We stand at the crossroads of gender balanced on the sharp edge of a knife.

Starting Hormones

STARTING HORMONES (#7)

Many individuals who seek gender-specialized counseling arrive with questions and some uncertainty whether taking hormones is appropriate for their situation. Others arrive with the feeling that they are ready to begin hormones or even have the expectation they will receive instant "approval" and a referral letter. Lastly, some individuals to avoid hassles or for a lack of resources circumvent counseling before starting hormone administration. This article is designed to help my readers be aware of some of the concerns and questions I routinely encounter when interacting with clients and other transgender individuals interested in hormone administration.

The most common situation I encounter is that individuals seeking or using hormones typically are not fully aware of the benefits or risks associated with hormone usage. For example some persons may start hormones believing that they are fast acting and will immediately improve a person's presentation. On the other hand, there are many others who acting out of desperation to resolve gender conflicted feelings will view obtaining hormones as their only salvation. Such persons frequently abandon all common sense by purchasing hormones on the black-market, using prescriptions that belong to others, taking hormones without their spouse's knowledge. The majority also risk their own health by failing to inform their physician of this important medical change.

The primary goal of transgender (or opposite sex) hormone administration is to allow sex hormones to reach target secondary sex tissues so that desired-upon cosmetic changes can be accomplished without jeopardizing other body systems. Individuals need to be aware that while cosmetic changes are not instantaneous hormones still are powerful chemical agents. They can play a contributing role in heart disease, high blood pressure, clotting disorders, liver dysfunction, weight gain and other disabling medical conditions. An individual can significantly reduce the chances of developing one of these conditions, as well as prevent complicating pre- existing health issues, when hormone administration is regularly monitored by a physician providing laboratory testing of blood chemistry.

Monitoring hormone levels also has aesthetic and emotional benefits. In the world of chemistry, more is not always better. Excessive estrogen in MTF individuals converts to testosterone and proves counterproductive to feminizing goals, often causing the individual to have a hardened appearance. Excessive testosterone in FTM individuals causes roid rages or excessive moodiness, and exacerbates dermatological problems. For both populations drastic changes in blood hormone levels can also seriously exacerbate depression.

Because regular physical check-ups and routine blood chemistry testing are essential for successful, safe hormone administration, all individuals are advised to maintain contact with their physician even if they are obtaining hormones through alternative sources.

Using hormones is a serious choice and involves taking responsibility for one's actions. Typically asking the question, "are hormones the right choice for me," should be the beginning of an in-depth self-examination process. Frequently questions regarding hormone usage can be complex and confusing. Therefore, individuals are encouraged to discuss their concerns with a gender-specializing therapist or physician familiar with the benefits and consequences of hormone administration. Lastly, no one should depend entirely on the "advice" they receive from friends or which they read about in "I just started hormones" stories. All to frequently these well-meaning accounts rarely emphasize that successful hormone administration needs to be individually tailored to each person's goals and body chemistry.

The following are questions briefly address some of the more specialized concerns individuals can have about hormone administration:

Does An Individual Need To Be Living "In Role" Full-Time To Be Considered An Appropriate Candidate For Hormone Administration?

Not necessarily. Hormone administration can be appropriate for individuals who consistently have a history of living in role at least part-time and who have consistently been interested in the changes hormones produce. Furthermore, a variety of individuals frequently need the cosmetic benefits of hormones before actually living "in-role" full-time. No individual however should start hormones without giving this important step serious consideration, particularly since regular usage causes physical changes. These changes over time will become obvious to others. Persons who are unprepared to disclose their transgender identity to others or have it brought to their attention (usually at inconvenient times) should seek out non-permanent cosmetic solutions for their transgender needs.

Are The Effects Of Hormones Reversible?

Generally for long-term usage, "no." If an individual tries hormones for a period of one to three months, generally most physical changes will reverse. However the longer an individual uses hormones the longer a "reversal" process will take, if at all possible. Typically in cases where an individual has been on hormones six months or longer, too much change has taken place to allow for complete reversal. In the case of MTF breast tissue, some but not all will recede. In the case of FTM voice change and hair growth, those changes are not reversible.

Should An Individual Tell Their Spouse When Starting Hormones?

Unless an individual is divorced or actually in the process of separating, in most circumstances the answer is, "Yes" An integral part of taking hormones is being able to accept the responsibility of self-identifying as a transgender individual. (No matter whether that individual had decided with absolute certainty if they are a transgenderist or a transsexual.) If an individual decides that using hormones is the right step for them, the spouse or significant other needs to know because this is a serious life-change that does not go without risks and consequences.

Can Using Hormones "Cure" Crossdressing Desires?

No, hormones (or anything else for that matter) cannot cure a transgender individual's crossdressing needs. Occasionally a physician or psychiatrist may prescribe very small dosages of hormones or anti- anxiety/anti-depressive medications, in combination with psychotherapy, to assist individuals who are having extreme difficulties with crossdressing-related anxiousness, obsessive-compulsiveness, or depression.

It should be noted that while having a transgender identity or engaging in crossdressing in and of itself is not mentally disordered, there are a very small minority of individuals who become so excessively focused on their crossdressing concerns that they are unable to function from day-to-day without intervention. Generally most crossdressers do not need pharmacological intervention, but would be better served investing their time exploring healthy outlets for their needs, e.g., groups, private parties, learning disclosure skills and so forth.

Can Hormone Administration Be Used In An Individual Who Is Uncertain Whether They Are A Crossdresser, Transgenderist Or Transsexual?

Occasionally it is possible. However, specifically using hormones as an "assessment" or "gender-determination" tool is a step that should never be initiated without counseling support from a gender-specializing counselor or therapist. In most circumstances, individuals who are consistently interested in hormone administration already have a fair degree of certainty where their gender identity is established or destined. Hormones typically provide validation only in part for what an individual already knows about him or herself. The risk presented in using hormones as a "gender-determination" tool, is that they can present an unfocused and unrealistic perspective of what "being done with transition" is like, particularly for the individual who has not started living in role even part-time.

Does Hormone Usage Change A Person's Libido And Ability To Orgasm Or Ejaculate?

Yes, the degree to which these factors change is different for each individual depending on "what type," "how much" and for "how long" hormones have been used. Also, whether or not an individual has had gonadal or Genital Reassignment Surgery plays a role. Lastly, if an individual is in poor physical health, stressed out or depressed, depressed or taking (certain) medications, these also can change a person's libido and performance ability. Starting hormones is typically a unique and individualized experience. Some individuals might note a sharp rise in the libido but a decreased ability to orgasm or ejaculate. Others sometimes find themselves having little or no desire for sex. For most persons these changes are not instantaneous but rather are gradual.

GIANNA E. ISRAEL provides nationwide telephone consultation, individual & relationship counseling, evaluations and referrals. She is principal author of the Recommended Guidelines for Transgender Care, writes Transgender Tapestry's "Ask Gianna" column; is an AEGIS board member and HBIGDA member. She can be contacted at (415) 558-8058, at P.O. Box 424447 San Francisco, CA 94142, or via e-mail at Gianna@counselsuite.com.