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How Soon Is Too Soon? (For Prescribing Hormones)

Updated: Feb 24, 2020

So, I've actually got a question for my readers this time. It has bothering me for a while. And I have researched, youtubed, etc. only to find limited scientific data, but a good deal of experiential information. But I really wanna hear from y'all. So....

How soon is too soon to prescribe hormones for someone who identifies as either transgender or as nonbinary to some degree? And what I mean specifically by that question isn't age-related, I am wondering about at what point after seeing me would you consider it okay to prescribe for someone. So say you come in and we discuss your history and whatnot, and at the end I say, "Well, you seem fairly sure, but I'd like to do some further exploration of your feelings about xyz before proceeding with hormones." I don't do that now, but should I? Let me explain a bit more....

Currently, if someone presents to my telemedicine clinic visit with what goes for typical transgender feelings/experiences/reports/etc, and they tell me they want hormonal transition, I go over in detail:

1. What transition means to them and how they came to this realization/decision.

2. What will physically happen.

3. The approximate timeline for these physical changes.

4. What this can mean for them in regards to how it will affect the varying aspects of their life.

5. Cost of therapy.

6. Side effects and permanent effects of hormones.

7. Medications generally used and their side effects.

8. Make a recommendation on a medication regimen.

9. What are their support systems?

10. I assess their current knowledge about hormone therapy, and transitioning in general, to be sure they are making a fully informed decision.

And many many other little details go into it as well, such as their previous medical/mental health history and current state of their overall health. But the main thing here is that I simply need to assess that the person is well-versed and prepared for the journey. My initial visit with a patient, depending on their level of understanding and background with hormones, lasts about 60-90 minutes on average. And unless I see some glaringly obvious reason why they should not transition, I will prescribe for them at that visit, as well as order baseline labs and schedule a follow up. To date, I have not had to turn anyone away or had to have anyone see me more than once prior to prescribing.

Now, there are many who tell me I am foolish to do this, for wide and varied reasons that usually boil down to a certain level of, "I just want you to be careful in case they are wrong." Hmmmmm. If they are wrong, it will not always be apparent anyway at the time. So how many hours do I then need to spend with someone to ascertain their own intimate desires for their body? It just doesn't feel right to me to tell someone "no" if I feel they are of sound mind, they state they are a different gender than assigned at birth, and they are well-educated on the transition process. I mean, yeah, there are red flags that I am trained to watch for and investigate further beforehand, but other than those, what? What do you think?

I have been researching de-transitioning lately, which is to say I have been looking for data and have been not finding much. I have been looking into this in part because I wondered if I prescribe too quickly. Unfortunately, there really aren't many studies out there currently, except a small few. Although, some are so biased and obviously transphobic that they can't be taken seriously, which only further limits the pool of data. At any rate, de-transitioning does occur, and while it is not common, it is somewhere between rare and not-unheard-of. Ha. One study put it at about a 2% incidence rate. Ok. So why? Why do these people de-transition? Was something missed on their initial evaluations? Were they given hormones too soon? Were they just plain wrong? Were they these so-called "trans-trenders" that seem to pop up in conversation with anyone who is trying to downplay the true transgender experience? Well, here is what I found so far...

Reasons for de-transitioning:

1. Safety. This could be physical, career, family, etc. They de-transition because being their true selves is putting them in harm's way due to the bigotry of society.

2. They had an underlying psych issue that could have been easily caught but wasn't for whatever reason.

3. Some few have sought escape from bad situations (both real and mental) through becoming an entirely new person.

4. And many, by far, seem to be running from something else inside and developed the mistaken belief that transitioning would solve their internal struggles.

The last one mentioned in #4 was the most prevalent amongst the interviews I watched with de-transitioning people. It is kind of like when a compulsively overeating obese person has surgery for weight loss without first addressing the psychological aspects of overeating. Then they lose a lot of initial weight, but their habits are the same, so they end up gaining a lot back. So they are still unhappy inside, just as they started off.

How to spot that, though? Your guess is as good as mine. Then how could I help prevent de-transitioners? Again, not so clear. Most of the folks on the interviews stated that they weren't sure that imposing an extended period of time before transitioning would have helped them figure out the real problem first or not. Many also said that they never would have figured it out without transitioning in the first place. So they saw transitioning as necessary for their eventual self-discovery. And while all of these people expressed "regret" to some degree, no one I saw really seemed angry about it as they are often portrayed by transphobic idiots. More often, they reacted as those who have placed a regrettable tattoo somewhere highly visible. They kind of talked about their experience as just that, an experience. Not something to be hated, but something they learned from. And now the tattoo is a reminder of how far they came.

Of course, there are always some nuts out there, too. Many that I suspect have been planted to throw doubt on transgender people's existence and validity. But the vast majority seemed pretty accepting of their transition and de-transition. Interesting.

So, you've heard my prescribing habits. And then you've heard some concerns I had that I investigated. What are some other things you would add for consideration? Or am I doing the right thing as it stands? I honestly cannot see telling people that they don't know what gender they are. If someone told ME that, I think I would get pretty rowdy pretty quickly. Ha! So as I said previously: Sound mind? Good understanding of the process? Healthy enough for it? Then I'm not standing in your way. And I don't know why others do. When I ask, they always say, "How can you know that they really know that about themselves in just 60-90 minutes?!" Well, how do you know you're right-handed? How do you know that you love your spouse? How do you know that you like the toilet paper with the sheets OVER the roll? Some things you just KNOW.

Love Y'all,

Stacie, NP

Spectrum: The Other Clinic

Transgender Hormone Therapy

Telemedicine Clinic in Mississippi

601-466-9495 Text Me!

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