Doctors, do they know what they're doing?

[V M]

I'd like to think that most actually studied in school and know what they are doing, but sometimes I wonder... HRT is serious stuff and I get a bit nervous sometimes when I read some of the threads about what some Dr.s are offering and/or having their patients do

Other times I suspect that the person asking the questions is self medicating and just guessing what a Dr. might say or do based on people's responses

Not sure what to think sometimes... Please friends, HRT is serious biz.

BE CAREFUL, BECAUSE YOUR LIFE COULD VERY WELL DEPEND ON THE CHOICES YOU MAKE REGARDING HRT

Said my piece

Love and Hugs

Virginia

[JungianZoe]

I know this much: if I don't get satisfactory answers on the 17th, I'm finding a new doc.   I'm incredibly dissatisfied that mine has one treatment regimen, and if it doesn't work, she gives up.  That's what's happening in my case.  I'd personally love a doctor who's not afraid to get experimental with HRT, because my body is incredibly tough to medicate.

[V M]

Please remember that I am not making reference to anyone particularly, I am reflecting upon the threads I have read over the past few years

Admittedly, my Dr. was somewhat unsure and made no promises, but she was the only one in my area who was willing to help me... Luckily, she studied quite a bit and her decisions and advise have worked out rather well... She specializes in women's needs

[Lisbeth]

Unfortunately you won't find any medical schools that offer a course of study on HRT for transsexuals. A lot of this has been trial and error and doctors sharing with each other what they have done. There are some books on HRT out there for doctors, but I have my doubts whether they are totally as they should be.

[Sabriel Facrin]

Problem lies therein even if theoretically some of these threads lie, there are honest doctor situations like this, and denying help can be harmful to the overall HRT attempt. D: Isn't the theme of some of these questions about the doctor doing strange things that wouldn't be done by a self-medicating anyway? o.o; (For example, when I posted on my thread being confused about lack of anything to deal with testosterone XD )
That and it's like Lisbeth said, it's not like there's crash courses on this, at least yet...

Thankies for worrying about people, though, V M ^^

[Ann Onymous]

HRT is not an exact science.  Competent providers will let their patients know that and know that there is a component of trial and error to it just because of the differences from one person to the next.  The medical profession is no different than any other profession that does not rely on absolutes...and as an example, there are things that I do in the legal realm that are not covered in law school.  We carved out our niche just like a lot of the doctors doing HRT have managed to do...

[Sunnynight]

My doctor is awesome. He's very flexible and open to new information on HRT, but he also has plenty of experience. I really couldn't ask for a better doctor. His bedside manner is great, too. He doesn't have a God complex and genuinely wants to help people.

That said, doctors are like all other people. Some of them suck and some of the are great. I'm convinced that there are plenty of people who self-medicate and know more than their local physician would.

[JungianZoe]

My doctor is awesome. He's very flexible and open to new information on HRT, but he also has plenty of experience. I really couldn't ask for a better doctor. His bedside manner is great, too. He doesn't have a God complex and genuinely wants to help people.

Mine has all of those qualities except for being flexible in her approach to HRT.  She's already told me that since my body's having problems with both of the HRT regimens she prescribes, then HRT probably won't work on me, my lack of breast development is probably genetic and I shouldn't expect much, and that's it.  I know there are plenty of other options out there, but my doc simply won't try anything else.

[Sunnynight]

Mine has all of those qualities except for being flexible in her approach to HRT.  She's already told me that since my body's having problems with both of the HRT regimens she prescribes, then HRT probably won't work on me, my lack of breast development is probably genetic and I shouldn't expect much, and that's it.  I know there are plenty of other options out there, but my doc simply won't try anything else.

It sounds like you already have an idea of what to do in your situation. Will you have to go very far to find another doctor?

[JungianZoe]

It sounds like you already have an idea of what to do in your situation. Will you have to go very far to find another doctor?

Yeah, I have an appointment with her on the 17th, and if it's the same old story, then I'm finding a new doc.  Shouldn't have to go far to find another because I'm in a major metropolitan area with loads of trans resources.

[Sunnynight]

Yeah, I have an appointment with her on the 17th, and if it's the same old story, then I'm finding a new doc.  Shouldn't have to go far to find another because I'm in a major metropolitan area with loads of trans resources.

That's good. I hope things work out well for you.

[JungianZoe]

That's good. I hope things work out well for you.

Thanks!   I just keep thinking it'd be nice to fill out a bra someday, but after 10 months with this doctor, I'm nowhere close.  I've lost confidence in her ability to help me get there when I hear of the wide range of treatment options that she won't consider.  I have the strongest liver any of my doctors has ever seen, but my hormone doc refuses to prescribe anything but oral E.  She was pleased that my E levels got over 100, which I'm finding from other people is kind of low.  And the AA she has me on is killing me with depression, so she prescribes antidepressants that cancel out the effects of HRT.  And she absolutely refuses to prescribe progesterone (unless it's the synthetic progesterone being used as my AA, which, like I said, is killing me).

It's mind-boggling...

[Sunnynight]

Thanks!   I just keep thinking it'd be nice to fill out a bra someday, but after 10 months with this doctor, I'm nowhere close.  I've lost confidence in her ability to help me get there when I hear of the wide range of treatment options that she won't consider.  I have the strongest liver any of my doctors has ever seen, but my hormone doc refuses to prescribe anything but oral E.  She was pleased that my E levels got over 100, which I'm finding from other people is kind of low.  And the AA she has me on is killing me with depression, so she prescribes antidepressants that cancel out the effects of HRT.  And she absolutely refuses to prescribe progesterone (unless it's the synthetic progesterone being used as my AA, which, like I said, is killing me).

