A Story About Medical Practice

[kathy bottoms]

I went in for another appointment (that my doctor requested).  I really didn't think she would prescribe anything more for me, but I did expect another referral or something tangable.  Instead she pretty much told me she can do nothing more for me, other than treat conditions I may encounter as a result of any medication I take.  But, she would send me to a therapist that has a trans group where they could hopefully help me feel more normal.  Funny,  I felt very normal before going to these last two appointments.  Now, because I don't wish to attend the group sessions she will no longer refer me to an MD who is a Transgender Specialist. 

For about a month and a half I was lead to believe that she understood Transsexual and Transgender issues.  But after these last two visits it's clear she knows nothing about trans patients.  I know there are doctors who are transgender specialists in my heathcare system, and not just the counselor (therapist) that I've spoken with before.  So why couldn't she just refer me to one like I asked?  I now know she has never had to deal with gender issues, and just thinks there is something mentally wrong with me.  But why stand in my way? 

Of all the things we discussed the most baffling was how she didn't know about antiandrogens for MTF patients, and how they help in feminization.  Hell, she was the one who originally prescribed a medication for me that is a known antiandrogen.  After all, she just scheduled a Mammogram because I grew breasts from using it in conjunction with another drug.  When I explained the odd occurrence, she said that it was just a side effect, and not the prescribed effect.  Paraphrasing her words,  "a medication designed for one purpose, is just not suitable for another, and is dangerous".   When discussed further she saw no value, or benefit, in MTF patients using Spironolactone or any other antiandrogen. 

Oh yes, she will do full blood work every three months for me even if I go outside my health care system for prescriptions.  And she said she will continue to be my GP for Internal Medicine (Not Good).  So now I'm just depressed, and trying to figure out where to find a Trans Friendly doctor inside my health care organization.  The closest ones are in the SF Bay Area, and they want a referral.  And how do I get a referral from a doctor that won't give me one. 

This will take forever, and may just make it impossible for me to move ahead inside the "norms" until I get a doctor willing to do a referral.  Back in the '70s when I drank a lot, I had one of their Therapists ask me why I felt it was necessary to drink just to make gender issues better.  Well, I quit drinking for awhile, and he convinced me to push gender issues aside.  What A Guy!  He didn't solve anything, just delayed it.  THINK I'LL MAKE A NICE SLOE-GIN-FIZ.

[Julie Wilson]

What you need to do here is ask yourself the big question, "How can I begin to take responsibility?"

You don't want to attend group sessions, why?  Is it because you are afraid or because you can't be bothered?

I suspect that your doctor has noticed your lack of initiative and doubts your ability to follow through with transition.  And then when you don't follow through and decide you made a mistake who are you going to blame, your doctor of course, right?

Show some initiative.  If you aren't willing to work with your health practitioner then work around the system. Initiative, not booze.

Speaking of which does it bother anyone else to see all the M2F photos with drink in hand?

Good Luck ^_^ !  Personal responsibility is key here.  Or maybe we could get together for drinks and talk about how horrible and stupid your health practitioner is, not.

[kathy bottoms]

Yes, I know.  But I needed to vent and rant. It gets things off my chest and when people reply (like you did) I can take it in and make sense of things a little better.  Thanks, because I did some of what you said, but not all.   Taking charge for me in this matter is to go to a doctor who has actually dealt with transgender patients.  My doctor just made me feel like a child and corrected me by saying things that I know are unfounded.

Anyway, after reading your post I sent her a message asking again to see a transgender specialist in the Sacramento area, if there is one, because I live closer to Sac than I do to SF.  And I asked to have the Therapist call me, or email before the end of the week.  I'd like to at least get a chance to find out what sort of group he has going. 

I didn't make the Sloe-Jin-Fiz.  I wanted to, but I quit drinking decades ago, and it's not a good time to start again.  After years of abuse in my 20s and 30s, the doctor says my liver is still good.  I want to keep it that way.

