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The goal of this consent form is to review the potential risks and benefits associated with the use of testosterone hormone therapy.
A. The full medical effects and safety of hormone therapy are not fully known.
Potential adverse effects may include, but are not limited to:
B. The risks for some of the above adverse events may be INCREASED by
C. Irreversible body changes (potential increases with length of time on hormones) resulting from hormone therapy may include, but are not limited to:
My signature below constitutes my acknowledgment of the following:
I have read and understood the above information regarding hormone therapy, and accept the risks involved.
I believe I have adequate knowledge on which to base an informed consent to the provision of hormone therapy I authorize and give my informed consent to the provision of hormone therapy.