{"id":9792,"date":"2025-11-25T12:15:27","date_gmt":"2025-11-25T10:15:27","guid":{"rendered":"https:\/\/transwiki.co.il\/articles\/hormone-replacement-therapy-hrt\/"},"modified":"2025-11-25T12:15:27","modified_gmt":"2025-11-25T10:15:27","slug":"hormone-replacement-therapy-hrt","status":"publish","type":"articles","link":"https:\/\/transwiki.co.il\/en\/articles\/hormone-replacement-therapy-hrt\/","title":{"rendered":"Hormone Replacement Therapy (HRT)"},"content":{"rendered":"

What is hormone replacement therapy?<\/span><\/h1>\n

Gender affirming hormone replacement therapy (HRT) is meant to align hormonal characteristics and their effects on the mind and body with a person\u2019s gender identity, based on their personal outlook and medical options. HRT in Israel is an accessible treatment, as it\u2019s covered by your Kupat Holim (HMO) through the healthcare basket (Sal Habriut \u05e1\u05dc \u05d4\u05d1\u05e8\u05d9\u05d0\u05d5\u05ea)<\/span> and does not<\/span> require an approval from the Gender Reassignment Committee<\/a>.<\/span>
\nKeep in mind that there isn\u2019t 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\u2019s best to do this under medical supervision and guidance.<\/span> <\/p>\n

<\/span><\/p>\n

This information about HRT is not meant to replace professional medical consultation. <\/span>
\nWe 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\u2019s recommended that you consult with family, friends, other trans people, doctors and professionals. <\/span>
<\/span><\/p>\n

 <\/p>\n

For more details on the effects of estrogen hormone therapy<\/a>, and on testosterone hormone therapy<\/a>.<\/span><\/p>\n

 <\/p>\n

Adults: how to start HRT in Israel?
<\/span><\/h1>\n
    \n
  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.<\/span><\/li>\n
  2. If you wish to, you can arrange for fertility preservation before starting HRT. For more details, see under fertility preservation<\/a>.
    Note: HRT can potentially cause permanent impairment to your fertility; if there\u2019s a chance you might want biological children in the future, we encourage you to consider the option of fertility preservation before starting HRT.<\/span><\/li>\n
  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<\/a>. <\/span><\/li>\n
  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: <\/span>
    \nBlood count and full chemistry (glucose, liver functioning, kidney functioning, lipids), testosterone, estradiol, prolactin, TSH, FSH, LH. <\/span>
    \nIn 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). <\/span>
    <\/span><\/li>\n
  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<\/a>) from your Kupat Holim. If you\u2019ve encountered difficulties acquiring the Tofes you can ask for help from the <\/span>Os Trans service<\/span><\/a>, or from some of the hospitals where you can get the appointment. <\/span> <\/span><\/li>\n
  6. You must come to the scheduled endocrinologist appointment with your recommendation letter, test results, and (if needed) the Tofes 17.<\/span><\/li>\n<\/ol>\n

     <\/p>\n

    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. \u05d4\u05e8\u05d5\u05e4\u05d0 \u05d9\u05e9\u05ea\u05e3 \u05d1\u05d4\u05de\u05dc\u05e6\u05d5\u05ea \u05e9\u05dc\u05d5, \u05d0\u05da \u05d1\u05e1\u05d5\u05e3 \u05d4\u05d4\u05d7\u05dc\u05d8\u05d4 \u05e2\u05dc \u05d2\u05d5\u05e4\u05da \u05d4\u05d9\u05d0 \u05e9\u05dc\u05da, \u05d1\u05de\u05e1\u05d2\u05e8\u05ea \u05de\u05d4 \u05e9\u05e0\u05d9\u05ea\u05df \u05dc\u05e1\u05e4\u05e7 \u05de\u05d1\u05d7\u05d9\u05e0\u05d4 \u05e8\u05e4\u05d5\u05d0\u05d9\u05ea. \u05d1\u05de\u05d9\u05d3\u05d4 \u05d5\u05ea\u05d7\u05dc\u05d9\u05d8 \u05dc\u05d4\u05ea\u05d7\u05d9\u05dc \u05d8\u05d9\u05e4\u05d5\u05dc \u05d4\u05d5\u05e8\u05de\u05d5\u05e0\u05dc\u05d9 \u05ea\u05d7\u05dc\u05d5 \u05d1\u05de\u05e2\u05e7\u05d1 \u05ea\u05e7\u05d5\u05e4\u05ea\u05d9.<\/span><\/p>\n

    In the first year you\u2019ll be under close medical supervision and have frequent tests to adjust the doses to your personal needs. After the hormone levels stabilize you\u2019ll usually meet the endocrinologist once a year. <\/span><\/p>\n

