Hormones before going full-time

[Numinum]

Here goes, I hope I'm posting this in the right place!

I keep reading posts from members who say they were x months before going full-time; is this something not possible in the UK? From what I understand I need to start going full-time before hormones on the NHS, is this different for going privately?

I don't have a lot of money saved up - probably about £800-1200 - so I don't think I could afford to go private, though if it's much easier to get the whole process started I might just bite the bullet and search for more jobs (I'm basically picking up any website/programming jobs I can find as it is, as well as a few English writing ones).

I'm still trying to get in touch with my GP again at the moment so I guess I've got time!

[Emily Aster]

This confused me too. I'm from the US and we can get hormones before the RLE. The RLE is just a prerequisite for SRS. I learned just a couple months ago that the RLE is apparently a prerequisite for hormones in the UK.

[Stephe]

I was full time for several years before I started HRT. I know this isn't a popular opinion but I don't think RLE before HRT is a bad idea. There is a LOT more to living full time as the opposite of your birth gender than taking some medications. It's quite far down my list. I myself wanted to make very sure I could deal with living full time before I started HRT.  Maybe "full time" shouldn't be required but I do think part time as your new gender should be done to make sure you -really- understand what you are getting into.

[Numinum]

I was full time for several years before I started HRT. I know this isn't a popular opinion but I don't think RLE before HRT is a bad idea. There is a LOT more to living full time as the opposite of your birth gender than taking some medications. It's quite far down my list. I myself wanted to make very sure I could deal with living full time before I started HRT.  Maybe "full time" shouldn't be required but I do think part time as your new gender should be done to make sure you -really- understand what you are getting into.

I absolutely agree that living full-time is more than just a prerequisite for medications, but I felt that starting hormones would give me a consistent confidence boost before going full time, simply because of the feeling that there's something going on behind the scenes.

I currently work under my female name (as I'm freelance) and my friends and family are all aware, but I'm still not sure I have the self confidence to go full time just yet, even though I know it's what I want to do. Ick.

[suzifrommd]

Maybe "full time" shouldn't be required but I do think part time as your new gender should be done to make sure you -really- understand what you are getting into.

Well I understand there are two reasons why the WPATH SOC no longer requires any RLE before HRT.

First, nearly all the effects of MtF HRT are reverseable. The only one that isn't, permanent breast development, occurs only after months and months of HRT and it still recedes after HRT is stopped (and can be corrected by surgery if it's really a disaster). So the relative harm in allowing a woman to start HRT before she understands what she's getting into is minor, in comparison to SRS, for example, which is traumatic and irreversible.

The second reason, and IMO the most convincing is that an awful lot of MtFs will, if you put roadblocks to medically supervised HRT in their way, will simply opt for unsupervised HRT, which CAN be catastrophic.

[Numinum]

I have to admit I didn't even consider an advantage to self-medicating until finding out this. It's something I really want to avoid unless there's no decent alternative, but I'm not going to jump to conclusions just yet - I'll talk it over with my GP the next time I can manage to get an appointment, have to show her the WPATH SoC too so I hope I can squeeze it all in to a single visit just to see if I have any options just yet.

[Stephe]

I guess in my case I was going to live full time no matter what happened. I wasn't going to wait months or more likely years to see if HRT "made it easier".  I'm not sure in my case it would have. The -only- thing I would do different if I had things to do over was sort out my voice much sooner.

[Numinum]

I guess it just varies from person to person; either that or I'm just particularly awkward. In my case I'd love if I had the self esteem to not care about hormones and all that, but I feel like it'd ease me into the whole process a little easier, being young and in a slightly iffy area of the city. [Edit: that really wasn't meant to sound like I was calling anyone else not young, I just read it and it totally sounded bad - I'll just be quiet, I'm probably making this worse for myself! ]

I still haven't managed to get in touch with my GP. Attempt 3 tomorrow since it's pretty late at the moment (4:30am for anyone wondering ).

[Numinum]

Scared again of my next GP visit and I can't sleep! I'm just going to give her the WPATH SoC and attempt to vocalize everything I've written, hopefully I get further than a psychologist visit this time, last time I was too nervous to say a whole lot.

[RachelH]

Many of us in the UK who do use HRT before RLE are self medicating, or a few are private clinics. 

The gender clinics are very aware that a considerable number of new patients may be self medicating, and some have strict policies regarding stopping  medication when entering their pathways.  The centre I use doesn't stop self medication, mainly as they realise the negative psychological effects of forcing someone to do so, I personally would have got extremely depressed very quickly.

I admit I am self medicating, and will be until mid February when I go for my next appointment and prove I've began and are in RLE.  I have however been fortunate in having a GP who will monitor my blood, and check my Liver functions, and likewise the doctors on ship when I'm away will do the same.

The main reason why I choose to do this was simple, in order for me to begin RLE I had to pass.  After a year I was ready, I went into RLE and everything, amazingly and very luckily, has gone to plan. 

I have argued, and will continue to do so, with the consultants regarding this pathway policy.  I think it is absolutely disgraceful that we cannot have HRT before RLE, we are adults give us informed consent.  In my opinion, you are just increasing the misery and increasing the depression in people who are already extremely vulnerable.  Forcing them to actually go out and live their nightmares of been perceived as "men in dresses" etc is not acceptable.  I had to choose another way, as do many others.  The pathway and care for transsexuals is very outdated in the UK as highlighted at #TransDocFail

[Aleah]

Here in Australia, we also don't need RLE before HRT since most doctors follow WPATH.

