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I think that far too many people feel the need to draw lines in the sand, depicting what you are, and at what point you become something else entirely. The gender spectrum is wide and varied, and you will find all sorts of people pushing the boundaries of each defined role type. I'm a crossdresser; but I'm also a little bit TG, a little bit TS as well. Too often someone wants to put me into one box or another, and ignore the feelings and behavior that makes me part all those things. The yearning I feel to be female makes me want to transition, to take hormones, to be a real girl. And yet, that is an impossibility, I can never be that, no matter what I do. And in so many ways, I am not a girl at all. But that doesn't make the feelings go away.
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One time I got diagnosed with Low Testosterone , my levels were very low and my Endo that I see for my thyroid issues prescribed me Testosterone. It felt great just for a couple of weeks then I started to feel the same way before the testosterone therapy but I still continued the testosterone for a few more months. I started noticing that my body was changing and rounding on places that never did, I even got little stretch marks on my buttock area, my testicles started to shrink and erections were very difficult to obtain, there was a feeling of emptiness down there that is difficult to describe but honestly it felt great also I got very weepy and emotional.
The odd thing is that my testosterone levels never improved actually decreased even more, not even doubling the dose of testosterone, it got to a point that my T levels got too low that my endo had to redo the lab work because he couldn't believe it were so low just above zero. I had to stop the T therapy because it was affecting my Prostate too, my urologist later explain to me that he believes the Testosterone for some reason was aromatizing into estradiol... The thing is that during that time I looked the best ever and crossdressing was really easy that always think to myself...What if but then again I know for experience Hormones are really powerful stuff
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I'd say while it goes beyond presentation, I don't think it goes beyond simple versions of expression. Even transsexuals are considered as expressing their true selves as the opposite genders. I'd also say there are extreme expressions that are more acceptable that this type of body modification (including other pretty extreme body modifications).
In terms of being considered a transsexual, the real question using more common concepts is whether or not the person wants/needs to live full time as the opposite gender.
Any other version kind of gets muddled into the grey spaces in-between the terms we label this stuff with. Normally all the warning labels associated with hormone use means that the risk is not recommended, or generally acceptable without a much more NEED oriented focus. In general it means that unless transitioning is the only way to ensure an individuals mental health, hormones should not be administered. This is very different than saying that by starting to take hormones you are automatically transsexual, but on the other hand that if you AREN'T transsexual and taking hormones, you fall outside of what is currently acceptable, even within the LGBT community. In many cases you may be doing something you would regret as well.
Hormones do have large effects on A LOT of the body, and adding from external sources can stress certain organs. Also especially for people who still identify with their birth gender, and may not have access to the right information to avoid the many side effects that can be irreversible using current technology (sterility being one). Another obstacle is without the imminent need to do so, an individual may not invest the money to avoid some of the negative effects (sperm/egg banking to keep the theme of my examples). All of this really leads to the generally accepted idea that only transsexual people take hormones, while it isn't exactly true using the strictest terms.