Centre County Trans Resource Guide map of Pennsylvania with CCTR-WG logo overlayed
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Hormone Replacement Therapy (HRT)

Your best means of accessing HRT in the Centre County area depends on several factors, including whether you have insurance or Medicare coverage, whether you are a legal adult, whether you can afford to pay for a prescription out of pocket (if necessary), and whether you are willing to DIY.

Local Providers (Insured or Medicaid)

Students and employees with access to UHS at Penn State should consider them as the first option for gender affirming care.

Otherwise, you may be able to get a referral through your primary care provider, or your insurance plan should be able to link you to a provider who is in network. Many local trans people have Dr. Paul Damaske or Dr. Kristen Frank-Dixon at Geisinger as a provider. If you know of other providers who should be added to this list, please reach out to a member of the CCTR-WG.

Providers that treat children are hard to find and frequently not local. One known option in-state is the Children’s Hospital of Philadelphia. If you know of other providers, please reach out to the CCTR-WG. Information can be kept confidential if necessary.

Medicaid is a federal program which is largely overseen by individual states that provides an insurer of last resort for millions of Americans. Recently, Republicans have tried to make significant changes to Medicaid, including (a) making it harder for poor people to qualify for it, and (b) prohibiting it from covering transition care. You may want to look into having other options, such as DIY, as a backup plan in case the availability of HRT through Medicaid changes.

If you are on Medicaid and have HRT prescribed to you by a local doctor, the working group would be interested in hearing about your experience.

Local Providers (uninsured)

The local organization Centre Volunteers in Medicine provides healthcare to uninsured people, so you may want to start by contacting them to see if they can help. You may also want to reach out to CentreLGBT+; in addition to their social projects, they have connections to other local nonprofits that can be useful to those dealing with financial hardship.

Note that if you are uninsured because you are unemployed and can’t afford insurance, you should check to see if you qualify for Medicaid. Pennsylvanians on Medicaid can have gender affirming hormone therapy paid for at organizations like Planned Parenthood that accept Medicaid.

If you know of other local providers offering resources to the uninsured, or those otherwise unable to pay, please reach out to a member of the working group.

Concierge Web-Based Clinics

These services charge a flat fee per-month or per-year for membership, which includes access to a licensed psychiatrist. This person can write you a prescription for HRT medications on an informed consent basis, which basically means that you should not have to prove to the provider that you are trans.

The two largest are Plume and FOLX. Both serve Pennsylvania residents. At FOLX, a membership paid annually is $300, blood tests are around $50 each, annual or semi-annual clinician visits are $80 each. Medications are paid separately; they will send your prescriptions to local pharmacies if you want and with a discount code (from GoodRX or similar) medications are likely to be less than $200 per year if you are on injection monotherapy. Insurance can help cover some of the costs, but usually will not cover the price of the membership.

True U is a newer alternative that is also more expensive; they advertise a price of over $1000 a year the first year before lab work (at $100 per visit) and medications. However, they also say that they will treat trans youth in some states with parental consent. If that is your situation, you may want to call them to check on availability.

DIY

Some trans people choose to DIY, meaning that they purchase medication directly without a prescription and take or inject it themselves, and track their own levels by ordering blood tests (labs) regularly. You can order HRT medications from overseas pharmacies who will sell to individuals without a prescription, or alternatively order from “homebrew” vendors (usually trans people themselves) who compound medication they order in bulk. Many people consider the overseas pharmacy method safer, although this is disputed.

Most HRT medications (with the notable exception of testosterone) are not controlled substances, which means possessing them is not a federal crime. Possessing prescription-only medication without a valid prescription is still against the law in many states.

Generally, any DIY method will require you to purchase cryptocurrency (e.g. Bitcoin), because that’s what most online vendors accept (though exceptions exist). How you go about this may depend on your technical proficiency as well as how anonymous you want to be. Most cryptocurrency vendors now require disclosure of your personal information (such as a social security number) because of Know Your Customer laws in the United States that seek to prevent money laundering.

If you want to be maximally secure, you will need to make some attempt to anonymize your Internet traffic (e.g. a VPN with good privacy guarantees such as Mullvad, or TOR Browser), and use a tracing-resistant currency to purchase the medication such as Monero. You can also try to purchase cryptocurrency with cash rather than use a regulated exchange like Coinbase or Kraken. Remember, however, that even extreme precautions can’t eliminate every risk (such as an e-pharmacy retaining records of your name and address). The priority is to make sure you get the medication you need reliably, not to become totally invulnerable.

Online Sources of Information about DIY

The DIY HRT Directory 2.0 is considered a reliable source of information as of this writing, and has information for both transfeminine and transmasculine people. For transfemmes, the estradiol pharmacokinetics playground offers an interactive model of estradiol serum levels based on dosage and frequency for injectables. Transfemscience analyzes much of the available research on hormone regimens for transfeminine people.

Planned Parenthood has a detailed injection guide for both intramuscular and subcutaneous injections. They also have exceptionally clear videos for both intramuscular and subcutaneous injections.

Some people in the local community have additional information or resources, and are typically happy to share.

Ordering Labs in the State College Area while DIY-ing

Quest Diagnostics offers on demand testing through their Quest Health platform, and has a State College location. Unfortunately, while they offer a testosterone test ($69), they don’t appear to offer one for estradiol outside of panels (hormone blood panels for women are $225 and include both testosterone and estradiol tests).

LabCorp has an Altoona location and offers on-demand testing of estradiol ($79) and testosterone ($69).

Private MD Labs can have a clinician approve blood tests for you and send them to Quest on your behalf. This is unfortunately cheaper than going through Quest directly, because it gives you access to specific tests at a negotiated rate. As of this writing, no one in contact with this working group has reported on whether getting labs this way worked for them. If you go this route, please let someone know.

Some providers also order tests for kidney function, such as creatinine and potassium levels, when you are taking medications like spironolactone. Those on bicalutamide are recommended to check liver function, because of rare potential side effects. Most of the tests common to liver function panels are included in the “comprehensive metabolic profile” included in the tests linked above.