Glucocorticoids have been responsible for the success of kidney transplantation, and for half a century they have been the most classical and widely used immunosuppressant, still playing an irreplaceable role in kidney transplantation. Likewise, because of the well-known side effects of hormones, attempts have always been made to minimize or even withdraw their use. Hormone withdrawal regimens have been a hot topic of discussion in the field of kidney transplantation, and there have been numerous controlled clinical studies on hormone withdrawal regimens internationally, the conclusions of which are not entirely consistent. The improvement of glucose metabolism, lipid metabolism, and osteoporosis is obvious, and this is a common conclusion in many studies, which is the positive effect of the hormone withdrawal regimen. At the same time, most clinical studies have also shown that the incidence of rejection in kidney transplant patients is increased to varying degrees after hormone withdrawal, which is a negative effect of hormone withdrawal and a concern for hormone withdrawal. Therefore, clinicians need to evaluate more carefully which patients are more suitable for hormone withdrawal and which patients need long-term hormone maintenance therapy. Personally, I think the next two areas deserve our attention. First, primary renal disease is an important factor to consider when withdrawing hormones. We can divide the primary diseases that trigger uremia into two categories: immune and non-immune factors, immune factors such as IgA nephropathy and chronic glomerulonephritis, and non-immune diseases such as polycystic kidney and diabetic nephropathy. It was found that among kidney transplant patients who survived long-term for more than ten years, if the primary disease is uremia caused by immune factors, such as IgA nephropathy, about more than half of the patients will have recurrence of nephritis, resulting in hypofunction of the transplanted kidney and the appearance of proteinuria, while patients with non-immune factors such as polycystic kidney uremia do not have this concern. Hormones are commonly used in the treatment of immune nephropathy, and the use of hormones after transplantation can also reduce the recurrence of primary nephritis to some extent. In addition, such patients may suffer from hyperalgesia and endogenous glucocorticoid deficiency in the organism due to long-term preoperative hormone therapy, and complete withdrawal of hormones sometimes results in signs of adrenocortical insufficiency and requires resumption of hormone use. Therefore, in recipients with immune nephropathy, hormones not only play an anti-rejection role, but also have a preventive effect on the recurrence of the primary renal disease. Therefore, maintenance therapy with small doses of hormones would be more prudent in patients whose primary is immune nephropathy, and the safety of hormone withdrawal may be higher in patients whose primary is non-immune factors such as diabetes and polycystic kidney. Second, the combination regimen of immunosuppressive agents is another important factor influencing hormone withdrawal. The first is the perioperative immune induction regimen. The perioperative period is a critical time period when the patient’s immune system undergoes a dramatic change, during which the body’s immune system undergoes a rebalancing process to accommodate the new kidney. Proper immune induction, such as treatment with polyclonal or monoclonal antibodies, can better inhibit or adjust the activation and remodeling process of the body’s original immune system, laying a good foundation for the long-term survival of the graft, and the safety of postoperative hormone withdrawal is higher for this patient. The second is the impact of the combination of immune regimens during the maintenance period. A large number of clinical studies in recent years have shown that the maintenance regimen using tacrolimus combined with primaquine has a lower incidence of rejection and a higher safety profile for the recipient after hormone withdrawal. Therefore, when considering hormone withdrawal, we should give due consideration to the combination of drugs used for induction and maintenance therapy. In conclusion, physicians and patients are looking forward to hormone withdrawal regimens, but in practice, we need to be careful and prudent, taking into account a variety of circumstances such as the patient’s primary disease, immune induction therapy, and the combination of immune regimens used for maintenance. We need more information from large multicenter samples to develop more scientific hormone withdrawal protocols.