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HRT Doctor: "Why I Wish All of My Patients Were Transgender"

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I came across this blog about a month ago, which is by an endocrinologist who writes about his experiences in practice. From what I can tell it's mostly directed at fellow practitioners but it has a wealth of information for patients, too. Here's the post I found (and commented on) that I find so helpful and... hopeful:

Why I Wish All My Patients Were Transgender

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The 0.6% number comes from a fairly recent study by The Williams Institute at UCLA. Indeed, they doubled their previous 0.3%. Note that the percentage is only for the adult population, about 1.4M people total. For perspective they say 3% are gay/lesbian.

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I wrote the following email to the doctor (who keeps his name private) who publishes this blog. I found his response to be very helpful and interesting.

My email to him:

Hello doctor,

I'm the one who added a comment to your post about "Why I Wish All My Patients Were Transgender": 

Thank you, thank you, thank you. As a 61 year old trans woman who is only now seriously contemplating HRT (after so many decades of denial, shame, fear) your writing gives me hope. I’d like to be one of those who feels great and confident in her body and soul.

A problem I'd like to pose to you, and which you might want to write about, is that part of the challenge of being trans is that there is no objective test for whether one is trans. I've gone through a lot of introspection, therapy, and study and I'm convinced that I am. So are my professional therapists. However I still suffer from a fair amount of self-doubt and questioning. I guess that's baggage from growing up when I did. But still...

I'm thus taking it all slowly, one step at a time, and with each step evaluating my feelings, after whatever euphoria has waned at least a little. I'm thus at the stage where I feel that hormone treatment is probably the correct next step. So here's the question: might low-dose HRT be a viable strategy for evaluating whether one is trans or not? The assumption is that if a cisgender person started HRT that they would experience their own version of gender dysphoria. Likewise, a trans person would feel a sense of relief, perhaps some sort of completeness, upon the same therapy. And perhaps some would not experience anything at all.

Do you have experience or an opinion on this? I've asked my gender therapist and another friend who is one: they both agree that this is a common experiment by trans people, who can evaluate their feelings and determine if HRT is right for them or not before permanent physical changes occur. That said they aren't endocrinologists!

Many thanks,


And here is his reply:

Hi Emma,

Your question is totally valid.  I wouldn't presume to tell you what might be appropriate for you, as I'm sure you understand that would be a decision among you, your therapist, and your endo.  I will say, though, that I think it's quite reasonable for someone who believes they have gender dysphoria (with the blessing of an experienced therapist) to "test the waters" with cross-hormone therapy.

I think it's difficult to use it as a tool to "prove" that the diagnosis of gender dysphoria is correct (or incorrect).  One reason for the difficulty is that, after I start someone on hormones, they often come back in 2-3 months feeling less dysphoric, but the degree of improvement is out of proportion to the dose of hormone (I usually start low and go slow) and the duration of therapy (short, only 2-3 months at that point).  I believe that this is due to a sort of placebo effect; people feel so much better after starting hormones because they are finally moving forward on the path to becoming who they know they should be (bad grammar, but you get my point).  This is incredibly powerful and can make it feel like the hormones are "working," when in reality it's probably more complicated than that.

All that said, I think it's a fine way to proceed.  There is no "set" dose of hormone that has to be used for someone interested in transitioning.  For example, my patients who identify as non-binary may ask for low-dose therapy to achieve some changes, but not drastic changes.  And that's ok.  The hormone dosing schedule should always be tailored to the person's goals (and their risks, like if they have medical problems that make hormone therapy a riskier proposition).

I hope this helps.  Let me know if you have other questions, and best of luck to you! 


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