Being transgender represents a misalignment between your internal sense of self and the sex you were born with. Sometimes this is about societal expectations and pressure to conform to gender ideals, sometimes it is about the physical body you were born into/the primary and secondary sex attributes of that body, and often it's both. Hormone replacement therapy is a way of altering the body's secondary sexual attributes to reduce the dysphoria that is cause from the misalignment of ones sense of self and their body.

Doing HRT carries massive life long side effects, which doctors are required to inform patients about. In some places, it requires months of therapy and a doctor's signoff. While I'm sure there are people who have hormonal imbalances, and some of them have perceived gender dysphoria because of it, I find it very unlikely (or at least extremely uncommon) those people would then start taking hormones, given that you have to be _pretty sure_ you're trans before getting near hormones. It seems very unlikely that in the course of a dip in hormone levels where dysphoria was sudden the course of action would be to transition rather than to seek an endocrinologist for answers. If this were common, I would think detransition rates, which many studies have shown to be very low, would be far higher than they are.

Even with 15 years of gender dysphoria, it took me six months post coming out to feel ready to start the hormone conversation, and an additional three months with the prescription sitting in my cabinet before I was ready to actually start taking it. Like I said, my hormonal level baselines were normal for a male.

Edit, RE your edit:

> "hormones have nothing to do with it but write me an Rx to mess with my hormones so that I'm more of a girl."

"Mess with my hormones" is a flippant and inaccurate way to describe a very difficult conversation trans people have with their doctors. You don't start hormones for fun and you don't start them because you're high on estrogen or testosterone. Hormones also don't make you "more of a girl." If you are a trans woman, you are a woman, regardless of whether you are on hormones, have had any kind of sex altering surgery, or have socially transitioned. You take hormones to bring your inward sense of identity outward and reduce the pain that comes from your sense of self not aligning with your appearance and the societal demands and expectations of your behavior.

I am not going to say that I agree with OP, or that OP's language isn't entirely too casual for someone close to this issue but it appears they're most focused on finding out why people have a different inner self than outer expression.

We recognize that the inner self's gender is unalterable (and if it weren't, I'm not sure I'd be comfortable with that sort of mind control), so we must bring the outer in alignment.

However where the inner self gender comes from is something I'm not sure we know too well. Is it the womb? Is it early childhood development? Do hormones and nutrition affect this process which we haven't even pin-pointed in anyway?

Personally, I think it's too early to call out chemicals as a cause. That's a bet we can't take until at least we know the process. And if we're at that point, we could do that mind control that I'm so much against.

> Being transgender represents a misalignment between your internal sense of self and the sex you were born with.

These thoughts, like every other thought anyone has, are mediated by hormones. I'm not saying any particular balance or resulting thought is good/bad/right/wrong/healthy/unhealthy.

But this is akin to saying "being aggressive represents a state of excessive confidence, not elevated testosterone levels." Sure! That's true. But it's also true that elevated testosterone levels tend to increase the frequency and intensity of occasions in which people find themselves in a state of excessive confidence.