I can see the merits in RLE before HRT for some, but it's a personal thing, personally I went part-time shortly after I started HRT. There is no danger in being on HRT for up to 6 months or more, I doubt anyone would be unhappy with the reversibility if they decided to stop and detransition at  that point.

Personally going full-time could be far more destructive for some than a being stuck with a bit of gyno! Losing family, friends, jobs.. a lot of that is irreversible. Better to see how you feel about your transition after a few months on HRT and then take that (and probably biggest) step.

I've heard of private clinics doing informed consent, maybe try that?

[Numinum]

Lots of thanks for the response, it definitely sheds some light on how the UK handles it. I'm pretty scared of self-medicating but I've accepted it as a possibility, though not until I'm completely sure there's no better route. Even if it were the route I took I'd be discussing health monitoring with a GP or doctor first.

There appears to be a staggering lack of options in Liverpool, possibly also in other areas. That is to say we don't yet have a sexual health clinic and the only WPATH-abiding therapists are way too far away.

Also I hope this isn't weird to say but Aleah your blog is really cute, just sat here and read through half of it with a huge smile on my face.

[Numinum]

GP agreed that I felt a bit like I was being passed off, she's going to get in touch with me in the next few days after contacting Abacus or the Women's Ward (I have no idea where either of them are, but I'll figure it out ).

I'm going to hold out my hopes for the time being - I felt awkward at first since she's been the doctor for most of my family too, but she's really friendly and is obviously trying to be as helpful as possible.

[JohnnieRamona]

I'm in the US, and I'm on HRT while still presenting as boy. I'm six months in and I feel GREAT. Best decision I've ever made. So that's my two cents.

[Shantel]

I was full time for several years before I started HRT. I know this isn't a popular opinion but I don't think RLE before HRT is a bad idea. There is a LOT more to living full time as the opposite of your birth gender than taking some medications. It's quite far down my list. I myself wanted to make very sure I could deal with living full time before I started HRT.  Maybe "full time" shouldn't be required but I do think part time as your new gender should be done to make sure you -really- understand what you are getting into.

Yes, good thinking especially if you intend to live out your life as a woman. If things don't work out as planned and you get cold feet at least you could back out gracefully.

[Nicolette]

Personally, HRT was essential before RLE. I needed to pass 100% in my work. If after a year and I still didn't pass then I would have had FFS. As it happens, I had some very minor FFS before RLE. HRT plus FFS was an incredible confidence boost and made dealing living fulltime a walkover. I can't imagine doing fulltime with male pattern fat distribution and body hair in my face and body and getting away with it.

[Shantel]

Personally, HRT was essential before RLE. I needed to pass 100% in my work. If after a year and I still didn't pass then I would have had FFS. As it happens, I had some very minor FFS before RLE. HRT plus FFS was an incredible confidence boost and made dealing living fulltime a walkover. I can't imagine doing fulltime with male pattern fat distribution and body hair in my face and body and getting away with it.

Guess we can conclude that everyone has different needs and transition isn't a one size fits all proposition. This has always been my take on the issue anyway. That's why it says MtF Androgyne next to my avatar. It clearly states my beginnings, the direction I'm going and where I intend to finish. One has to concede that we all have diverse expectations of what our eventual outcome will be.

[JessicaH]

I can't fathom trying to transition without HRT and can think of zero benefits in doing so. The damage that I will incur when I "come-out" will be far more irreversible impact on my life than taking HRT or even having SRS.  It's not right but then more passable you are when you go full time the easier you will be able to adjust in a new role and the better people will be able to see the real you.

I will admit (and not proudly but for honest discussion) that it messes with my head seeing someone obviously male bodied, presenting as female. Matter of fact, it's that kind of thing that scared me back in the closet several times in the past and made me think that the idea of being able to be passable was foolish. Someone that it really far from passing just messes with most peoples head and it's not about transphobia. Our brains are very hardwired to SEE certain things and the brain has certain expectations when it experiences something. Kind of like tasting milk when you were expecting Mountain Dew. Even if you love Mountain Dew, there is a high level of dissonance when you don't taste what you were expecting.

I certainly don't advocate telling anyone how they should transition but I think it absolutely cruel to deny someone the opportunity of HRT before they transition. There is also a possibility that they start HRT and quickly discover that all this girly stuff is just silly, once the testosterone levels drop and the E levels rise. Only drawback is that if you are trans, you probably aren't going to give up the HRT once you try it and that 30-60 trial run will quickly be 2-3 years and counting! :-)

[Numinum]

I can't fathom trying to transition without HRT and can think of zero benefits in doing so. The damage that I will incur when I "come-out" will be far more irreversible impact on my life than taking HRT or even having SRS.  It's not right but then more passable you are when you go full time the easier you will be able to adjust in a new role and the better people will be able to see the real you.

I feel like you completely 'get' my feelings towards HRT before full-time. In my case I can understand (but not relate) to the people saying they didn't need HRT beforehand, but to me I feel like instead of getting experience as a woman, I'll get experience as a guy in a dress, at least in how people approach me. I'd also want to go for HRT first for those moments of looking in the mirror and thinking 'heck, at some point in the future I'll pass more easily'. Personally that would make the whole experience a million times less daunting.

No update from my GP yet but it's only been a few days so far, still keeping my hopes up.

[Numinum]

GP said it'd be a few days, phoned after a week and got told to 'wait a few more weeks' by the secretary there. Just when I thought I was getting somewhere.