Author Topic: Awkward: How do I explain HRT to the doctor?  (Read 1390 times)

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Offline Battle Goddess

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Re: Awkward: How do I explain HRT to the doctor?
« Reply #20 on: June 06, 2021, 08:28:15 am »
Right. When the doctor requested them, it seemed like a bit much, but then I'm not a practicing medical professional. But the more I thought about it, none of them sounded familiar from any of the information or personal experiences I'd read about, even among other expats who've started HRT here in Korea.

Very frustrating to say the least, and I'll leave it at that and just sit here and grumble quietly.
Perhaps they feel like a bit much, perhaps they are a bit much, but perhaps you might reframe the issue for yourself. You might look at it as a good, thorough workup that you end up being real happy you had. There's no way I could get all that done in the USA sans insurance for only two grand.
"It's not really a choice. Because we're not choosing to transition...we're choosing to be happy." -- SarahC

"Have a gentle manner ❤️" -- Chrissy Ryan
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Introductory Post: https://www.susans.org/forums/index.php/topic,242617.msg2196235.html

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Offline flyinginside

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Re: Awkward: How do I explain HRT to the doctor?
« Reply #21 on: June 06, 2021, 08:50:35 am »
Sure, there are many ways to look at it. People should have more regular and low-cost access to preventative testing and be willing to take advantage of it.

But I'll have to stick with "That is a huge chunk of savings to let go when I don't have to," with a sprinkling of "Wait, I have to pay $2,000 without any assurance that I can start HRT?" ;)

The subjectivity of the cost -- whether it's a bargain or not here, there, or anywhere -- is not the point. The fact that it is very likely arbitrary is. $2,000 is several months' rent or, for someone like me, enough groceries for at least a year.

Especially, as I said, when other trans women here have not had to clear such a performative financial demonstration of their commitment to receiving HRT.

I'll sort it out on Tuesday. And again, I have nothing against the doctor personally. I think she's new to this, though, and may be having trouble getting up to speed. I'm willing to hear her out, at the very least.

Anyway, I'm just repeating myself. But thanks to everyone for their input! :D

Offline Battle Goddess

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Re: Awkward: How do I explain HRT to the doctor?
« Reply #22 on: June 06, 2021, 08:54:33 am »
Not to pry, but since you did mention others in Korea who have done HRT, are their docs no longer accepting patients?
"It's not really a choice. Because we're not choosing to transition...we're choosing to be happy." -- SarahC

"Have a gentle manner ❤️" -- Chrissy Ryan
"Working on it" -- Battle Goddess


Introductory Post: https://www.susans.org/forums/index.php/topic,242617.msg2196235.html

Whiny HRT and Transition Blog: https://www.susans.org/forums/index.php/topic,244163.msg2217618.html

Spironolactone January 10 2019
Divigel January 20 2019
Estradiol Valerate March 14 2019

Offline flyinginside

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Re: Awkward: How do I explain HRT to the doctor?
« Reply #23 on: June 06, 2021, 08:57:54 am »
No, that's a good question. I may have to consider going to one of them instead. Unfortunately, they are in Seoul and I live about four hours away by train. I could go there to get started and then get a referral to a local hospital, but it would still be irksome to travel that far several times. It would be a whole-day undertaking each time. *Pouts*

Offline AnonyMs

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Re: Awkward: How do I explain HRT to the doctor?
« Reply #24 on: June 06, 2021, 09:48:38 am »
It's not impossible that, as her first HRT patient (and the hospital's first, too), she's curious about the treatment and wants to put me through the paces to gather a lot of data. She also mentioned documenting my body hair and didn't explain why very well. Ha ha.

If that’s the case they can pay for it.

Offline Battle Goddess

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Re: Awkward: How do I explain HRT to the doctor?
« Reply #25 on: June 06, 2021, 10:09:31 am »
No, that's a good question. I may have to consider going to one of them instead. Unfortunately, they are in Seoul and I live about four hours away by train. I could go there to get started and then get a referral to a local hospital, but it would still be irksome to travel that far several times. It would be a whole-day undertaking each time. *Pouts*

I hear you.

Perhaps, too, you could get your doc to have a consult with one of them about necessary intake testing after explaining the financial burden she's imposing on you.

My own (very experienced) endo does in fact want to physically cast an eye on me at 6-month intervals, we did blood draws every month until my levels stabilized and still do them quarterly, and I checked in with him frequently over the phone at first of my own volition because I'm paranoid. But that's just me, and I know I'm basically in pretty good shape.

So no matter what, I'm certain you can count on a fair amount of F2F contact in your partnership.

