Why hormones are often prescribed before a single therapy session

1. Twenty-minute “assessments” are real
People who later detransition report that the shortest documented therapy session leading to an immediate hormone recommendation lasted only twenty minutes. “I sat down with the therapist for about twenty minutes, said I was feeling dysphoria from an identity misaligned with my body and needed to change something, and just like that I was given a recommendation for HRT to start immediately.” – ayesb source [citation:0dbba6f0-59e1-42a8-bafd-b2ae2498b012]

2. No follow-up is expected
After the brief visit, many never saw the therapist again. “Two weeks later I was on testosterone blockers and a smaller dose of estrogen, and I haven’t seen the therapist since.” – ayesb source [citation:0dbba6f0-59e1-42a8-bafd-b2ae2498b012]
Others describe the same pattern: two 30-minute appointments and a physical, or two sessions totaling about an hour, after which prescriptions were handed out with no ongoing oversight.

3. Therapists feel they cannot suggest alternatives
Clinicians often believe they must affirm the patient’s self-diagnosis and fear being accused of conversion therapy if they explore other causes or treatments. “Gender-affirming therapists are trained to not question their patient’s perceived identity… they can’t refuse you hormones or offer alternative treatment.” – lurker_number_69 source [citation:1430719b-2cd2-4c35-8713-1512230ae7d7]

4. Referral systems shift responsibility
Because the therapist only writes a letter and an endocrinologist actually prescribes, the therapist has little incentive to slow the process. “There are only downsides for the therapist to refuse, and they’re not the ones fulfilling it anyway.” – slushpilot source [citation:c4de3829-f953-440e-8d13-535f99067e49]

5. Red flags are routinely ignored
Even documented histories of eating disorders, personality disorders, or long-standing depression were not treated as reasons to pause. “She also had on record that I had a previous history of mental health issues, including eating disorder. Somehow this didn’t raise a red flag for her.” – [deleted] source [citation:33273ec1-e0ca-4f64-912b-8cf6f84b2915]

A hopeful closing thought
These stories show that medical transition is frequently offered as a first-line response, yet the people who lived it now wish someone had instead helped them explore the feelings underneath. If you are questioning your gender, know that non-medical paths—talking through trauma, building self-esteem, and learning gender non-conformity—can bring the same relief without lifelong physical consequences. You deserve time, care, and real conversation before any irreversible step.