And no, I don't like groups, and I am a shy and private person who spent a lot of time alone over the years.  Plus when speaking in front of a group it's very difficult.  I also understand that the therapist may be the one who sends referrals to the specialist, and he would need to see how I handle my life right now.  But it would have been nice if my doctor told me more.

So how did I make it as an assistant program manager over hundreds of people for so long?  Who knows, probably just dumb luck.  I'm obviously not good at it.

[Catherine Sarah]

Hi Kathy,

When discussed further she saw no value, or benefit, in MTF patients using Spironolactone or any other antiandrogen. 

On that point alone, I'd run screaming from a Medical Practitioner that made a remark like that.

Hope it works out for you.
Be safe, well and happy
Lotsa huggs
Catherine

[Alainaluvsu]

Yeah me too. My endo has even told me she doesn't have much experience with trans patients but she has never denied me spiro.

[kathy bottoms]

The doctor just sent a list of doctors for LGBT patients.  Can't find one that lists any kind of Trans Medicine on their profile.  More confusing than necessary, but I have to muddle through it anyway.

[Alainaluvsu]

Why is it absolutely essential that they do?

[Jamie D]

Kathy, the use if a medication for a use other than its original design is called "off label."  I'll give you an example.  Aspirin was designed as a pain reliever.  It was later found to have a beneficial effect ans an anti-inflamatory, and against platelet clumping and heart disease.

Spironolactone was designed as a diuretic.  But it was quickly recognized to have anti-androgenic properties.  It is widely prescribed as an AA now, and less often for its original intent.

Your doctor is just not knowledgeable.  You need a new one.  If you go to a group therapy, just ask the others who they see.  There is one GP near me who is known as GLBT-friendly, and gets a boatload of business because of it.

[kathy bottoms]

Each doctor on the page has a list of specialties under their profile.  And since they are listed on the Transgender page I can only assume they are all familiar with Trans issues.  Just curious why it isn't in any profile.  Not that it matters, because the one closest to me will get my call.  Going to get into the group session also.

[Asfsd4214]

Kathy, the use if a medication for a use other than its original design is called "off label."  I'll give you an example.  Aspirin was designed as a pain reliever.  It was later found to have a beneficial effect ans an anti-inflamatory, and against platelet clumping and heart disease.

Spironolactone was designed as a diuretic.  But it was quickly recognized to have anti-androgenic properties.  It is widely prescribed as an AA now, and less often for its original intent.

Your doctor is just not knowledgeable.  You need a new one.  If you go to a group therapy, just ask the others who they see.  There is one GP near me who is known as GLBT-friendly, and gets a boatload of business because of it.

On the topic of off label.

Medications aren't really 'designed' to begin with. We talk about drugs being designed like how we would design an airplane but it really doesn't work that way. There are a handful of drugs that actually have been designed with some degree of intelligence, but the majority of them have simply been discovered through trial and error of candidate drugs.

To say "spironolactone wasn't designed for x" is really a misunderstanding of chemistry. Drugs are not designed the way we generally consider things to have been designed.

Also as this poster said, off label prescribing is extremely common.

[kathy bottoms]

Thank you all.       

The doctor called me today and said I can pick any doctor on the Gender Specialist list and make my own appointment.  She said the specialist will understand how to prescribe hormones, and knows the uses of other drugs in order to enhance the estrogen in the ways I was concerned about.  She also said  the local therapist would not be necessary if I see the specialist because the specialist will probably manage therapy.  I hope she's right.

On top of that I called the Gender Health Center in Sacramento and they said they can see me.  But they have a waiting list, and can see me in about 3 weeks.  Too bad, I'll be out of town by then.  These people were really understanding and took the time to discuss options over the phone. 

The un-rhymed Mantra for now is: This will work out. This will work out.  This will work out. 

[Julie Wilson]

Nice to see you are taking your power back ^_^ .