by Gianna E. Israel
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:
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.
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.