What is hormone replacement therapy?

Gender affirming hormone replacement therapy (HRT) is meant to align hormonal characteristics and their effects on the mind and body with a person’s gender identity, based on their personal outlook and medical options. HRT in Israel is an accessible treatment, as it’s covered by your Kupat Holim (HMO) through the healthcare basket (Sal Habriut סל הבריאות) and does not require an approval from the Gender Reassignment Committee.
Keep in mind that there isn’t necessarily a connection between gender identity and any particular decisions about medical or social changes, and not every person on the trans spectrum is interested in HRT as part of their transition. Also, you can stop HRT at any point if you wish. It’s best to do this under medical supervision and guidance.

This information about HRT is not meant to replace professional medical consultation.
We encourage you to do some deep research on your own about the effects of HRT, while keeping in mind the process that you may undergo yourself. In addition, it’s recommended that you consult with family, friends, other trans people, doctors and professionals.

For more details on the effects of estrogen hormone therapy, and on testosterone hormone therapy.

Adults: how to start HRT in Israel?

1. You must schedule an appointment with an endocrinologist or family doctor with experience in gender affirming hormone replacement therapy (a regularly updated list is found further down). You should start with the appointment for an endocrinologist, since the waiting times can be longer. You should know that even an experienced family doctor may not give a prescription without the recommendation of an expert endocrinologist.
2. If you wish to, you can arrange for fertility preservation before starting HRT. For more details, see under fertility preservation.
   Note: HRT can potentially cause permanent impairment to your fertility; if there’s a chance you might want biological children in the future, we encourage you to consider the option of fertility preservation before starting HRT.
3. Reach out to a mental health professional (social worker, psychologist, or psychiatrist) and ask for a letter affirming your ability to give informed consent to gender affirming HRT. Not every endocrinologist requires such a letter, but you should bring one just in case. You can get this service from some of the trans community organizations which offer individual assistance.
4. You must get several medical tests done before starting the treatment. The following list specifies the required tests, but you should consult with an endocrinologist or family doctor to get referrals for the relevant tests:
   Blood count and full chemistry (glucose, liver functioning, kidney functioning, lipids), testosterone, estradiol, prolactin, TSH, FSH, LH.
   In addition, for feminizing HRT you must also get blood clotting tests (PT, PTT), and for masculinizing HRT you may need to do a pelvic organs ultrasound (uterus and ovaries; this can be an external ultrasound).
   
5. You need a referral from your family doctor to your appointment with the endocrinologist. If the appointment is at a hospital clinic you must also get financial coverage (Tofes 17) from your Kupat Holim. If you’ve encountered difficulties acquiring the Tofes you can ask for help from the Os Trans service, or from some of the hospitals where you can get the appointment.
6. You must come to the scheduled endocrinologist appointment with your recommendation letter, test results, and (if needed) the Tofes 17.

In your first meeting with the doctor we recommend that you have an in-depth talk with them, as a basis for their recommendations for treatment and for the start of regular check-ups. You should talk about your goals, fertility considerations if you have any, side effects, your emotional state, treatment methods (for example: shots, gel, pills, or patches, and combinations between them), and any other issue or question you may have. Any question is the right question to ask! You can come with an escort and/or write out your thoughts and questions in advance. In addition, the doctor should refer you to any missing blood tests or ultrasound tests, or to any other individual assistance that you might need. הרופא ישתף בהמלצות שלו, אך בסוף ההחלטה על גופך היא שלך, במסגרת מה שניתן לספק מבחינה רפואית. במידה ותחליט להתחיל טיפול הורמונלי תחלו במעקב תקופתי.

In the first year you’ll be under close medical supervision and have frequent tests to adjust the doses to your personal needs. After the hormone levels stabilize you’ll usually meet the endocrinologist once a year.

Suggestion: before starting your transition, inquiry or treatment, you should check if you have private health insurance. Even if it’s part of a family insurance policy that began at a young age, or a workplace insurance policy, it may be useful for other treatments you might want to have outside the public health system. Keep in mind that every insurance company has a qualification period – that is, a waiting period until the insurance goes into effect. לכן מומלץ מאוד לשקול את האפשרות להרשם לביטוח בריאות פרטי עוד לפני התחלת הטיפולים.
After you’ve begun the transition process, some companies may exclude certain treatments from the insurance (if the insurance policy doesn’t specify otherwise), and you may need to fund some of the treatments yourself if you don’t get them through the public healthcare system.

Children and teenagers – how to start HRT?

