Hormones Around Surgery: Stopping, Continuing and Restarting Safely
Advice about stopping hormones before surgery is not the same for every patient undergoing gender-affirming surgery. The plan depends on the hormone being used, the type of operation, personal clot risk and the surgical team's protocol. Oestrogen may require specific consideration because of clot risk, while testosterone is often managed differently.
Advice about stopping hormones before surgery is not the same for every patient undergoing gender-affirming surgery. The plan depends on the hormone being used, the type of operation, personal clot risk and the surgical team's protocol. Oestrogen may require specific consideration because of clot risk, while testosterone is often managed differently. The final plan should be agreed by the surgeon, anaesthetist and hormone prescriber.
Patients should not stop or restart hormone therapy on their own simply because they have an upcoming operation. A personalised pre-operative plan is safer than following general advice from another patient's experience.
Why Does This Question Exist at All, and What Is the Clot Risk?
The discussion about stopping hormones before surgery mainly relates to the possibility of venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE).
Surgery itself can temporarily increase clot risk. Several factors may contribute, including the duration of an operation, reduced mobility during recovery and individual medical risk factors.
Certain oestrogen preparations can also influence clotting risk. This is why the surgical team considers hormone therapy as part of the overall pre-operative assessment.
Why Is Oestrogen Discussed More Often?
The relationship between oestrogen and clotting is one reason patients taking feminising hormone therapy may receive specific instructions before surgery.
However, this does not mean every patient taking oestrogen must automatically stop it.
The decision can depend on factors such as:
- The type and route of oestrogen
- Dose and treatment regimen
- Type and duration of surgery
- Expected mobility after surgery
- Previous history of blood clots
- Smoking
- Age
- Body weight and other health conditions
- Other medicines
- The surgical team's protocol
Modern clot-prevention measures may also form part of the perioperative plan.
Surgery Adds Its Own Risk
Long operations and periods of reduced mobility can increase VTE risk independently of hormone treatment.
Depending on the procedure and individual risk, preventive measures may include early mobilisation, compression devices or medication prescribed to reduce clot risk.
This is why HRT and clot risk before an operation should be considered as part of the patient's complete surgical risk profile rather than looking at hormone therapy alone.
How Does Advice Differ Between Oestrogen, Testosterone and Anti-Androgens?
There is no universal rule covering every type of gender-affirming hormone therapy.
Different medicines have different effects and therefore need to be considered individually.
Oestrogen
Oestrogen usually receives the most attention when planning hormone management around surgery because of its relationship with thromboembolic risk.
Depending on the patient's risk profile and the team's protocol, the plan may involve continuing therapy, modifying it or temporarily pausing it.
For someone considering oestrogen before top surgery or another gender-affirming procedure, the correct approach should come from the treating team rather than a general online schedule.
Testosterone
Testosterone is managed differently from oestrogen.
For many patients, testosterone may not need to be routinely discontinued for every operation. However, the decision still depends on the individual's health, blood results, type of procedure and surgical protocol.
For example, a patient wondering about testosterone before chest surgery should confirm the plan during the pre-operative assessment rather than assuming that continuing or stopping is always correct.
Anti-Androgens
Anti-androgen medicines also need individual review.
The decision may depend on the specific medicine and its effects on blood pressure, electrolytes, kidney function or other perioperative considerations.
Some medications may require changes for reasons unrelated to clotting.
This is why patients should provide the surgical and anaesthesia teams with a complete list of:
- Hormones
- Anti-androgens
- Prescription medicines
- Over-the-counter medicines
- Vitamins
- Supplements
Do not stop prescribed medicines unless the treating team specifically instructs you to do so.
Read more about top surgery before or after hormones.
Which Personal Factors Change the Decision?
Two patients undergoing the same operation may receive different instructions about stopping hormones before surgery because their individual risk profiles are different.
Previous Blood Clots
A previous DVT or pulmonary embolism is particularly important information.
Patients should tell their surgical team about any personal history of clotting and, when relevant, significant family history.
Smoking
Smoking can affect surgical recovery and may contribute to cardiovascular and clot-related risks.
It can also interfere with wound healing, making smoking status important during pre-operative planning.
Mobility
Patients expected to have reduced mobility after surgery may require additional consideration.
Early mobilisation is commonly encouraged when medically appropriate because movement can form part of postoperative clot prevention.
Type and Duration of Surgery
A relatively short procedure and a major operation lasting several hours do not carry identical perioperative risks.
The type of gender-affirming surgery therefore influences the overall plan.
Other Medical Conditions
The team may also consider conditions or factors such as:
- Cardiovascular disease
- Previous clotting disorders
- Obesity
- Certain blood abnormalities
- Reduced mobility
- Other medicines affecting clotting
- Age and general health
The decision should be based on the complete clinical picture rather than hormone use in isolation.
