Starting hormone therapy is an important part of the gender affirmation process for many trans people. In North Macedonia, it is possible — but often surrounded by bureaucratic barriers, uninformed doctors, financial costs, and a lack of sensitivity.

That’s why we’ve prepared this guide to help you navigate the system.

🔍 What Do You Need to Start Hormone Therapy?

To be prescribed hormone therapy, you will usually be asked for the following documents and tests:

🧠 Psychiatric report and opinion
– A professional assessment confirming the presence of gender dysphoria and that the person is psychologically ready for therapy.

🧪 Blood tests and biochemical analyses
– To check your general health condition.

🧬 Hormonal status
– Measuring levels of estrogen, testosterone, prolactin, and other hormones.

🧫 Karyotype (genetic confirmation)
– Chromosomal analysis (XX or XY), which some endocrinologists require before prescribing therapy.

✅ Basic Steps Toward Hormone Therapy

✅ Step 1: Consultation with a Psychologist or Psychiatrist

Why it’s important:
The first step usually involves a conversation with a psychiatrist (or psychologist experienced in gender issues). This session aims to confirm gender dysphoria and provide a professional opinion that you are ready to begin hormone therapy.

What to expect:

• A conversation about your gender identity, personal history, and expectations from therapy
• One or more sessions may be needed
• You’ll receive a written report/opinion to use when visiting your general practitioner (GP) and endocrinologist

✅ Step 2: Visit Your General Practitioner

Why it’s important:
Your GP connects you to all other medical services — they issue referrals for endocrinologists, laboratories, and other specialists.

What to expect:

• You’ll need to explain that you require hormone therapy
• Request referrals for specialists and laboratory tests
• You may encounter misunderstanding or discrimination. If your GP is not supportive, you have the right to change your GP.

💬 If you don’t know where to go:
Contact us — we can provide information about trans-friendly doctors who have experience working with trans people. You’re not alone — we’re here to help.

✅ Step 3: Specialist Examinations

Why they’re important:
Specialists will assess whether you are physically ready to begin hormone therapy.

Endocrinologist – the main doctor who prescribes and monitors the therapy.

What to expect:

• A medical examination and a discussion about risks, effects, and options
• The endocrinologist will usually require: a psychiatrist’s opinion, hormonal status, blood test results, and karyotype

✅ Step 4: Laboratory Tests

Why they’re important:
These tests determine your health condition and whether it’s safe to start therapy.

What to expect:

• Blood test and hormonal panel
• Karyotype (genetic test) – done once in a lifetime

✅ Step 5: Prescription of Hormone Therapy

Why it’s important:
Hormone therapy must be prescribed by a qualified medical professional — usually an endocrinologist — based on all previous test results.

What to expect:

• You’ll receive a prescription for hormone therapy (currently, only tablets are available in North Macedonia)
• You’ll get recommendations for dosage and monitoring frequency

✅ Step 6: Regular Checkups and Monitoring

Why they’re important:
Hormones have a strong effect on the body, so regular monitoring is essential to avoid health risks.

What to expect:

• Checkups every 3–6 months
• Repeat tests and therapy adjustments
• Monitoring of both physical and mental health

✅ (Optional) Social Transition

Why it’s important:
Alongside medical transition, many trans people find social affirmation in daily life equally meaningful.

What to expect:
Social transition (at school, work, or with family) is a personal and often challenging process — but you don’t have to go through it alone.

🤝 You’re Not Alone

This process can be challenging, but you don’t have to go through it by yourself. We’re here to help with information, support, and connections to doctors and the community.

📩 If you need guidance, information, or a space where you’ll be understood — write to us at:
transformamk@gmail.com

Or contact us through our social media:

1. Facebook
2. Instagram

Your health and dignity matter.