Well, in response to both Flame and Clara, I can add this...the TG field seems to have come a long way recently in learning from past mistakes, and in adapting to the needs of individuals.
The endo I visited last week was at pains to state that, following the recommendation of a therapist or counselor, he would be fine with prescribing whatever level I felt comfortable with, according to strictly what I wanted, and then to alter that forward or backward at any point, again strictly according to my desire. The basic thrust was that it was all up to me, and that nothing (short of surgery) was irreversible.
Now, I grant that every doctor will be different. There are bound to be some whose personal views are less understanding. But there are also a lot of good ones, depending on where you live, of course. And the counselor I saw was only concerned with assisting me in whatever I wanted, not in pushing an agenda. I think the either/or thing may have been prevalent in even recent years, Flame, but I think it is quickly being replaced with a much better understanding of the complexities of this issue, and the wide variety of appropriate response. Again, I think it is mostly a matter of who you see. And, further, I think the necessity of therapy or counseling prior to obtaining a referral for HRT is simply a safety mechanism to eliminate or reduce the number of individuals who might pursue the course on a whim, or based in other mental problems that might have nothing to do with actual GID.
On the other hand, there are many TG individuals I have run across on other boards, who, for whatever reason, are still adamantly trying to assert the either/or thing themselves. I suspect they are, as are some heavily religious people, insecure in their own choice and wish to "convert" others in order to calm their own insecurity. But even then, there are also lots of others now pursuing a gender-fluid approach, using some HRT but with no intention of a full surgical transition. It is a big wide world and I think many people are beginning to realize one size never fits all.
As to your last question, Flame, I know some people who do consult a doctor prior to weight loss programs or new exercise regimes. And I myself see one annually just to get a check up. Sometimes we have a mentality that doctors are only there to be used when something is "wrong" but I don't think that is necessarily correct. They have skills and knowledge, and I think it can make sense to make use of their expertise. If we don't like what they have to offer, or advise, we are always free to decline to follow their suggestions, just as I do every time I light one of my little cigars. Tee hee. But in this case, since society makes doctors the gatekeepers to synthetic hormones, and since synthetic hormones are cheaper and supposedly more effective than the herbal programs we follow, it begs the question "why not?" Insurance or lack thereof becomes one effective answer to that question.
Note... I am not doing that myself (pursuing synthetic HRT)... nor do I expect to anytime soon, if ever. And I cannot envision ever, ever wanting a full transition with surgery. Rather, this entire conversation is all just for the fun of pursuing a hypothetical.
And, I know, Flame, that you have a mind that enjoys that kind of discourse, as well, don't you? I know I always enjoy your intelligent comments.
And I am glad you like my name, Flame, though I have never seen Stargate...is it worth watching?
Hugs