It's mind-boggling...

That's so strange. Injectable estrogen would be easier on your liver anyway, and it just has less bad side effects in general. It's all my doctor really prescribes. If I were in your position I'd find a new doctor. It really sounds like she doesn't know what she's doing.

[JungianZoe]

That's so strange. Injectable estrogen would be easier on your liver anyway, and it just has less bad side effects in general. It's all my doctor really prescribes. If I were in your position I'd find a new doctor. It really sounds like she doesn't know what she's doing.

I'm going to try a new doc, but I just talked to a few people who said they don't know of any docs in Denver who prescribe injectables or natural progesterone...   I'm really confused as to why not.

[Ann Onymous]

I'm going to try a new doc, but I just talked to a few people who said they don't know of any docs in Denver who prescribe injectables or natural progesterone...   I'm really confused as to why not.

Because doctors get set in their ways and prospective patients tend to be reluctant to look outside of the box...my original provider for management of HRT was an MD I found through the gay and lesbian yellow pages and who had no real experience with HRT management (although he was an internist who did a lot of endocrinological work).   He was open to whatever I suggested...same provider also later agreed to do HRT for an F2M friend of mine, again on an informed-consent basis.

Although that was 20+ years ago, I have a feeling the same approach would work in the present era, especially with so many more people being able to find providers via the interwebs (instead of the bound G/L yellow pages that spent time on the top of my stack of phone books)... 

[Sunnynight]

I'm going to try a new doc, but I just talked to a few people who said they don't know of any docs in Denver who prescribe injectables or natural progesterone...   I'm really confused as to why not.

Who knows. You might find a doctor that doesn't routinely prescribe them, but would be willing to try, especially if you make a good case for injectables (less dmg to the liver, less risk of DVT and clots).

[JungianZoe]

Because doctors get set in their ways and prospective patients tend to be reluctant to look outside of the box...my original provider for management of HRT was an MD I found through the gay and lesbian yellow pages and who had no real experience with HRT management (although he was an internist who did a lot of endocrinological work).   He was open to whatever I suggested...same provider also later agreed to do HRT for an F2M friend of mine, again on an informed-consent basis.

Although that was 20+ years ago, I have a feeling the same approach would work in the present era, especially with so many more people being able to find providers via the interwebs (instead of the bound G/L yellow pages that spent time on the top of my stack of phone books)...

I'm going to have to try that, because my doctor only does two extremely conservative approaches to HRT that aren't working well on my body.  She won't do progesterone, she won't do injectable estrogen, nothing.  Just one method and she says that nothing else will work if those two methods fail.  I'm not ready to buy that explanation, so I need a doctor who's willing to find something that works on my hard-to-medicate body.

[Sunnynight]

I'm going to have to try that, because my doctor only does two extremely conservative approaches to HRT that aren't working well on my body.  She won't do progesterone, she won't do injectable estrogen, nothing.  Just one method and she says that nothing else will work if those two methods fail.  I'm not ready to buy that explanation, so I need a doctor who's willing to find something that works on my hard-to-medicate body.

I wonder if you have a highly efficient liver, and oral estrogen is just having trouble getting past it.

[JungianZoe]

I wonder if you have a highly efficient liver, and oral estrogen is just having trouble getting past it.

Oh, I do... it's medically proven.  Three doctors have said I had the strongest liver they'd ever seen.  My gastro back in the day said my liver was "a rock god."  It destroys everything that goes into my body.  Back when I needed pills to control stomach acid, we went through six different medications in three months, increasing the dosage until they stopped working and then going to the next-strongest pill.  At the end, I was on the highest dose of the strongest medication available and it stopped working in four days.

Turns out that any medication that's regularly taken doesn't work on me because my liver gets really good at destroying it and my body's natural processes (even bad ones like the one that could have turned to stomach cancer) take over.  What finally worked was taking the medication irregularly so that it shocked my system every time.

All thanks to my liver...

My HRT doc knows this about me and still refuses to do anything but oral estrogen, saying that if it doesn't work, then I'm one of the unlucky ones who can't expect any results from HRT.

[Ann Onymous]

I'm going to have to try that, because my doctor only does two extremely conservative approaches to HRT that aren't working well on my body.  She won't do progesterone, she won't do injectable estrogen, nothing.  Just one method and she says that nothing else will work if those two methods fail.  I'm not ready to buy that explanation, so I need a doctor who's willing to find something that works on my hard-to-medicate body.

When I started HRT, we went through a metric phucton (technical term there ) of different meds trying to find something that my hyperactive metabolism would work with...he tended to have pharmaceutical samples of stuff that he would give me so we were not filling script after script of stuff that wasn't working.  Never did the injectables, but we did finally move to ethinyl estradiol when we came to the conclusion that synthetics were about the only thing that would do anything for me outside of taking giant mega-doses multiple times a day of the bio-identical estrogens. 

He also added the progesterone after I inquired about compounded P (this was before Prometrium hit the market and in a period where my insurance covered compounded prescriptions).

Oh, and he took all possible steps to code things in a manner that never caused a blip on the insurance company's radar...although some carriers may be more hip to such issues in the current era...