Level Up Wellness Group
Current Address (your address MUST match the address on file with the Ministry of Health (ie. the same address registered to your health card):
Yes ( I have reviewed and acknowledge the above)
Before starting or continuing hormone therapy, it is important to understand the potential risks, benefits, and long-term effects of this treatment. By signing this form, you acknowledge that you have reviewed the following information, had an opportunity to ask questions, and are providing informed consent.
Testosterone Therapy (Masculinizing Treatment): Testosterone can cause irreversible changes like a deeper voice, facial and body hair, and muscle growth. Risks include an increased chance of blood clots, heart disease, and elevated red blood cell count. For individuals with ovaries and a uterus, testosterone may increase the risk of uterine and ovarian cancer. It can also reduce fertility and stop menstrual cycles, though pregnancy is still possible until cycles completely cease. Fertility preservation is recommended before starting treatment if pregnancy is desired.
Estrogen Therapy (Feminizing Treatment): Estrogen therapy can cause irreversible changes, including breast development and body fat redistribution. Risks include blood clots, stroke, and heart disease, particularly for those with risk factors like smoking or obesity. Long-term use may increase the risk of breast cancer and affect liver function. Estrogen may also reduce fertility permanently. Fertility preservation options, such as sperm banking, should be considered before starting therapy.
Additional Medical/Psychiatric Conditions (Past & Present)
Yes