According to the guidelines of the international professional organizations, minors cannot start HRT without a mental health professional’s recommendation and a gender dysphoria diagnosis. HRT is only given to children and teens if there’s a recommendation from a mental health professional with experience treating gender diverse children and teens, who gives a diagnosis of gender dysphoria and determines that HRT will benefit the minor. Not every therapist has the knowledge or clinical authorization suited to this, and so we recommend you go to a mental health professional who is trained and experienced in this field. The gender clinics for children and teens have mental health professionals with whom you can schedule a diagnostic process.

In addition, medical treatment requires the signatures of every parent or legal guardian on the consent forms. The timing for the beginning of treatment depends on the child’s preferences, the parents’ approval, and the stage of puberty. If one of the parents refuses to approve the treatment you can reach out to legal consultation.

Medical supervision for children and teens on the trans spectrum under the age of 18 is done at one of the children’s endocrine clinics with a specialization in gender. These clinics are found in two hospitals – they are the Dana Dwek children’s hospital in Ichilov hospital, and the gender diverse children and teen’s clinic in Sheba hospital.
For the remaining steps of the process, see above in the section on starting treatment for adults. You should know that HRT for minors also requires a ג29 form be approved by an endocrinologist and renewed each half a year.

There are two options for HRT in minors: puberty blockers, and cross-sex hormones (estrogen and testosterone).

Puberty blockers

Blockers delay the development of secondary sex characteristics that are not wanted at present, assuming sexual puberty still hasn’t ended. For those assigned male at birth this is mostly preventing or stopping the deepening of the voice, growth of facial and body hair, enlargement of the adam’s apple, and changes to the structure of the body and face. For those assigned female at birth this is mostly preventing or stopping development of breasts, the monthly period, and changes to the structure of the body and face.
The most common blocker used in Israel is called Decapeptil. This is an intramuscular shot (that is, injected into the muscle) given once every 4 weeks, 3 months, or half a year, depending on the doctor’s decision and the Kupat Holim’s approval.

You can start blocker treatment as soon as signs of puberty begin to appear.

The biggest advantage of blocker treatment is that it’s completely reversible. After stopping the use of blockers, sexual puberty will resume from the point where it was stopped.

Studies prove that using blockers significantly reduces psychological distress and allows for time to explore and understand your gender identity before the appearance of secondary sex characteristics.

Blocker treatment without cross-sex hormone treatment can, in the long run, cause a decrease in bone density. You must make sure to track and check bone density. It’s also recommended to consume a sufficient amount of calcium, to do weight-lifting exercise, and to keep a proper level of vitamin D.
You can get a prescription for blockers from a children’s endocrinologist based on the minor’s wishes, the parents’ approval, and a recommendation from a mental health professional with expertise in gender.

Cross-sex hormones

Cross-sex hormones lead to physical changes which match the desired gender expression, and can in this way reduce gender dysphoria. Unlike blockers, cross-sex hormones cause changes in the body, and some of these changes are irreversible. Hormones are prescribed by an endocrinologist based on the minor’s wishes, the parents’ approval, and a recommendation from a mental health professional with expertise in gender.

In the case of non-binary minors, the minor and medical team will decide on the form of hormonal treatment that is most beneficial for them.

For more details on the effects of estrogen hormone therapy, and on testosterone hormone therapy.

Hormone prices in the Kupat Holim

The information in this chart is up to date as of January 2024. The purpose of the chart is to give an estimate of the prices, and the price may be different when you purchase the hormones, or if you have supplementary coverage at your Kupat Holim.

People who are recognized as chronically ill won’t pay more than the price ceiling as specified on the Ministry of Health Website.

Clinics that offer HRT for adults

For the entry on Gender Affirmation Clinics

Central Israel

“Mabat” – Transgender Health Center

The center for gender health, Ichilov hospital, Tel Aviv
The clinic includes many services for the trans community.
The services available at the endocrinology institute: hormonal treatment and supervision, a nurse’s guidance on injecting testoviron.

• Gender affirmation endocrinologists in the clinic: Dr. Iris Yaish, Dr. Yael Sofer
• Phone – 03-6973417 (talk to the secretary)
• Email – end-c@tlvmc.gov.il
• Phone for an appointment with the nurse – 03-6973497
• Facebook page Briutrans [Trans health]
• Facebook group Briutrans
• Appointment scheduling online
• Working hours – Sunday through Thursday, 8:00-15:00

“Keshet” gender transition clinic

Wolfson hospital, Holon

• Appointments by phone – 03-5028111
• Whatsapp – 052-7241043
• Facebook
• Email – zimuntorim@wmc.gov.i

Sheba hospital gender transition clinic

Sheba (Tel Hashomer) hospital
It’s possible to contact the clinic through the coordinator of the Gender Reassignment Committee, Ziva Margalit (but it’s not required to go through the Committee to get hormonal treatment here).

