Tracking gender-affirming HRT: what to log and why

The guidance this sits under

Gender-affirming hormone therapy is not menopause care and is not governed by menopause guidance. The two frameworks most commonly referenced are the WPATH Standards of Care, version 8, published in 2022, and the Endocrine Society clinical practice guideline on endocrine treatment of gender-dysphoric and gender-incongruent people. Many services also work from the UCSF Gender Affirming Health Program guidelines.

All three describe assessment, informed consent, and periodic clinical and laboratory monitoring during therapy. They exist because the therapy is long-term and because monitoring is individual — which is exactly why this page describes what is worth recording rather than what to take or how often to be tested. Those are decisions for the clinician working with you, and the guidance itself frames them that way.

Feminizing therapy: what changes slowly enough to need a record

Feminizing regimens typically involve estradiol, delivered by patch, gel, spray, oral or sublingual tablet, or injection. Many regimens also include an antiandrogen — spironolactone, cyproterone acetate or bicalutamide are all used in different health systems — or a GnRH analogue. Which combination, and in what form, varies enormously between countries and services.

The changes themselves develop over months to years, and published guidance gives expected onset and maximum-effect ranges rather than fixed timelines. That gap between expectation and experience is where a record earns its keep, because the honest answer to "is anything happening?" at month five is usually unavailable from memory.

Worth recording, on a fixed short scale, monthly rather than daily:

• Breast development and tenderness. Tenderness and change often move separately, and tenderness in particular tends to fluctuate.
• Skin and body-hair changes. Slow, and easy to misjudge without a baseline.
• Body-fat redistribution. Measurements taken consistently are far more informative than impressions; photographs at fixed intervals are the other common approach.
• Mood and energy. Both commonly reported as changing, in both directions, particularly early on and after any regimen change.
• Libido and sexual function changes. Frequently affected, frequently not raised in appointments.
• Anything you were told to watch for. Antiandrogens differ in their monitoring considerations, and your prescriber will have named what matters for the one you are on.

Masculinizing therapy: the same principle, different fields

Masculinizing regimens involve testosterone, most commonly by injection or gel. Changes again develop over months and years, with guidance giving ranges rather than dates.

• Voice changes. Recording a short voice memo at fixed intervals is more informative than any rating, because the change is gradual and your own perception adapts alongside it.
• Facial and body hair. A slow-moving field where a baseline is the whole value.
• Menstrual changes and eventual cessation, if applicable — dates, flow, and any return of bleeding, which is worth raising rather than assuming.
• Skin changes, including acne, which is commonly reported and often peaks then settles.
• Mood, energy and libido.
• Injection sites, covered below.

Injections: site rotation and the interval problem

Injectable regimens create two record-keeping needs that no other route has.

The first is site rotation. Repeated injection into the same tissue causes local problems, so sites are rotated — and rotating reliably over years is a memory task that fails. A record of which sites were used when turns it into a lookup. HRT AI holds injection sites on a body map with a per-site cooldown and can record discomfort at a site, which is the practical version of this.

The second is where in the interval symptoms sit. With intervals of days to weeks, levels are not flat, and symptoms concentrated in the days before the next dose are a common and specific observation worth reporting accurately. It is only visible if the days between injections are logged too — which is precisely when nothing is happening and people stop.

General injection technique and safety guidance is published by the WHO and CDC and is worth reading once from a primary source rather than from a forum. Nothing about technique should come from a marketing site, including this one.

Lab results: keep them, with their units

Published guidance describes periodic laboratory monitoring during gender-affirming hormone therapy, with the specifics — which analytes, how often — set by the clinician. What is squarely your side of the line is keeping the results, and two details make that worth doing properly.

First, record the unit. Estradiol is commonly reported in pg/mL in some countries and pmol/L in others; testosterone in ng/dL or nmol/L. A number without a unit is meaningless, and a series that silently mixes units is worse than no series at all — it looks like a change that never happened. This is a real problem for anyone whose care crosses a border or a lab provider.

Second, record the reference range the lab printed, and treat it as the lab's range rather than a target. Reference ranges are population intervals from a given laboratory's methods, and appropriate ranges in gender-affirming care are a matter for your clinician rather than something to read off a printout. HRT AI stores results with their unit, converts between the common units, and describes a value as inside or outside a typical range rather than "normal" — a deliberate wording choice, because "abnormal" is a clinical judgement and a tracker is not entitled to make it.

Analytes it can hold include estradiol, total and free testosterone, SHBG, prolactin, haematocrit and haemoglobin, thyroid values, lipids, HbA1c, ferritin and vitamin D — the ones that commonly appear on monitoring panels. What yours should include is a clinical question.

The therapy history: the part only you can keep

This is the argument for tracking that applies specifically to gender-affirming care rather than being borrowed from menopause. Care is frequently discontinuous. People move between services, wait long periods for appointments, transfer between private and public provision, cross borders, and sometimes see a clinician who has no access to earlier records at all.

In that situation a dated therapy history that you hold is often the only complete record in existence. Worth keeping:

1. Every regimen you have been on, with start and stop dates. Compound, form, and route — not necessarily the amount, which your prescriber has, but certainly the form.
2. Why each change happened. Side effect, availability, provider preference, your own choice, a supply gap. This is the context that is never in a transferred record.
3. Any interruptions, with the reason. Supply gaps and clinical decisions look identical afterwards and are not the same event.
4. Surgical history and dates, where relevant, since it changes what the rest of the record means.
5. Your lab series, with units and dates.

HRT AI freezes each dose or route change with a short summary of what changed, and records a reason when a regimen is paused — which is the same list, kept as a side effect of ordinary use rather than as an exercise.

Why a menopause tracker covers this at all

Reasonable question. The answer is that the underlying machinery is the same: hormones on schedules, delivered by the same thirteen routes, producing slow changes that need a baseline, with labs and dose history to keep. Most trackers built for one population handle the other badly or not at all.

So HRT AI treats gender-affirming care as a first-class setup rather than a checkbox. Feminizing and masculinizing are distinct tracks, chosen at setup, and they change what the app tracks and how it talks to you. Antiandrogens and GnRH analogues are in the compound catalogue alongside estradiol and testosterone. The lab set includes the analytes those regimens actually involve, with unit conversion. Injection sites and cooldowns are supported for injectable regimens.

And details that matter more than they sound: the clinician report omits the bleeding calendar entirely when there is no uterus, so nobody is handed a menstrual section that does not apply to them; the app never assumes anatomy from a track. Health data stays on the device — there is no account and no cloud sync — which for many people in this group is not a preference but the reason a tracker is usable at all.

What it will not do is tell you what to take, suggest a dose, or comment on whether your levels are where they should be. That constraint is enforced in the software, not just intended. See the editorial standards, and for how stage-based menopause tracking differs, perimenopause, menopause, surgical menopause and POI.