Getting Cold Feet Before Starting Hormones: What It Really Means by Dr. Z

You've been thinking about transition for years. You've been waiting for that medical appointment. You finally got scheduled to start hormones—and suddenly you're backpedaling. You feel like maybe you don't need it. Maybe the dysphoria isn't that urgent. Maybe you can live in your assigned gender just fine.

This phenomenon of getting cold feet before starting hormones is incredibly common. More common than almost any other transition step. Here's why it happens:

You're crossing a significant threshold. This isn't just a social transition or coming out. This is medical treatment that will physically change your body, alleviate dysphoria, and create visible changes that might force disclosure before you're ready. Your psyche recognizes: this feels like a point of no return.

Inner resistance kicks in. You deeply want this—you need this—but you're also terrified of everything that comes with it. You're acutely aware of the challenges: losses, relationship changes, uprooting your entire life, and replanting yourself in different soil. As humans, we'd rather stay in pain we know than face pain we don't. You've gotten accustomed to living with dysphoria daily. You know how to survive that pain. The pain you anticipate from the transition? That's unknown territory.

Here's the false fallacy: You're going to experience pain and challenges either way. You might as well experience them while taking steps toward authenticity—where you gain connection to yourself, reduce dysphoria, and people who love the real you, rather than perpetuating the same pain with zero room for positive change.