When to Stop / Seek Help
This page may save your life
Know these emergency warning signs before starting HRT. If you experience any of them, seek medical attention immediately. Do not wait.
Venous Thromboembolism (VTE) — Blood Clots
Deep Vein Thrombosis (DVT) — Clot in the Leg
| Symptom | Notes |
|---|---|
| Swelling in one leg | Usually the calf or thigh |
| Pain or tenderness | Cramping sensation, often in the calf |
| Redness or discolouration | The affected area may look red or darker |
| Warmth | The skin feels warm to the touch |
What to do: Seek medical attention within 24 hours. A DVT can travel to the lungs and become life-threatening.
Pulmonary Embolism (PE) — Clot in the Lung
| Symptom | Notes |
|---|---|
| Sudden shortness of breath | Can't catch your breath |
| Chest pain | Sharp pain, worse when breathing deeply |
| Coughing up blood | Even a small amount |
| Rapid heart rate | Heart racing or pounding |
| Lightheadedness/fainting | Feeling like you might pass out |
What to do: Call emergency services immediately. PE is life-threatening.
Stroke / Transient Ischemic Attack (TIA)
| Symptom (FAST) | What to Look For |
|---|---|
| Face drooping | One side of the face droops; uneven smile |
| Arm weakness | One arm drifts downward when both raised |
| Speech difficulty | Slurred speech or trouble speaking |
| Time to call emergency | Call emergency services immediately |
Also: sudden severe headache, sudden confusion, sudden vision loss in one eye.
Meningioma (CPA-Related)
| Symptom | Notes |
|---|---|
| Persistent headaches | New or worsening headaches over weeks/months |
| Vision changes | Blurred or double vision |
| Seizures | Any type of seizure |
| Hearing changes | Ringing in ears (tinnitus) or hearing loss |
| Nausea/vomiting | Unexplained and persistent |
| Personality changes | Memory problems or mood changes |
These symptoms develop slowly over months. If you're on CPA and have any of these, stop CPA and see a doctor for an MRI.
Severe Depression or Suicidal Thoughts
Get help immediately
If you have thoughts of harming yourself, call a crisis hotline or go to the nearest emergency room.
- US: 988 (Suicide & Crisis Lifeline)
- UK: 111 (NHS) or 999 in emergency
- International: Find your local crisis hotline at findahelpline.com
- Trans-specific: Trans Lifeline — translifeline.org
If CPA is causing or worsening depression, consider:
- Stopping CPA (T may rise but it's safer than severe depression)
- Switching to bicalutamide or spironolactone
- Seeking mental health support
Signs of Severe Hyperkalemia (Spiro Users)
| Symptom | Notes |
|---|---|
| Muscle weakness | Feeling unusually weak or tired |
| Numbness/tingling | Especially in hands, feet, or around mouth |
| Heart palpitations | Irregular heartbeat or fluttering |
| Nausea | Persistent stomach upset |
Hyperkalemia from spironolactone is rare in healthy people under 45, but can occur if you have kidney issues, are on interacting medications, or take potassium supplements.
Allergic Reaction
| Symptom | Notes |
|---|---|
| Rash or hives | Itchy red bumps or patches |
| Swelling | Face, lips, tongue, or throat |
| Difficulty breathing | Wheezing or tightness in chest |
| Anaphylaxis | Rare but life-threatening |
When to Simply Stop HRT (Non-Emergency)
You can stop HRT temporarily (days to weeks) without major harm if:
- You have a major surgery coming up (discuss with surgeon — some recommend stopping oral estrogen 2–4 weeks before)
- You suspect your medication is counterfeit or contaminated
- You need to preserve fertility temporarily
- You're experiencing unmanageable side effects (mood, fatigue, etc.)
Stopping HRT is safe
Unlike some medications, stopping HRT abruptly is not dangerous. Your testosterone will gradually return to pre-HRT levels over weeks. Breast tissue and infertility are permanent, but most other changes reverse.
What NOT to Do
- ❌ Don't ignore symptoms hoping they'll go away
- ❌ Don't take aspirin to "prevent clots" without a doctor's advice
- ❌ Don't stop all HRT without a plan (but stopping short-term is fine)
- ❌ Don't lie to doctors about being on DIY HRT in an emergency — they need to know
Be honest with emergency providers
In an emergency, tell the doctor exactly what medications you are taking and what doses. If you are on DIY HRT, say so. They cannot help you effectively if they don't have the full picture. Patient confidentiality laws protect you.
Emergency Contact Template
Keep a card in your wallet with:
HRT MEDICATIONS (current):
[Medication] - [Dose] - [Frequency]
[Medication] - [Dose] - [Frequency]
BLOOD TYPE: [Your blood type]
ALLERGIES: [Any allergies]
EMERGENCY CONTACT: [Name] - [Phone number]
MEDICAL CONDITIONS: [Any relevant conditions]References
Connelly PJ, et al. (2021). Managing the risk of venous thromboembolism in transgender adults undergoing hormone therapy. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC6628137/
American Stroke Association. FAST Signs of Stroke. https://www.stroke.org/en/about-stroke/stroke-symptoms
Weill A, et al. (2021). Use of high-dose cyproterone acetate and risk of intracranial meningioma. BMJ. https://www.bmj.com/content/372/bmj.n37