels and enhancing the effects of estrogen.

Masculinising Hormone Therapy Without Blood Tests:
For those undergoing masculinising hormone therapy, a similar approach can be adopted:

• Standard Dose of Testosterone: A standard dose equivalent to 50mg of testosterone daily is a recommended dose. This dosage is designed to promote masculinising changes while being mindful of potential side effects.
• Optional Use of GnRHa: Depending on individual needs, GnRHa may be used alongside testosterone to suppress estrogen production..

Androgenising Therapy

For people wishing to androgenise their body, smaller dose of hormones can be safely used without monitoring, while monitoring progress in accordance with physical changes.

Pubertal Induction for Young People:
For young individuals who have not undergone puberty and are seeking pubertal induction:

• Titrating Dose: A gradually increasing dose is used to mimic the natural progression of puberty. The therapy starts with a low dose, gradually increasing to the standard adult dose by the tie the young person reaches 16.
• Monitoring Physical and Emotional Development: Close attention is paid to the progression of physical changes characteristic of puberty, as well as the emotional and psychological impact of the therapy.

Conclusion:
While regular blood tests are ideal in managing hormone therapy, there are protocols in place for those who cannot access such monitoring. It’s crucial to maintain open communication with healthcare providers, reporting any physical or emotional changes, and discussing any concerns that arise. Remember, the absence of blood tests doesn’t mean that hormone therapy has to be halted; rather, it requires a more individualised and clinically observant approach to ensure safe and effective treatment.