Body hair? Goodness. One would think she would have had internet access.
"It's not really a choice. Because we're not choosing to transition...we're choosing to be happy." -- SarahC

"Have a gentle manner ❤️" -- Chrissy Ryan
"Working on it" -- Battle Goddess


Introductory Post: https://www.susans.org/forums/index.php/topic,242617.msg2196235.html

Whiny HRT and Transition Blog: https://www.susans.org/forums/index.php/topic,244163.msg2217618.html

Spironolactone January 10 2019
Divigel January 20 2019
Estradiol Valerate March 14 2019

Offline RandiL

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Re: Awkward: How do I explain HRT to the doctor?
« Reply #26 on: June 06, 2021, 12:06:16 pm »
I get several of those as part of my routine care, outside of anything to do with HRT.

-bone density test - I did have this once as an aging person

-echocardiogram - only if symptoms indicate a need, which hasn't happened for me

-chest x-ray - same, only if needed

-endoscopy - I did have this once because I had specific symptoms

-colonoscopy - routine screening exam

-mammogram - routine screening

-ultrasonogram - only if symptoms

-prostate exam - routine screening

For HRT my doctor orders the hormone tests as well as what she calls a metabolic panel.

And my primary care also orders an even more comprehensive set of blood tests annually including fasting blood draw and PSA.

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Offline flyinginside

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Re: Awkward: How do I explain HRT to the doctor?
« Reply #27 on: June 07, 2021, 07:47:56 am »
Precisely. When they're routine care or in response to certain symptoms, they're very good ideas. And in fact, a number of them are fully or mostly covered by the national insurance here -- they're just not covered at all if they're requested as part of "optional" or "cosmetic" treatments, as HRT is considered here.

In other words: D'oh. :(

Offline Battle Goddess

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Re: Awkward: How do I explain HRT to the doctor?
« Reply #28 on: June 07, 2021, 09:36:12 am »
Well, heck. I've lived in Chicago. The solution there would be to show up at another doctor's office with a pocketful of twenties and say that you want a raft of diagnostic tests. A pocketful of twenties smoothes over all sorts of little bureaucratic snags, even outside of Chicago.

You yourself mentioned that you're a woman of a certain age, no? If these tests wouldn't be untoward, perhaps a little doctor-shopping could get them for you as a matter of routine maintenance. Would the system in Korea not then allow you to share the results with your HRT doc?
"It's not really a choice. Because we're not choosing to transition...we're choosing to be happy." -- SarahC

"Have a gentle manner ❤️" -- Chrissy Ryan
"Working on it" -- Battle Goddess


Introductory Post: https://www.susans.org/forums/index.php/topic,242617.msg2196235.html

Whiny HRT and Transition Blog: https://www.susans.org/forums/index.php/topic,244163.msg2217618.html

Spironolactone January 10 2019
Divigel January 20 2019
Estradiol Valerate March 14 2019

Offline flyinginside

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Re: Awkward: How do I explain HRT to the doctor?
« Reply #29 on: June 12, 2021, 11:35:39 pm »
Oops. I've been busy lately, teaching a university course and preparing for a new one and finishing the first draft of my book and blah blah.

Just wanted to add an update, to be thorough: I talked about the tests with the doctor, and she said they weren't really necessary for HRT. She said if I wanted to skip them it would be fine, and I said, "YES!" Because, again, they're important for general well-being, but they're a financial burden if they're not immediately necessary (and if you're paying out of pocket).

That said, I decided to put off starting HRT until maybe August or September. Now that the path forward is clear, I want to be extra-sure that this is something I want to commit to. Plus, I need to consider leaving Korea and possibly going somewhere to start a PhD program. I need to get all my little duckies in a row. :D

Offline barbie

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Re: Awkward: How do I explain HRT to the doctor?
« Reply #30 on: June 15, 2021, 09:01:22 pm »
Oops. I've been busy lately, teaching a university course and preparing for a new one and finishing the first draft of my book and blah blah.

Just wanted to add an update, to be thorough: I talked about the tests with the doctor, and she said they weren't really necessary for HRT. She said if I wanted to skip them it would be fine, and I said, "YES!" Because, again, they're important for general well-being, but they're a financial burden if they're not immediately necessary (and if you're paying out of pocket).

That said, I decided to put off starting HRT until maybe August or September. Now that the path forward is clear, I want to be extra-sure that this is something I want to commit to. Plus, I need to consider leaving Korea and possibly going somewhere to start a PhD program. I need to get all my little duckies in a row. :D

To save the cost, you may have better contact other transgender expats who have done HRT in S. Korea. I have contacted only two expats so far, but my impression is that it seemed simple and easy once you find a doctor who knows well about transgender and HRT. The transgender community here in S. Korea is closed and clandestine, and even I have never faced any other Korean transgender people except those in 'the transgender bar'

In my case, I stopped before undergoing HRT, but the doctor requested a psychiatric test to get a prescription for HRT. It costed about US$400. But you may not need it, as the questionnaires of the test are all in Korean. Prescription for transgender expats may be a grey area between legal and illegal stuffs, but I am not quite sure.