    Suggestion: before starting your transition, inquiry or treatment, you should check if you have private health insurance. Even if it\u2019s 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 \u2013 that is, a waiting period until the insurance goes into effect. \u05dc\u05db\u05df \u05de\u05d5\u05de\u05dc\u05e5 \u05de\u05d0\u05d5\u05d3 \u05dc\u05e9\u05e7\u05d5\u05dc \u05d0\u05ea \u05d4\u05d0\u05e4\u05e9\u05e8\u05d5\u05ea \u05dc\u05d4\u05e8\u05e9\u05dd \u05dc\u05d1\u05d9\u05d8\u05d5\u05d7 \u05d1\u05e8\u05d9\u05d0\u05d5\u05ea \u05e4\u05e8\u05d8\u05d9 \u05e2\u05d5\u05d3 \u05dc\u05e4\u05e0\u05d9 \u05d4\u05ea\u05d7\u05dc\u05ea \u05d4\u05d8\u05d9\u05e4\u05d5\u05dc\u05d9\u05dd.<\/span>
    \nAfter you\u2019ve begun the transition process, some companies may exclude certain treatments from the insurance (if the insurance policy doesn\u2019t specify otherwise), and you may need to fund some of the treatments yourself if you don\u2019t get them through the public healthcare system.<\/span><\/p>\n

     <\/p>\n

    Children and teenagers \u2013 how to start HRT?<\/span><\/h1>\n

    According to the guidelines of the international professional organizations, minors cannot start HRT without a mental health professional\u2019s recommendation and a gender dysphoria diagnosis. HRT is only given to children and teens if there\u2019s 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.<\/span><\/p>\n

    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\u2019s preferences, the parents\u2019 approval, and the stage of puberty. If one of the parents refuses to approve the treatment you can reach out to legal consultation. <\/span><\/p>\n

    Medical supervision for children and teens on the trans spectrum under the age of 18 is done at one of the children\u2019s endocrine clinics with a specialization in gender. These clinics are found in two hospitals \u2013 they are the Dana Dwek children\u2019s hospital in Ichilov hospital, and the gender diverse children and teen\u2019s clinic in Sheba hospital.<\/span>
    \nFor 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 \u05d229 form be approved by an endocrinologist and renewed each half a year. <\/span><\/span><\/p>\n

    There are two options for HRT in minors: puberty blockers, and cross-sex hormones (estrogen and testosterone).<\/span><\/p>\n

     <\/p>\n

    Puberty blockers<\/b><\/span><\/h2>\n

    Blockers delay the development of secondary sex characteristics that are not wanted at present, assuming sexual puberty still hasn\u2019t 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\u2019s 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. <\/span>
    \nThe 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\u2019s decision and the Kupat Holim\u2019s approval. <\/span><\/p>\n

     <\/p>\n

    You can start blocker treatment as soon as signs of puberty begin to appear.<\/span><\/p>\n

    The biggest advantage of blocker treatment is that it\u2019s completely reversible. After stopping the use of blockers, sexual puberty will resume from the point where it was stopped. <\/span><\/p>\n

    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.<\/span><\/p>\n

    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\u2019s also recommended to consume a sufficient amount of calcium, to do weight-lifting exercise, and to keep a proper level of vitamin D. <\/span>
    \nYou can get a prescription for blockers from a children\u2019s endocrinologist based on the minor\u2019s wishes, the parents’ approval, and a recommendation from a mental health professional with expertise in gender.<\/span><\/p>\n

    <\/span><\/p>\n

    Cross-sex hormones<\/b><\/span><\/h2>\n

    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\u2019s wishes, the parents’ approval, and a recommendation from a mental health professional with expertise in gender.<\/span><\/p>\n

    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.<\/span><\/p>\n

    For more details on the effects of estrogen hormone therapy<\/a>, and on testosterone hormone therapy<\/a>.<\/span><\/p>\n

     <\/p>\n

    Hormone prices in the Kupat Holim<\/span><\/h1>\n

    The information in this chart is up to date as of January 2024<\/span>. 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.<\/span> <\/span><\/p>\n

    People who are recognized as chronically ill won\u2019t pay more than the price ceiling as specified on the<\/span> Ministry of Health Website<\/span><\/a>.<\/span><\/span><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
    Hormones<\/b><\/span><\/td>\nClalit<\/b><\/span><\/a><\/td>\nLeumit<\/b><\/a><\/span><\/td>\nMeuhedet<\/b><\/a><\/span><\/td>\nMaccabi<\/b><\/a><\/span><\/td>\n<\/tr>\n
    Testoviron<\/b><\/p>\n

    TESTOVIRON DEPOT 250MG<\/b><\/span><\/td>\n

    <\/span><\/p>\n

    		19 shekels<\/td>\n18.5 shekels<\/span><\/td>\n33.31 shekels<\/span><\/td>\n33.31 shekels<\/span><\/td>\n<\/tr>\n
    Nebido<\/b><\/span> <\/p>\n

