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Balancing Safety and Accessibility: The Case for Three-Month Prescriptions of Testosterone for Gender-Affirming Care


In recent years, the conversation around the prescription of controlled drugs, including testosterone for gender-affirming care, has gained significant attention. Testosterone is a controlled substance due to its potential for misuse in body-building, but is crucial for many individuals undergoing gender transition. Some discussion centres on the appropriate length of prescription for individuals with a genuine clinical need for testosterone medication, with a growing consensus supporting three-month supplies. This article delves into the reasoning behind this, emphasising the clinical necessity and the safety of such a practice.

The Clinical Need for Testosterone in Gender-Affirming Care:

Testosterone plays a pivotal role in gender-affirming therapy for transgender men and some non-binary individuals. It aids in aligning their physical characteristics with their gender identity, which can significantly improve mental health and quality of life. The World Professional Association for Transgender Health (WPATH) and the Endocrine Society underscore the importance of testosterone hormone therapy as a part of gender-affirming care, recognising it as not elective or cosmetic, but essential for many transgender individuals.

Prescribing Limits for Controlled Drugs:

Traditionally, controlled drugs, including testosterone, have been subject to varying prescribing limits to prevent abuse and diversion. These restrictions often include shorter prescription durations, rigorous monitoring, and frequent medical visits. While these measures are crucial for certain controlled medications, applying them uniformly to testosterone for gender-affirming care is unnecessarily burdensome for patients and healthcare providers.

Three-Month Supply: Balancing Accessibility and Safety:

The most important endpoint strikes a balance between ensuring patient safety and improving accessibility. Longer prescription periods can reduce the logistical and financial burden on patients, who otherwise need to make more frequent visits to healthcare providers. It also acknowledges the ongoing, chronic nature of gender-affirming hormone therapy.

Addressing Safety Concerns:

Concerns about patient safety, particularly the risks of overuse or diversion, are paramount when discussing any adjustment in prescription practices for controlled substances. However, when testosterone is used as part of supervised gender-affirming care, the risk of misuse is minimal. The therapeutic use of testosterone in this context is highly regulated, involving regular monitoring and follow-up by healthcare professionals, ensuring that it is used safely and effectively.


Offering three-month prescriptions of testosterone for individuals undergoing gender-affirming care is a rational approach that recognises the genuine clinical needs of this population. It is a policy that prioritises patient wellbeing, ensuring continued access to essential medication while maintaining safety protocols to prevent misuse. As society progresses towards greater understanding and acceptance of transgender health needs, healthcare policies must evolve accordingly, offering compassionate, practical, and safe medical care.

Updated on January 23, 2024

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