Still fucking around with the hormones a lot. A Psychiatrist may take a different view on this than I would with my Psychology background (Psychiatry being far more medical based than Psychology) though, so take that as you will. I am always erring on the side of avoiding using such things until the person's body (and mind) are stable. You see how strong my distaste for anti-depressants and mood stabilizers are and those are bread and butter in the industry, get me into hormones and I just don't want to even go there until I know it is safe. Edit - This is me admitting that this may be a lack of professional application of the degree and being far more theory based than practical application of the knowledge. My favouring of Psychoanalysis and Gestalt therapy both kind of suggest that I like to think of working with patients for a while and the real world applications obviously are something quite different.
I agree with the general rallying against anti-depressants (as do most people I know who've been on anti depressants). In general you need to fix the source of the problem--if there's something in your life that's making you unhappy you have to deal with it (anti-depressants should only be a short term "keep me functioning through this" when you can see the light at the end of the tunnel and just need to hold it together until you get there). Or that's the explanation I've read anyway--never actually been depressed >_>
Here's the problem, though: being trapped in the wrong body MAKES a lot of people depressed. You can't cure the core problem WITHOUT prescribing hormones. On the other hand, there's a double-edged sword here--putting people on hormones essentially throws them into puberty (regardless of their current age), and puberty is an emotionally unstable time for...basically everyone. For this reason it's dangerous to put an extremely depressed person on hormones.
And as far as talking it out before starting hormones? Yeah, that's generally actually required (for different regions I've heard numbers from 3 months to 2 years of therapy required before starting hormones, and generally the therapist can decide to not write the patient a letter of reference if he or she doesn't think the patient is ready). So...no, this doesn't sound like a rapid "oh well I'll just write you a hormone prescription then." I would consider 6 months of therapy for anything to be pretty long, and a sign of serious problems.
I still question the effects the use of pubert blockers has on the subject in this case the mind is going to be doing some very strange things in that kind of case (And not in a transgender kind of "strange" I mean just in a basic developmental way compared to most. Puberty kind of sucks, but some of it is a crucible that does form a part of your mental development and plenty of it stems from the parts of puberty that go beyond Estrogen and testosterone).
I'll be honest, I couldn't tell you specifics of how puberty blockers affect the brain. I don't even know if they're necessarily legal in America, even, or what the actual drugs are (I was reading about some school of transgender children in Europe, which is where I came across the concept, but it would not surprise me at all if America was more draconian).
As far as psychological social development, though, that can shut down in transgender cases (they do not want to grow as their original gender, so they basically put their personality in cold storage). That said, someone who is living as the target gender may not actually have these developmental issues, as they may be getting the teenagerhood they want, and thus not be putting on the mental brakes.