    NEBIDO VIAL 1000MG\/4ML<\/b><\/span><\/td>\n

    		199.2 shekels<\/span><\/td>\n240.5 shekels<\/span><\/td>\n384.80 shekels (80% of 481 shekels)<\/span><\/td>\n

    <\/span><\/p>\n

    		240.5 shekels (50% of 481 shekels)<\/td>\n<\/tr>\n
    Testomax 25mg \u2013 Testosterone gel<\/b><\/span><\/p>\n

    TESTOMAX 25MG 30PATCH<\/b><\/span><\/td>\n

    		106.5 shekels<\/span><\/td>\n105.61 shekels<\/span><\/td>\n140.81 shekels<\/span><\/td>\n14.08 shekels (10% of 140.81 shekels)<\/span><\/td>\n<\/tr>\n
    Testomax 50mg \u2013 Testosterone gel<\/b><\/span><\/p>\n

    TESTOMAX 50MG 30PATCH<\/b><\/span><\/td>\n

    		106.5 shekels<\/span><\/td>\n190.13 shekels<\/span><\/td>\n253.51 shekels<\/span><\/td>\n25.35 shekels (10% of 253.51 shekels)<\/span><\/td>\n<\/tr>\n
    \u05d2’\u05dc \u05d0\u05e0\u05d3\u05e8\u05d5\u05d2’\u05dc.<\/b><\/span><\/p>\n

    ANDROGEL 50MG 30PATCH<\/b><\/span><\/td>\n

    		<\/td>\n191.76 \u05e9”\u05d7<\/span><\/p>\n

    (\u05de\u05d7\u05d9\u05e8 \u05dc\u05d0\u05d5\u05de\u05d9\u05ea \u05d6\u05d4\u05d1 127.84 \u05e9”\u05d7)<\/span><\/td>\n

    		204.54 \u05e9”\u05d7*<\/span><\/td>\n255.68 \u05e9”\u05d7 \u2013 \u05dc\u05d0 \u05d1\u05e1\u05dc<\/span><\/td>\n<\/tr>\n
    Estrofem 1mg<\/b><\/span><\/p>\n

    ESTROFEM 1MG 28TAB<\/b><\/span><\/td>\n

    		19 shekels<\/span><\/td>\n

    <\/span><\/p>\n

    		18.5 shekels<\/td>\n18.66 shekels<\/span><\/td>\n19.18 shekels<\/span><\/td>\n<\/tr>\n
    Estrofem 2mg<\/span><\/b><\/p>\n

    ESTROFEM 2MG 28TAB<\/span><\/b><\/td>\n

    		20 shekels<\/span><\/td>\n18.5 shekels<\/span><\/td>\n

    <\/span><\/p>\n

    		19.86 shekels<\/td>\n18.66 shekels<\/span><\/td>\n<\/tr>\n
    Evorel 50 \u2013 Patches<\/b><\/span><\/p>\n

    EVOREL 50 8 PATCH<\/b><\/span><\/td>\n

    		19 shekels<\/span><\/td>\n18.5 shekels<\/span><\/td>\n

    <\/span><\/p>\n

    		33.82 shekels<\/td>\n33.82 shekels<\/span><\/td>\n<\/tr>\n
    Dermestril \u2013 estrogen patches<\/b><\/span><\/td>\n18.5 shekels<\/span><\/td>\nNot available<\/span><\/td>\nNot available<\/span><\/td>\n–<\/span><\/td>\n<\/tr>\n
    Estrogel \u2013 estrogen gel<\/b><\/span><\/p>\n

    OESTROGEL GEL 80GR<\/span><\/b><\/td>\n

    		19 shekels<\/span><\/td>\n18.5 shekels<\/span><\/td>\n36.16 shekels<\/span><\/td>\n36.16 shekels<\/span><\/td>\n<\/tr>\n
    Spironolactone 25 mg <\/b><\/span><\/p>\n

    SPIRONOLACTONE TAB 25MG<\/b><\/span><\/td>\n

    		19 shekels<\/span><\/td>\n

    <\/span><\/p>\n

    		11.46 shekels<\/td>\n

    <\/span><\/p>\n

    		11.46 shekels<\/td>\n

    <\/span><\/p>\n

    		11.46 shekels<\/td>\n<\/tr>\n
    Spironolactone 100mg <\/b><\/span><\/p>\n

    SPIRONOLACTONE TV 100MG<\/b><\/span><\/td>\n

    		19 shekels<\/span><\/td>\n23.40 shekels<\/span><\/td>\n23.40 shekels<\/span><\/td>\n23.40 shekels<\/span><\/td>\n<\/tr>\n
    Androcur <\/b><\/b>
    \n\u05dc\u05d0 \u05d6\u05de\u05d9\u05df \u05d1\u05e8\u05d5\u05d1 \u05d4\u05de\u05e7\u05d5\u05de\u05d5\u05ea.<\/i><\/b>
    \nANDROCUR 10MG<\/b><\/span><\/td>\n    		15 shekels for 15 pills<\/span><\/td>\n18.5 shekels<\/span><\/td>\n30.82 shekels<\/span><\/td>\n30.82 shekels<\/span><\/i><\/span><\/p>\n

