All About Gender Affirming Hormone Therapy (GAHT) in Ontario

All About Gender Affirming Hormone Therapy (GAHT) in Ontario

July 2, 2026 · by · in Uncategorized

What is Gender Affirming Hormone Therapy (GAHT)? 

GAHT consists of taking either estrogen or testosterone hormones to change your body to align with your gender identity. 

  • Deciding to start GAHT is a personal decision and your gender journey is valid no matter what you decide.   

How do I get GAHT?

GAHT is not a specialized area anymore, so in most cases your primary care provider, including family doctors and nurse practitioners, can provide it. 

  • If your physician is uneducated in trans healthcare, Rainbow Health Ontario has many resources made for clinician education. 
  • If you need a primary care physician or feel uncomfortable with your current one, Rainbow Health Ontario has a directory that can be used to find trans affirming providers. 

GAHT in Guelph

There are clinics in Guelph that specialize in gender affirming care! They can prescribe and monitor hormones, support gender exploration, provide surgery referrals, among many other transition-related services. 

Is the Cost of GAHT Covered by the Ontario Drug Benefit (ODB) program and EAP?

  • Patients covered by the Ontario Drug Benefit (ODB) program include those on Ontario Works (OW), the Ontario Disability Support Program (ODSP), seniors over 65 years of age, youth under 25 years of age (via OHIP+ unless they have a private drug plan) and those on the Trillium Drug Program. 
  • For patients covered by ODB, injectable testosterone and topical gel formulations are covered with the submission of an Exceptional Access form (EAP).
  • Anti-androgens and oral estradiol are covered without the need for EAP approval.
  • If you have private drug coverage, you can check to see if it covers GAHT. 
  • University of Guelph’s Student Health Benefits Plan also covers GAHT. Drug coverage is a max of $5,000 per benefit year. 

All About Testosterone!

Note: Every body is different, so the effects of testosterone vary from one person to another! Some changes are permanent, whereas others are reversible if you stop hormones. 

T Changes Include: 

  • Deeper voice 
  • Facial/body hair growth
  • Enlarged clitoris (bottom growth)
  • Potential for decreased fertility (T IS NOT BIRTH CONTROL, IT DOES NOT GUARANTEE INFERTILITY) 
  • Changes in body fat and fat redistribution 
  • Increased muscle mass, strength and muscle definition
  • More oily skin, acne 
  • Increased libido, changes in sexual function 
  • Menstruation may become irregular or stop 
  • Increased sweat
  • Thinning hair
  • Increased appetite
  • Vaginal atrophy, dryness and/or itching
  • Changes in mood 
  • Changes in cholesterol (LDL increase, HDL decrease). 

NOTE: THESE ARE NOT ALL THE POSSIBLE CHANGES OF TESTOSTERONE THERAPY. YOU SHOULD DISCUSS ALL CHANGES AND HEALTH RISKS WITH YOUR PHYSICIAN. 

How long does it take to work?  

  • The changes take time and vary widely from person to person. The changes generally begin to take place within the first 3 months and may continue for 3+ years. 

How do I take T?  

INJECTION: 

  • Testosterone can be injected subcutaneously (SC) or intramuscular (IM). 
    • Intramuscular is more common, but subcutaneous is generally less painful. 
    • See here for a handy guide on self-injecting both subcutaneously and intramuscularly. 

TRANSDERMAL: 

  • Transdermal methods include gel and a patch. 
  • Gel is applied to and absorbed through the skin.
    • It can induce more gradual changes than injectable testosterone.  
    • See here for a handy guide on applying gel. 

See below for a chart with an overview of the different types of testosterone, provided by ACT Toronto. 

All About Estrogen!

Note: Every body is different, so the effects of estrogen vary from one person to another! The only permanent change on estrogen is breast tissue growth. 

E Changes Include: 

  • Growth of breast tissue
  • Softer skin
  • Thinning or slowed hair growth on the face and body
  • Body fat redistribution to the hips and thighs
  • Decreased muscle mass and strength 
  • Change in libido and sexual function
  • Decreased spontaneous erections
  • Decreased sperm production/reduced fertility (E IS NOT BIRTH CONTROL AND IT DOES NOT GUARANTEE INFERTILITY)
  • Decreased testicular volume after long term use
  • Mood changes

Anti-Androgens: 

  • Anti-androgens work to block the effects of testosterone and may be taken along with estrogen in pill form. 

Progestins: 

  • Some people might decide to take progesterone a year after starting HRT. 
  • Progesterone is not well studied, so fewer people take it. 
  • They are taken in pill form. 

NOTE: THESE ARE NOT ALL THE POSSIBLE CHANGES OF ESTROGEN THERAPY. YOU SHOULD DISCUSS ALL CHANGES AND HEALTH RISKS WITH YOUR PHYSICIAN. 

How long does it take to work?  

  • The changes take time and vary widely from person to person. The changes generally begin to take place within the first 3 months and may continue for 3+ years. 

How do I take E?  

Methods for taking E include:

  • Medication (pills)
  • Injectable 
    • Most common due to lower cost
    • One type of injection site: intramuscular (IM)
  • Transdermal (patch/gel)

See below for a chart with an overview of the different types of estrogen and anti-androgens, provided by ACT Toronto.

Other Informative Resources About GAHT:

Feminizing Hormone Therapy:

Folx:

Rainbow Health:

Masculinizing Hormone Therapy:

Folx:

Rainbow Health: