I am a transgender woman who has long sensed that I was different from the boy I was raised as—though it took me many years to fully realize the nature of that difference. Growing up, I was keenly aware of a sense of incongruence between how others saw me and how I saw myself, but I did my best to suppress and rationalize those feelings, never quite knowing how to articulate them. Only recently, in March of 2023, did I begin my own transition in earnest. Since then, I’ve often reflected on how it would have helped to read compassionate, nuanced information earlier in life—information that respected my autonomy and validated my feelings.
I share this personal background because I know firsthand the questions, fears, and uncertainties so many transgender individuals face—particularly if they’re “eggs,” still sorting out the realization that they might indeed be transgender. One of the biggest decisions many of us consider is whether to begin hormone therapy. Hormone therapy can be life-changing, but I also recognize that it’s not necessarily the best or only path for everyone. I’ve met trans people who have flourished without hormones, or who need time to consider alternative routes before adding a medical dimension to their transition.
This article will thus address the following question: Is hormone therapy always the best option for all transgender individuals? We will discuss the reasons hormone therapy is popular and often beneficial, while also exploring the many reasons it might not be right—or might not be right yet—for everyone. We’ll look at alternative or complementary treatments that can support transition goals, and emphasize that a personalized healthcare approach is key to ensuring that each individual’s journey is respected and affirmed. We’ll also address the phenomenon of gatekeeping—the idea that someone has to meet rigid standards before “deserving” care—and why compassion and open-mindedness are so crucial in trans healthcare.
Finally, we’ll define the term “egg” as it’s used in the transgender community: typically referring to an individual who has not yet consciously acknowledged or embraced their transgender identity but has some underlying sense of incongruence or questioning. If you identify as an egg, or if you suspect you might be an egg, this article is for you. And if you’re a family member or ally, I hope you’ll walk away with a deeper appreciation of the many facets involved in affirming and supporting someone’s gender identity—whether that entails hormone therapy or not.
Understanding Hormone Therapy
Hormone therapy for transgender individuals generally involves either a regimen of estrogen (often combined with testosterone blockers) for transfeminine people, or testosterone for transmasculine people. By altering the levels of certain hormones in the body, people can experience changes that align more closely with their internal sense of self. For transfeminine individuals, this might include breast growth and a redistribution of body fat, while transmasculine individuals might notice deeper voice changes and an increase in muscle mass, among other effects.
Benefits of Hormone Therapy
- Physical Alignment: Aligning the body with one’s gender identity can significantly reduce dysphoria. Many trans folks find that hormone therapy brings relief from a discomfort that was once pervasive in their everyday life.
- Improved Mental Health: Multiple studies have shown that transgender people often experience heightened well-being and fewer symptoms of depression or anxiety when their bodies begin to reflect their gender identity.
- Social Validation: Hormone-induced changes (e.g., facial and body shape, skin texture) can help transgender individuals navigate social situations more confidently, alleviating stress about being perceived accurately.
Challenges of Hormone Therapy
- Medical Risks & Side Effects: Although hormone therapy can be safe when supervised by an experienced medical professional, there are potential risks. These might include altering cholesterol levels, impacting fertility, and other side effects that require ongoing monitoring.
- Emotional Adjustments: Hormonal changes can impact emotional patterns, libido, and mood. Adapting to these new states may require patience, self-awareness, and possibly therapy or counseling.
- Accessibility & Cost: Regular doctor’s visits, blood tests, and prescription costs can be a hurdle for those lacking insurance coverage or stable financial resources.
Before we dive into the reasons hormone therapy may not suit every transgender individual, it’s important to acknowledge just how empowering and transformative it can be for many people, myself included. However, no single medical intervention is ever a perfect fit for everyone—especially when gender identity and self-expression can be so wonderfully diverse. In the next section, we’ll explore why hormone therapy might not always be the go-to option and examine how personalized approaches to transition can better serve each individual’s unique needs.
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Why Hormone Therapy May Not Be Right for Everyone
For all its potential benefits, hormone therapy may not align with everyone’s transition goals, health needs, or personal beliefs. Some transgender individuals thrive on a path that does not include hormones. Others, including those with complex medical histories, might need to delay or avoid hormone therapy altogether. Recognizing this diversity is crucial to building a compassionate, inclusive view of transgender healthcare.
- Diverse Gender Identities & Expressions: The transgender community spans a vast range of identities: nonbinary, genderqueer, agender, bigender, demigirl/demiboy, and more. Hormone therapy typically follows a more binary medical model, but not everyone identifies in binary terms. Some may desire partial feminization or masculinization, sometimes known as microdosing, while others focus on social or legal transitions without altering hormone levels at all.
- Personal & Cultural Beliefs: An individual’s cultural or religious background can play a significant role in medical decisions, including whether to start hormone therapy. Some people may feel uncomfortable using hormones for philosophical or health-related reasons. Others, especially those with families or communities that don’t support medical transition, may find it emotionally complex to commit to hormone therapy—no matter how strongly they might desire it.
- Mental Health Factors: No one is required to achieve flawless mental health before starting hormone therapy, but certain mental health concerns can complicate the transition process. For instance, those experiencing severe depression, anxiety, or trauma might want to address these issues in therapy before or concurrently with starting hormones. A holistic approach can ensure that emotional well-being and practical considerations are aligned, ultimately improving outcomes and reducing distress during the transition.
Having explored the myriad reasons why hormone therapy may not be the right choice—or the only choice—for every transgender individual, it becomes clear that there is no universal blueprint for transition. Factors like personal identity, culture, finances, and medical risk profiles all shape one’s journey, underscoring the need for a more nuanced approach. This realization naturally leads us to consider how healthcare can best accommodate these differences. In the next section, we’ll delve into person-centered care, examining how collaborative decision-making and individualized treatment plans empower transgender people to pursue the transition paths that feel most authentic to them.
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The Role of Personalized Healthcare
Modern medicine is increasingly embracing person-centered care, which means focusing on an individual’s unique needs, circumstances, and goals rather than a predetermined blueprint. For transgender patients, this approach means each person’s transition journey can—and should—look different. Part of my motivation to write this article stems from wishing I’d encountered more providers who genuinely listened to my personal story and concerns, rather than fitting me into a standard track for transition.
Collaboration between patient and clinician forms the bedrock of a positive healthcare experience. Effective medical professionals invite patients to ask questions, voice doubts, and explore alternatives in a nonjudgmental environment. Since I started my own transition in March 2023, the value of having an open, empathetic medical professional has become abundantly clear to me. Shared decision-making fosters trust and ensures that patients feel empowered, not pressured.
Sometimes, well-intentioned family, friends, or even members of the transgender community assume that hormones are the “obvious” next step for anyone questioning their assigned gender at birth. This isn’t always the case. People have different comfort levels, various personal histories, and individualized reasons for exploring or avoiding hormone therapy. Instead of seeing hormones as a universal solution, we can adopt a flexible and supportive mindset, ensuring trans people of all identities are validated in their unique choices.
Having explored how personalized care puts you in the driver’s seat of your own transition journey, it’s time to look at the specific non-hormonal or complementary options available. While hormone therapy can be life-changing for many, it’s not the whole picture—nor is it always the right fit for everyone. In the next section, we’ll dive into the wide range of alternative treatments and supports that can help you affirm your gender on your own terms, from mental health services to voice training and beyond.
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Alternative or Complementary Treatments
Hormone therapy can be a primary route to relief for many, but there are also numerous other ways to address and alleviate gender dysphoria—and sometimes these are all a person needs, at least for a time. Below are some common non-hormonal treatments or strategies that transgender individuals may consider.
Mental Health Therapy & Counseling
Why It Helps:
- Self-Discovery: Trained gender therapists can facilitate exploration of your gender identity, life experiences, and transition goals in a structured, supportive environment.
- Stress Management: Transition-related decisions and social pressures can cause anxiety and depression. Therapy offers coping tools to handle these stressors.
- Planning & Goal-Setting: A mental health professional can help you map out next steps, whether that’s hormone therapy, social transition, or simply working on self-acceptance.
For many “eggs,” therapy can be the key to understanding who they are and what they want before making any irreversible changes. Even for those who are certain about being transgender, therapy can be a powerful source of emotional resilience throughout the transition journey.
Voice Training & Communication Coaching
Why It Helps:
- Confidence Building: A voice that aligns with your internal sense of gender can greatly reduce dysphoria and help you feel more comfortable expressing yourself.
- Real-World Impact: Voice training can lessen instances of misgendering, which can boost confidence and sense of safety in public.
For some transfeminine people, voice training is pivotal—even more so than certain physical changes—because it directly influences how others perceive them in everyday communication. The same can apply to transmasculine folks who want to refine vocal techniques and speech patterns.
Social Transition
Why It Helps:
- Immediate Affirmation: Changing name, pronouns, clothing, or hairstyle can deliver a sense of relief and self-affirmation well before considering hormones.
- Low Medical Risk: Social transition involves few to no medical interventions, but can still address important elements of one’s identity.
This step can be approached at a personalized pace—some do it all at once, while others integrate changes gradually. For instance, I found it immensely freeing to experiment with clothing and pronouns in safe circles before committing to more public changes.
Laser Hair Removal & Other Aesthetic Treatments
Why It Helps:
- Targeted Dysphoria Relief: Unwanted body or facial hair can be a consistent source of anxiety for many transfeminine individuals. Similarly, transmasculine folks might prefer hair treatments that emphasize or reduce certain features.
- Body Positivity: Making even small aesthetic changes can enhance self-esteem, fostering a sense of belonging in one’s own body.
These treatments can be done independently of hormone therapy or as a complementary measure, allowing people to customize which changes matter most.
Surgical Procedures Without Hormones
Certain surgeries—like top surgery (breast augmentation or mastectomy), facial feminization, or tracheal shave—do not always require prior or ongoing hormone therapy. Some transgender people find relief primarily through surgical alignment rather than hormonal shifts. While many clinics recommend or require hormones as a prerequisite for specific procedures, exceptions and individualized protocols do exist.
While these alternative or complementary avenues can offer valuable paths toward relief and self-fulfillment, it’s essential to recognize that navigating transgender healthcare often involves overcoming systemic barriers as well. In particular, overly restrictive or outdated practices—commonly known as gatekeeping—can complicate access to vital services and undermine the principle of personal autonomy. In the following section, we’ll examine the pitfalls of gatekeeping, how it manifests, and why a balanced yet flexible approach is necessary for truly comprehensive transgender care.
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The Dangers of Gatekeeping
“Gatekeeping” in trans healthcare occurs when medical providers, mental health professionals, or even community members impose strict, sometimes arbitrary barriers to receiving care—often demanding a person exhibit stereotypically masculine or feminine traits, or fulfill a rigid set of criteria before being deemed “worthy” of transition-related services.
Historically, transgender individuals had to prove their readiness for hormone therapy by living as their identified gender for an extended period—commonly called “real-life experience.” While some measure of preparedness can be helpful, forcing people to present themselves in narrowly defined ways to receive basic care is both harmful and outdated. If you encounter a provider who insists on narrow criteria or whose approach feels invalidating, seeking a second opinion might be necessary.
Legitimate medical evaluation can help detect any potential risk factors and ensure that decisions are well-informed. However, thoroughness should never morph into paternalism or condescension. Genuine, informed consent models honor patient autonomy. In my own transition, having a clinician who asked thoughtful questions without casting doubt on my self-knowledge was invaluable—and it’s something I wish every trans person could experience.
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Supporting Eggs in Their Exploration
The concept of an “egg” holds significant cultural meaning within the trans community. In general usage, “egg” is slang for a trans person who has not yet come to terms with their identity—a term often applied retrospectively to one’s past self or to someone believed to be trans but not out. This metaphor extends to what’s called an “egg crack moment,” the point at which a trans individual realizes they aren’t the cisgender person they once believed themselves to be. For some, this understanding is swift and defining; for others, it’s preceded by years of inner conflict, subtle questioning, or accumulated hints that eventually break through denial or uncertainty.
There’s also what some refer to as “egg theory,” a kind of logical framework that prospective trans individuals use internally to gather evidence—consciously or otherwise—that supports their trans identity before they feel ready to transition. Originating around the mid-2010s, “egg” became popular online shorthand for a trans person who has yet to realize or accept their identity, or “crack their shell.” Through these concepts, the trans community has cultivated a shared language that encourages introspection and self-acceptance.
For someone wrestling with unidentified dysphoria, the egg metaphor can be both revealing and reassuring. It underscores that self-realization is a process and that it’s perfectly normal to take time before identifying explicitly as trans. As a community, we tend to view this unhatched identity not as a failing but as a step on the journey, one often enveloped in confusion, denial, or disbelief. Recognizing yourself as an “egg” can bring relief by showing you’re not alone—countless others have traversed that same path to self-discovery.
Eggs, by nature, occupy a delicate phase of possible denial or intense introspection. They often have unanswered questions: “Is this real?” “Am I trans enough?” “What if I regret coming out?” Because cracking one’s egg can be equally enlightening and terrifying, offering gentle support and understanding—rather than demanding immediate commitments—proves invaluable. By respecting every stage of exploration, we allow people to name their truth at a pace that feels safe and empowering.
The Role of Family & Allies
Families and allies can provide crucial reassurance and resources during this time. Simple, affirming phrases like “I’m here if you want to talk” or “I accept you no matter what” help eggs feel safe enough to examine their identity. This environment of unconditional positive regard is what eventually enables a person to “crack” their egg on their own terms—leading, if and when they’re ready, to a deeper recognition of their gender identity. Conversely, dismissive language or rushed expectations can nudge someone further into self-doubt or silence.