How Do the Surgeon, Anaesthetist and Prescriber Agree a Plan?
Hormone management around surgery may involve more than one healthcare professional.
This is important because each clinician contributes a different part of the risk assessment.
The Surgeon
The surgeon understands:
- The planned procedure
- Expected operating time
- Surgical bleeding considerations
- Expected recovery
- Postoperative mobility
- Procedure-specific complications
The surgeon can therefore explain how hormone therapy fits into the surgical plan.
The Anaesthetist
The anaesthetist evaluates perioperative medical risk.
This includes reviewing medicines, previous anaesthesia, cardiovascular and respiratory health, clotting concerns and other factors relevant to safe anaesthesia.
The Hormone Prescriber
The clinician managing HRT understands the patient's hormone regimen, treatment goals and monitoring requirements.
If a temporary adjustment is required, the prescriber can help determine how it should be managed.
At Elegance Transgender Clinic, Dr. Ashutosh Shah considers hormone planning as part of the broader pre-operative and postoperative pathway, with decisions coordinated according to the planned procedure and the patient's individual medical risk factors.
Patients preparing for surgery can also review pre-operative hormone preparation.
Pre-Operative Hormone Decision Checklist
| Hormone Type | Usual Pre-Operative Approach | Factors That May Change the Plan | Restart Timing | Who Signs It Off? |
|---|---|---|---|---|
| Oestrogen | Individualised; continuation, modification or temporary pause may be considered | VTE history, route/dose, smoking, mobility, procedure and other medical risks | Individualised after postoperative assessment | Surgeon/anaesthetist with hormone prescriber as appropriate |
| Testosterone | Often assessed for continuation rather than automatically stopped | Blood results, cardiovascular factors, procedure and individual health | If paused, restart is individualised | Treating surgical and prescribing teams |
| Anti-androgens | Depends on the specific medicine | Blood pressure, electrolytes, kidney function and anaesthetic considerations | Depends on medicine and postoperative status | Surgical/anaesthetic team and prescriber |
| Other HRT-related medicines | Reviewed individually | Medicine-specific effects and interaction with surgery/anaesthesia | Individualised | Relevant treating clinicians |
Important: This table is a planning guide, not a personal medication schedule. Follow the instructions provided by your own surgical and prescribing teams.
What Does Restarting Look Like After Discharge?
Restarting hormones after surgery should also be planned rather than done automatically on a fixed day.
The appropriate timing can depend on why the medication was paused in the first place and how recovery is progressing.
Why Isn't There One Restart Date?
After surgery, the team may consider:
- Whether the patient is walking normally
- Whether there have been complications
- Current clot risk
- The type of operation performed
- Other medications being taken
- Whether further procedures are planned
- The reason the hormone was initially paused
A patient recovering quickly from one procedure may therefore receive different advice from someone who has undergone a longer operation or has additional risk factors.
Follow the Discharge Instructions
Before leaving the hospital, patients should ideally know:
- Which medicines to restart.
- Which medicines remain temporarily paused.
- When each medicine can be restarted.
- Whether the previous dose should be resumed.
- Who to contact if the instructions are unclear.
Do not guess based on how you feel.
Feeling well after surgery does not necessarily mean the factors that led to a temporary hormone change have resolved.
Information about post-operative hormone support can help patients understand the follow-up pathway.
What Happens If Hormones Were Not Paused as Advised?
If you were instructed to pause a hormone but accidentally continued taking it, tell your surgical team as soon as possible.
Do not hide the information because you are worried that the operation may be delayed.
The team needs accurate information to make a safe decision.
Does It Automatically Mean Surgery Is Cancelled?
Not necessarily.
The next step depends on the medicine, dose, procedure, timing and individual risk.
The surgical or anaesthesia team may reassess the situation and decide what is appropriate.
Do Not Try to Correct the Dose Yourself
If you accidentally continued medication, do not take extra doses, abruptly alter another medicine or attempt to compensate without medical instructions.
Provide the team with:
- Name of the hormone or medication
- Dose
- Route of administration
- Date and time of the last dose
- Any other relevant medicines
The clinicians can then decide whether any change to the surgical plan is required.
For ongoing hormone care, see HRT referrals and monitoring.
Conclusion
Stopping hormones before surgery is not an automatic requirement for every gender-affirming procedure. The appropriate plan depends on the type of hormone, surgical procedure and individual risk factors.
Oestrogen may receive greater consideration because of clot risk, while testosterone and anti-androgens have different perioperative considerations. The important point is that patients should neither stop nor restart prescribed hormone therapy independently.
Discuss your medication well before the operation, follow the written pre-operative instructions and make sure you understand the restart plan before discharge. A coordinated approach allows hormone therapy and surgical safety to be considered together.