So I live in a shitty Midwestern city and there aren’t a lot of trans-friendly doctors in this joint. I’m lucky enough that my school has a therapist specializing in LGBT issues and he’s pretty good, but as far as hormones go, the only MD we knew of in this hellhole has retired and run away to Florida or some such place. However, the local Planned Parenthood clinic offers trans services, so I’m working with them. Which brings me to the subject of the various Standards of Care.
For the most part, treatment of trans people is guided by the WPATH Standards of Care. These are generally accepted as the best guidelines for the treatment of transfolk. However, Planned Parenthood has its own SoC.
The major difference is the hormone replacement therapy bit. WPATH doesn’t prescribe when trans people should start hormones. For this reason, a lot of people, especially MtFs, like to start hormones first and then transition to living full-time once those hormones have started to do their job. At Planned Parenthood, you have to live full-time for 2-3 months before starting hormones. I think this is the better option.
I feel like a lot of trans people (mainly women and girls) think hormones will be some sort of magic bullet that makes them automatically pass. Passing takes time and effort. I’ve been working for a while to learn to pass, and I’m getting pretty good. Hormones may help with fat redistribution and whatnot, but they won’t magically make you pass. By having some real-life experience before starting hormones, you’re sure that this is what you want to do. Hormones really fuck with your system, and some of the changes can become permanent. Furthermore, estrogen can cause mood swings and depression, so if you have hidden emotional problems that haven’t been dealt with, you could crash hardcore. (My doctor says Premarin is the estrogen that she’s had most problems with in the mood swing area.) For this reason, it is best to live full-time first, then start the hormones once you’ve adjusted. Therefore, I think the WPATH should suggest that a few months of RLE be mandatory for hormone replacement therapy.
Again, I know a lot of trans women think hormones are a magic bullet, but you can’t bank on them. Get some experience passing first.