Understanding and embracing the concept of an “egg” fosters empathy for anyone still discovering their transgender identity. It serves as an important reminder that every journey differs, and not everyone arrives at self-realization overnight. By recognizing these nuances, we not only create a more inclusive environment but also empower eggs to transition at their own pace—whether that means starting hormones, changing pronouns, or simply experimenting with self-expression one small step at a time.
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Weighing All Sides of the Issue
For many transgender people, hormone therapy provides a critical means of addressing long-standing dysphoria. Physical, emotional, and psychological changes can seem like a missing puzzle piece finally snapping into place. Studies consistently show that trans individuals who receive gender-affirming healthcare, including hormone therapy, experience lower rates of anxiety, depression, and suicidal ideation.
On the other side, not everyone needs hormones to feel complete. Some folks focus on social transition, mental health supports, or aesthetic treatments to alleviate dysphoria. Others prefer to delay hormones while they sort out broader life circumstances, such as job security or family acceptance. Emphasizing alternative or complementary paths in no way undermines the importance of hormone therapy; rather, it highlights that each person’s timeline and comfort level can vary greatly.
The question, “Is hormone therapy always the best option?” cannot be answered with a simple yes or no. While it is often transformative and arguably essential for many transgender people (myself included), others may find comparable fulfillment in different forms of transition. Whether that’s therapy, voice training, or another route, the ultimate aim is aligning one’s inner self with outward expression. Personalized choice, free from coercion or stigma, remains paramount.
Personalized Healthcare: Steps to Get Started
Self-Reflection & Research
Before leaping into hormone therapy—or consciously deciding against it—take time to reflect. Ask:
- Which aspects of my life and body cause the most discomfort or distress?
- What are the core changes I seek, and are they necessarily hormonal?
- Am I prepared for the potential side effects or emotional shifts of hormone therapy?
- Do I want to try steps like name changes, pronoun changes, or aesthetic alterations first?
Reading reputable articles, following gender-affirming doctors or clinics online, and joining support forums can shed light on these questions. Just take care to discern reliable sources from sensational or unvetted claims.
Seek Knowledgeable Medical Professionals
If you do decide to explore hormone therapy—or even if you just want more information—finding a qualified provider is essential. A knowledgeable clinician will explain the realistic outcomes of hormone therapy, including timelines, side effects, and possible risks. Many larger cities have LGBTQ+ health centers or providers who specialize in transgender medicine; if you live in a smaller community, telehealth options may be available.
Informed Consent & Ongoing Assessment
Informed consent is a model of care wherein you and your provider carefully review the benefits, risks, and alternatives of hormone therapy, then jointly decide the next step. There are typically fewer gatekeeping requirements, allowing transgender individuals to make autonomous decisions once they have all necessary information. By incorporating regular follow-ups and blood tests, you can track your body’s responses, adjust dosages, and address any new concerns along the way.
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The Bottom Line
It took me years of self-discovery to arrive at the point where hormone therapy felt like the natural choice, and even then, I started my medical transition only in March of 2023. I share this milestone because it underscores how varied each person’s journey can be. Some transgender people know from childhood they want hormones, while others do not feel compelled to take that step. Neither path is more “valid”; each is simply a reflection of personal circumstances, identity, and comfort.
Whether hormone therapy stands out as a necessary treatment or feels like too much, too soon, it’s crucial to understand that all transgender individuals deserve respect and autonomy in plotting their transition path. From voice training to surgical options or mental health therapy, many roads can lead us toward the relief and happiness of living as our authentic selves.
When we let go of the myth that hormone therapy is universally right for everyone, we open the door to a more flexible and empathic approach, one that embraces the diversity of trans experiences. While hormone therapy can indeed be profoundly life-changing for many of us, it’s not a panacea for every individual’s needs—and that’s okay. Validating these differences prevents gatekeeping, fosters supportive communities, and helps everyone—eggs, out-and-proud trans people, families, and allies—meet each person right where they are.
If you’re reading this as someone just beginning to question your gender, know that there is no expiration date on self-discovery and no rigid timeline you must follow. Don’t be afraid to explore therapy, social transition, and the many other facets of affirming your identity before making a definitive choice about hormones. Trust your instincts, and gather information from knowledgeable sources and caring professionals.
As someone who lived for years with an unspoken sense of difference, only to finally embrace a more authentic version of myself in my adulthood, I offer heartfelt reassurance: Your identity is valid from the moment you begin to sense it. Let your journey unfold at your own pace. Allies, friends, and family, please remember that empathy and acceptance are the biggest gifts you can offer, no matter where someone is on their path.
Transgender healthcare works best when tailored to the individual. That might include hormone therapy, and it might not. Ultimately, the beauty of this personal odyssey is that there are as many transition stories as there are trans people telling them. By honoring each story’s uniqueness, we celebrate the resilience and authenticity that define our vibrant community.
