I know I'm getting far ahead of myself, but this has been in the back of my mind ever since I realized I needed to speak with a therapist.

I feel like some kind of physical transition might suit me. I feel like HRT would be a key step in sussing all that out. Say I go, and they agree that HRT might be a good idea for me. They give me the OK, but I want to sit on it. I worry that they might see my delay, decide I'm not "serious" about this, and take back their approval. Is this reasonable fear, or just paranoia? I'm really good at using convoluted remote possibilities to stop me from doing the things I need to do.

Again, I feel like some kind of physical transition might suit me. Part of me, though, is just as anxious about them confirming as rejecting that. In a lot of ways, 2010 was a low point in my life. Just on the financial end, it'll take at least until the middle of next year before I'll finish digging myself out of that hole. I think I can deal with that, as there are a ton of other things I need to do for myself that don't involve much money. Step one: losing all this extra weight before someone harpoons me! 

I know HRT itself can be relatively cheap and I know there are low dose HRT regimens that provide mostly psychological relief. But I also know two things from reading here: once I start, I may never want to face life without it; once I start, I may never want to slow down...

Most referrals and scripts have a 12 month shelf life. But that is going by Australian standards.. though I assume it's the same else where. I don't think anyone is expecting you to rush into anything if anything waiting shows that you have given it extra thought and not just going blindly into it. If you do have any doubts most decent doctors will pick up on that just from the things you say.

Haha, no, they do not have a shelf life.  But don't be surprised if the clinic/doctor that is going to be prescribing you hormones might ask you why it took you so long to start if the date on your letter is quite far in the past.  If it is really bothering you, you should simply be able to tell your therapist to not write you the letter until you know you are ready to begin HRT.  Or, ask for a new one with a recent date.

Thanks for your responses, Muffin and Ashley. 

So many people here are desperately trying to get their HRT letters. I figured the therapists were so used to seeing that, they'd be suspicious of anyone who doesn't race to the endo the first chance they get. I guess it does seem kind of silly. If they did do that to me, it's probably a sign that I should run away from them.