Can you imagine obtaining a hormone recommendation letter, perhaps even visiting your physician and going to the pharmacy, but then deciding not to follow through taking the prescription?  Not using or actually stopping hormones once they have been started is more common than most transgender people recognize.  This article probes the reasoning behind such decisions, as well as provides information to persons who feel uncertain whether taking hormones is the right step.

It is often believed that starting hormones demonstrates that a person truly has a transsexual or transgender identity.  Paired with this misconception is the credo that taking hormones indicates a person is truly committed to making a permanent transition.  After all, isn't the purpose of taking hormones to develop the much desired physical traits of one's true gender identity?  In many regards, yes.  However, many people who start hormones do so unprepared for the vast amount of emotional and social changes that accompany this transition step.  Sometimes just going through the process of obtaining a recommendation and prescription helps an individual decide if going through significant changes is right for him or her. 

Transitioning, we come to find, is more about many other aspects of our lives rather than solely about the medicine we take.  To self-identify as having a transsexual or transgenderist identity is itself a very difficult process.  Very few people start out as one gender and then magically realize one day that they must transition.  Instead, as with all things involving personal growth and development, transition is a process involving recognition, experimentation, stepping forward, even reversing changes that don't work for us.  Included, too, are disclosing to family and friends, developing an employment disclosure and coming out dates, learning how to dress and shop, even undergoing electrolysis and cosmetic surgery.  Hormones are only one piece of the puzzle of what constitutes gender-change.

Essentially, transsexual individuals seek permanent, full-time transition and genital reassignment.  Transgenderists, on the other hand, seek a more flexible gender presentation which can include permanent changes but not genital reassignment surgery.  Often at the beginning of a transition, most transsexuals and transgenderists seek to gain the physical and sometimes the mental benefits associated with taking hormones.  However, it is often not until the prescription is actually in hand, or the changes begin, that many transgenderists decide that using hormones may take away too much of their original gender.  In other situations, and particularly with transsexuals, having a lot of unresolved personal affairs inhibit the desire to proceed further with new physical changes that would be easily observed by others and create social complications.

Therapists and physicians diligently strive to insure that transgender individuals understand the consequences of hormone use before starting. It is however ultimately up to the transgender man or woman to ensure that he or she has prepared for the changes and consequences.  Spouses need to be informed of the change.  So, too, do close friends.  These important people do not need to be left concerned and confused as to why events are occurring without explanation.  Lower androgenizing dosages may be useful for MTF's who have not disclosed to employers and completed their electrolysis.  Higher MTF dosages and FTM prescriptions can then be initiated later after an employment transition date has been established, when people are aware of why a person is changing.

Careproviders often have fears about inappropriate persons starting hormones.  The reality is, however, that more harm exists among transgender persons who are denied prescriptions and subsequently self-administer hormones.  For this reason both careproviders and their clients must collaboratively plan transition steps, so that treatment may be started at the most appropriate time.  There are numerous health risks associated with self-administering, and having periodic blood laboratory testing to insure that one is receiving the correct dosage is part of good transition planning and health care.  Self-medicating is never a good idea, however, stopping hormones if they consistently feel wrong is an acceptable and responsible exception.  This change should be told to the prescribing physician on a person's next office visit.

Over the years I have observed that some individuals obtain a recommendation and prescription, and then stop taking hormones when the prescription runs out, and then disappear from the gender community for several years.  Approximately four-fifths of these persons actually resume taking hormones and reinitiate contact with the gender community at a later point.  In returning to counseling these individuals often appear sheepish or embarrassed about not having followed through with their original plans.  These feelings are however unnecessary.  A person should never regret his or her efforts at trying to understand gender identity issues.

Sometimes stopping and restarting later is what is required in order to decide if transitioning is right.  Most of these second or even third-time starters believed that a new relationship or change of employment would make their gender issues disappear or reduce the desire to transition.  We now know, there is no cure for having a transgender identity, although it is possible to take a short vacation.  These individuals should not be punished for their indecisiveness, particularly since self-imposing a stop of hormones or transition can provide the person time to answer questions which might not otherwise be answered.

I occasionally receive calls from therapists and counselors, as well as clients, regarding the situation of a person who cannot make up his or her mind.  In other words, they start and stop repeatedly over the course of time, and never can come to a firm decision whether staying on hormones is right.  In the vast majority of these situations this pattern indicates that the individual has unresolved issues related to transition which may not always pertain directly to the medications.  Beyond informing pre-existing relationships of the change, many individuals have simply not spent enough time exploring within the community, and engaged in dressing or role play within their new identity.  However, in other circumstances a continual pattern of starting and stopping evolves, this may reveal the person has a transgenderist identity, which in contrast to the transsexual identity can fluctuate widely between maleness and femaleness.  This pattern is not unhealthy once an individual comes to terms with needing both male and female gender identity components.

If indecisiveness is a pattern a person does not want, sometimes establishing a three month commitment period can help resolve uncertainties.  Those that decide to go commit, usually are able to stay with it, but some stop afterwards.  Most importantly, those that decide against a trial period, usually do so because they simply are not ready. There is nothing wrong with not being ready to start hormones, and the wait is worth it because of the tremendous responsibilities associated with hormonal changes.  

Beyond discussing uncertainties with one's therapist and physician, it can also be extremely helpful to hear experiences of others who are unsure whether moving ahead is the right step.  Many of these individuals can be contacted on the Internet or at one's local support group.  After hearing opinions from professionals and friends, an individual's choice to either start or stop hormones can be positive if given the correct self-introspection.  Transition is often for many a one-time event, and after completion life generally stabilizes.  During the decision-making processes, however, exploring one's feels, gender role, and the changes that come with hormones should be enjoyed.  Make the experience yours.