• Phone – 03-5302677
• Email – ziva.margalit@sheba.health.gov.il
• The endocrinologist Dr. Liana Shkolnik-Tripto is also the Committee endocrinologist
• Other endocrinologists at the hospital who have been recommended: Dr. Sigal Ben Shmuel, Dr. Naama Peltz Sinvani.
  

The LGBTQ Gynecological Clinic

Meir hospital, Kfar Saba

• Initial consultation on gender reassignment – both hormones and surgery
• The hospital belongs to the Clalit Kupat Holim but this services is available for members of every Kupat Holim.
• Location – Meir hospital, outpatient clinics building, first floor, “Women’s clinic”
• Working hours – Wednesday 9:00-12:00
• Email – galcwork@gmail.com

Haifa

Trans spectrum clinic at Bnei Zion hospital

The gender clinic is a part of the endocrinology clinic. The clinic has high availability and even provides the option for remote appointments by video call. The appointments are available in Hebrew, English, Arabic, and Russian.

• Endocrinologist: Dr. Ekaterina “Katya” Yovanovich
• Address – Bnei Zion hospital, Golomb 47 Haifa; outpatient clinics
• Email – orit.miller@b-zion.org.il
• Phone for appointments – 04-8359359 (extension 1), ask for an appointment for the gender clinic in the endocrinology clinic.

Beer Sheva

Soroka hospital endocrinology clinic

This is not a designated LGBTQ community clinic, but you can reach out to Dr. Merav Fraenkel for HRT.
You should know that there is a low availability of appointments and there may be a very long waiting time.

• The clinic website
• Phone – 08-6403270, 08-6400748
• Email – somr11@clalit.org.il

HRT through the Kupat Holim and family doctors (adults)

A Kupat Holim endocrinologist or family doctor with experience or training in gender affirming care can manage your HRT. You can find a regularly updated list here:

Family doctors at Clalit Gan Meir clinic

A clinic run by Dr. Gal Wagner intended for the entire LGBTQ community, but which serves the general population as well. The clinic includes family doctors, nurses, skin doctors, psychiatrists, nursing and caregiving services, proctologists, and voice therapy.
Clalit Kupat Holim members can get in touch at:

• Address – 2 HaMaccabi St., Tel Aviv Yaffo (Bezalel market complex)
• An explanation about the clinic’s services
• The clinic’s website

• Phone – 03-7622310

• Online appointment service on the Clalit website

Family doctors at Maccabi Kikar Habima clinic

The clinic serves the LGBTQ community as well as the general population.

Dr. Ruth Gophen and Dr. Lia Eshet – experts in family medicine
Maccabi Kupat Holim members can get an appointment in the following ways:

• Address – next to Kikar Habima (Habima square), 30 Ben Zion Boulevard Tel Aviv.
• The clinic website
• The clinic facebook page
• Phone – 053-9956366

Sprinzak clinic – Meuhedet

Meuhedet’s flagship LGBTQ clinic. The clinic provides endocrinological treatment and supervision for people on the trans spectrum.
Contact:

• Sprinzak 15, Tel Aviv Yaffo
• Phone – 03-6941555
• Email – TelAviv15@meuhedet.co.il

Dr. Olga Ben Court – LGBTQ family doctor

Sees patients at Clalit’s Bonen clinic in Haifa.
Contact at:

• 73 Moria Boulevard, Haifa
  Phone – 04-8117222
• Phone – 04-8117222

Family doctors trained in hormonal treatment and supervision by the endocrinologist Dr. Daphna Shochat in December 2023:

• Dr. Slav Lusheimer, Lev Ha’Ir clinic Jerusalem, Clalit
• Dr. Yael Ronen, Lev Ha’Ir clinic Jerusalem, Clalit
• Dr. Yoni Leicht, Ayalon clinic Tel Aviv, Clalit
• Dr. Olga Ben Court, Bonen clinic Haifa, Clalit
• Dr. Yael Maliniak, Givataim, Maccabi
• Dr. Tzvia Koller Botzer, Misgav medical center, Maccabi

Doctors who completed a specialized training for treating trans people including hormonal treatment and supervision in July 2024:

The training was done by the LGBT Healthcare Society (Israeli Medical Association) and Project Gila

