Informed consent for hormone replacement therapy (HRT) or testosterone replacement therapy (TRT), including compounded bioidentical hormones. Covers off-label/compounded drug risks, cardiovascular risks, monitoring requirements, and contraindications for menopausal HRT, TRT, and gender-affirming hormone therapy.
The Hormone Replacement Therapy (HRT/TRT) Informed Consent is a ready-to-use healthcare & wellness template you can send for signature in minutes. It is written for 1 signer (patient) and, by default, expires 30 days after it is sent if left unsigned. It covers hrt, trt, hormone therapy, testosterone, estrogen, progesterone. Like every Abundera Sign template it is a convenience draft structured for ESIGN Act and UETA compliance, not a substitute for legal advice. Each signed copy is sealed with PAdES-LTA digital signatures, dual RFC 3161 timestamps, and a tamper-evident evidence package in WORM storage.
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# Hormone Replacement Therapy (HRT/TRT) Informed Consent **Practice:** ___________ **Prescribing Provider:** ___________, ___________, license number ___________, NPI ___________ **Patient Name:** ___________ **Date of Birth:** ___________ **Date of Consent:** ___________ --- ## 1. Purpose and Type of Therapy The prescribing provider has evaluated the Patient and recommends the following hormone therapy for the indication(s) stated: **Type of therapy:** ___________ **Indication:** ___________ **Medications prescribed:** ___________ *(Examples: estradiol patches/gels/pills/injections; progesterone/progestins; testosterone injections/gels/pellets; anti-androgens such as spironolactone; finasteride; DHEA)* **Route of administration:** ___________ **Starting dose and schedule:** ___________ --- ## 2. FDA-Approved vs. Off-Label vs. Compounded Use **FDA-approved:** Many hormone products used in HRT and TRT are FDA-approved (e.g., EstradiolTM patches, Prometrium®, AndroGel®, Depo-Testosterone®, estradiol valerate injectable). The Patient's prescribed medications and their approval status: ___________. **Off-label use:** Some hormone doses, routes, or combinations (particularly in gender-affirming care or for certain menopause symptoms) are used off-label. The Patient has been informed of any off-label uses in their regimen: ___________.