Typically, the liver test may be the only requirement for HRT.

Yes. All doctors here are hungry for money, which I can understand.

barbie~~



Just do it.

Offline flyinginside

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Re: Awkward: How do I explain HRT to the doctor?
« Reply #31 on: June 15, 2021, 10:40:04 pm »
In terms of medical treatments and medication, if it's legal for Korean citizens, it's legal for anyone else, foreign or otherwise. And since I'm a legal resident paying into the national insurance program, there should be no difference in the rates I pay. Should.

But yeah, I'm clear to start HRT whenever I want, so that's a nice option. No one ever suggested that I need a psych test; the doctor and hospital both seem to have an informed consent approach.

As for the cost of hormones, for estrogen pills, at least, they're about 200 won ($0.20) per pill. The doctor checked that for me. Injections are more but still exceedingly cheap. So that's a feather in my cap. ;)

The few trans women in Daegu I've met have all been taking estrogen they buy online, which freaks me out. But they've typically been in Korea without visas, working in factories and such, so they don't have access to proper healthcare. :(

Offline barbie

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Re: Awkward: How do I explain HRT to the doctor?
« Reply #32 on: June 16, 2021, 03:33:09 pm »
As for the cost of hormones, for estrogen pills, at least, they're about 200 won ($0.20) per pill. The doctor checked that for me. Injections are more but still exceedingly cheap. So that's a feather in my cap. ;)

Yes. Even without national insurance, medical costs in S. Korea are cheaper than in the US with insurance. For example, about 15 years ago, I had to take chest x-rays and it cost about 4k won (ca. USD 4), but it was more than USD 60 with insurance + USD 10 or 20 copayment in the US. And most basic dental cares here are cheaper than the USD 10 or 20 copyaments in the US. In the US. I took out all of the baby teeth of my kids, but here in S. Korea no parents do that as the dental cost for it is so cheap (probably less than USD 1) and you can visit the dental office even without reservation. In the US, I had to wait at least 1 week after reservation.

barbie~~

Just do it.

Offline flyinginside

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Re: Awkward: How do I explain HRT to the doctor?
« Reply #33 on: June 16, 2021, 06:55:09 pm »
Well... Routine healthcare tends to be cheaper here, sure, and that's good.

But as they say, you get what you pay for -- about 30 seconds to talk to the doctor before he rattles off a list of tests and "up-sells" needless prescriptions and so on, and then you make another appointment to come back to make another appointment to get the test results before making yet another appointment to have the doctor shuffle the papers around for a minute or two and "explain" the tests, and on and on. ;)

Even the best, most well-meaning healthcare is still set up like fast food here. When you get into something more dire, like specialized surgery, cancer treatment, and such, you're still going deep into your pockets, and that's why people (including me) still have to pay for personal insurance. Those low, low healthcare costs are more like a discount coupon, so again, if it's routine, it's good that it won't break the bank. But if it takes a moment of insight from a specialist for an illness that isn't one-size-fits-all, I hope you have savings!

Even in my own experience which I've been sharing here, I had to pay about $500 before the doctor admitted, yes, all those tests and stuff weren't necessary. So whether a test is cheap or expensive, the system will always be rigged to get your money and put it in their pockets. ;)

Anyway, I'm not bashing anything, I'm just saying that the reality of the situation isn't all K-pop gloss and high-speed glitz. It's still just another country with its high points and lows. For every BTS cloud of noise, there's the reality of, say, no anti-discrimination law, and for all the high PISA test scores among students there's the OECD's highest rates of suicide among school-aged children.

But this has nothing to do with my post, so I'll shut my yap now! ;)

Offline barbie

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Re: Awkward: How do I explain HRT to the doctor?
« Reply #34 on: June 17, 2021, 03:01:59 pm »
Well... Routine healthcare tends to be cheaper here, sure, and that's good.

But as they say, you get what you pay for -- about 30 seconds to talk to the doctor before he rattles off a list of tests and "up-sells" needless prescriptions and so on, and then you make another appointment to come back to make another appointment to get the test results before making yet another appointment to have the doctor shuffle the papers around for a minute or two and "explain" the tests, and on and on. ;)

Yes. I know it well. It can happen in the US, too. About 20 years ago, my primary care doctor gave me a referral to visit a specialist in the D.C. area. I drove for 2 hours, and the specialist talked just for 10 seconds. It was a kind of conveyor belt. At that time, I was a state employee, and the state covered most of my health insurance (ca. USD 7k every year).

And all of my 3 kids were born in the US. The doctors and nurses were really kind and caring. But the overall bill charge was more than USD 10k for each of my babies. In S. Korea, they are not so kind and caring, but the charge is less than USD 100. I pay about USD 4k every year for national health insurance.

I am now finally at home (Jeju island).


barbie~~
Just do it.

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