• Clalit Kupat Holim
  • Dr. Boaz Hasid, family doctor, Tel Aviv
  • Dr. Nili Elior, family doctor and geriatric doctor, Tel Aviv
  • Dr. Yonatan Leicht, family doctor, Tel Aviv
  • Dr. Amos Edri, family doctor, Tel Aviv
  • Dr. Slav Lusheimer, family doctor, Jerusalem
  • Dr. Yael Ronen, family doctor, Jerusalem
  • Dr. Masha Kupernikov, family doctor, Tel Aviv
  • Dr. Dror Yudovich, family doctor, Givataim
  • Dr. Neta Lankry, family doctor, Hertzlia
• Leumit Kupat Holim:
  • Dr. Libi Saharoni, internal medicine, Naharia
  • Dr. Alex Shifotovsky, family doctor and pain expert, Tel Aviv
• Meuhedet Kupat Holim:
  • Dr. Jonathan Brill, family doctor, Tel Aviv
  • Dr. Olga Peled Simon, family doctor and infectious diseases, Hertzlia
  • Dr. Shiri Uri, family doctor, Hod Hasharon
  • Dr. Amit Horn, family doctor, Efrat
  • Dr. Neta Eisher-Schwartz, family doctor, Haifa
• Maccabi Kupat Holim:
  • Dr. Elias Hawileh, family doctor, Tel Aviv
  • Dr. Lilach Kemer, family doctor, Hod Hasharon
  • Dr. Lia Eshet, family doctor, Hadera
  • Dr. Yaara Eran-Drumer, family doctor, Hadera
  • Dr. Tehila (Tili) Fisher-Yosef, family doctor, Kfar Yona
  • Dr. Shiri Adel, family doctor, Kfar Yona
  • Dr. Shay Dvir, family doctor, Modi’in-Maccabim-Reut
• IDF:
  • Dr. Natali-Yuval Burshtein, family doctor, Medical Corps
• Ichilov hospital:
  • Dr. Roee Noi, geriatrics, Tel Aviv

Kupat Holim endocrinologists:

You can make an appointment with an endocrinologist directly in your Kupat Holim, not just in hospital clinics.
The following list is partial and does not include all of the excellent and recommended doctors:

• Clalit Kupat Holim:
  • Clalit Mushlam coverage: Dr. Carmela Shechner, Haifa
  • Clalit Mushlam coverage: Dr. Yona Greenman, Tel Aviv
• Maccabi Kupat Holim:
  • Dr. Yael Sofer
  • Dr. Iris Yaish
  • Dr. Sigal Shaklai
  • Dr. Keren Turgeman
  • Dr. Dana Zaid
  • Dr. Elizabeta Plai
  • Dr. Daphna Shochat (limited availability starting in 2024)
• Meuhedet Kupat Holim:
  • Dr. Sigal Ben Shmuel (for hormonal treatment and supervision):
    • Sprinzak 15 Tel Aviv
    • 03-6941582
    • Sunday through Thursday 8:00-14:30
  • Dr. Michal Yacobi

  • Dr. Yonit Marcos

Children and teenagers gender affirming clinics

Dana-Dwek children’s hospital, Ichilov hospital, Tel Aviv Yaffo

An endocrinological clinic for children and teens on the trans spectrum which includes a multi-disciplinary team that gives aid to trans minors and their parents. The clinic team includes experts in children’s endocrinology, nurses, a dietitian, social workers and psychologists.

The team works in full cooperation as a part of a holistic healthcare, with the aim of fully addressing the patient’s and family’s needs for the most beneficial outcome. In addition, the team cooperates with other medical professionals in the hospital (men’s and women’s fertility clinics, women’s health, plastic surgery, etc.) and with mental health professionals in the community who have expertise in this field.
In order to get hormonal treatment for minors a parental approval is required.

• Send a fax to the number 03-6974306 with the following:
  • A referral from a family doctor
  • A letter from a mental health professional (clinical social worker, clinical psychologist or psychiatrist) with a Master’s degree or above.
    Write the parent’s phone number on the fax.
  • Email – pend-clinic@tlvmc.gov.il or maayana@tlvmc.gov.il או להשאיר הודעה אצל המזכירה בטלפון: 03-6972513
• Address: Weizman 6 Tel Aviv, ground floor, Dana-Dwek clinic
• Phone – 03-6972513
• Fax – 074-7219843
• The clinic website

Endocrinological clinic for children on the trans spectrum at Sheba (Tel Hashomer) hospital

The clinic is based on a full cooperation between the children and teenager’s endocrinology clinic and the child and teenager psychiatry clinic, as well as the Shiba Women and Maternity fertility preservation center. The team manages the clinic with an understanding of the complexity and sensitivity of the young people who come to the clinic. The trans children and teens are given a compassionate, supportive and accepting care and we guide them on their medical and emotional path.

In order to get hormonal treatment for minors a parental approval is required.

• Email – Inbal.Shemesh@sheba.health.gov.il
• Phone – 03-5305015
• The clinic website