    21.27 \u05e9”\u05d7 (15% \u05de\u05ea\u05d5\u05da 148.23 \u05e9”\u05d7) 45\u05d8\u05d1\u05dc\u05d9\u05d5\u05ea?<\/span><\/p>\n

    23.90 \u05e9”\u05d7 (15% \u05de\u05ea\u05d5\u05da 159.30 \u05e9”\u05d7) 45 \u05d8\u05d1\u05dc\u05d9\u05d5\u05ea?<\/span><\/td>\n<\/tr>\n

    \u05e6\u05d9\u05e4\u05e8\u05d5\u05d8\u05e8\u05d5\u05e0\u05d4 50<\/b> \u2013 \u05db\u05d3\u05d5\u05e8\u05d9\u05dd.<\/span><\/span><\/p>\n

    CIPROTERONA 50MG 50TAB<\/b><\/span><\/td>\n

    		20.63<\/span><\/td>\n20.2 \u05e9”\u05d7<\/span><\/td>\n141.6 \u05e9”\u05d7<\/span><\/td>\n20.23 \u05e9”\u05d7 (10% \u05de\u05ea\u05d5\u05da 123.79 \u05e9”\u05d7, \u05db\u05e4\u05d5\u05e3 \u05dc\u05d0\u05d2\u05e8\u05ea \u05de\u05d9\u05e0\u05d9\u05de\u05d5\u05dd \u05e9\u05dc 20.23 \u05e9”\u05d7)<\/span><\/td>\n<\/tr>\n
    Decapeptil 22.5mg <\/p>\n

    DECAPEPTYL DEPO INJ22.5MG<\/b><\/span><\/p>\n

    \u05de\u05d7\u05d9\u05e8 \u05de\u05e7\u05e1\u05d9\u05de\u05dc\u05d9 \u05db\u05d5\u05dc\u05dc \u05de\u05e2”\u05de 2375.51 \u05e9”\u05d7.<\/span><\/td>\n

    		210 shekels<\/span><\/td>\n2428.44 shekels<\/span><\/td>\n2428.44 shekels<\/span>
    \n(significantly less when showing a prescription)<\/span><\/span><\/td>\n    		2428.44 shekels<\/span>
    \n(significantly less when showing a prescription)<\/td>\n<\/tr>\n
    Decapeptil 11.25mg <\/p>\n

    DECAPEPTYL DEPOT 11.25M<\/b><\/span><\/p>\n

    \u05de\u05d7\u05d9\u05e8 \u05de\u05e7\u05e1\u05d9\u05de\u05dc\u05d9 \u05db\u05d5\u05dc\u05dc \u05de\u05e2”\u05de 1287.14 \u05e9”\u05d7.<\/span><\/td>\n

    		171 shekels<\/span><\/td>\n207.47 shekels<\/span><\/td>\n1383.13 shekels<\/span>
    \n(significantly less when showing a prescription)<\/span><\/td>\n    		1383.13 shekels<\/span>
    \n(significantly less when showing a prescription)<\/span><\/td>\n<\/tr>\n
    Decapeptil 3.75 mg <\/p>\n

    \u05de\u05d7\u05d9\u05e8 \u05de\u05e7\u05e1\u05d9\u05de\u05dc\u05d9 \u05db\u05d5\u05dc\u05dc \u05de\u05e2”\u05de 449.61 \u05e9”\u05d7.<\/span><\/td>\n

    		62 shekels<\/span><\/td>\n76.05 shekels<\/span><\/td>\n506.98 shekels<\/span>
    \n(significantly less when showing a prescription)<\/span><\/td>\n    		506.98 shekels<\/span>
    \n(significantly less when showing a prescription)<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

     <\/p>\n

    Clinics that offer HRT for adults<\/span><\/h1>\n

    For the entry on Gender Affirmation Clinics <\/a><\/span><\/p>\n

    Central Israel<\/span><\/h2>\n

    \u201cMabat\u201d<\/a> \u2013 Transgender Health Center<\/span><\/h3>\n

    The center for gender health, Ichilov hospital, Tel Aviv
    \nThe clinic includes many services for the trans community.
    \nThe services available at the endocrinology institute: hormonal treatment and supervision, a nurse\u2019s guidance on injecting testoviron.<\/span><\/span><\/p>\n