HRT from a General Practitioner

[Keira]

So...I currently live in the middle of nowhere, and there are no medical specialists (endocrinologists, general practitioners, therapists, you name it etc.) that know anything about transgender people. Besides, "Well we can refer you to a clinic several hundred miles away".

So I got information on hrt for my GP to read, he asked, "is it possible for you to go to one of these clinics?", I said no it would be too costly and time consuming to drive there/fly there. After all I can't afford to take off a week of work every time I need my dosage modified.

So, my GP said that he would be willing to prescribe hrt to me, and so now Im currently on spiro.

I guess what Im asking is, can they monitor it properly?

I'm afraid my GP is going to tell me, "Sorry I don't have the experience to do this, but I can refer you to an endocrinologist", at which point the endo will then tell me, "You need to see a therapist first".

Sorry...Im just sort of freaking out that I might be denied HRT after having it for a month...

Does anyone else go to their GP for HRT?

[Keira]

Is there anyway you could have an occasional visit with a specialist?  Maybe once a month or every other month, just to keep tabs on your GP's approach?  Once the therapy has been started, an endo might be willing to relax on the gatekeeping.

I basically live in the middle of BC...and the only two closest places that have specialists are Vancouver and Edmonton. To get to Vancouver in a reasonable amount of time I would probably have to fly there...which costs more money.

And, since I'm in BC, Edmonton (AB) probably won't take my care card and plus it would cost me additional money to have my lab paperwork sent back here; which is of course assuming that I can get an appointment with the endo, and also assuming they are okay with informed consent.

Yeah...living in the middle of nowhere really sucks...

[Northern Jane]

If there is a lab locally that can do the blood work your GP could probably manage the HRT in consultation with an endo in a distant city but DON'T take a chance on the GP doing it without expert guidance!

My GP managed my HRT from about 10 years post-op to 25 years post-op and she did what she THOUGHT was right and normal practice. When I finally insisted on seeing an endocrinologist for confirmation I had early stages of osteoporosis from inadequate primary hormone levels for too many years. The endo immediately increased my estrogen levels and it took 3 years to correct the bone density loss.

[Sammy]

Basically, You need Your blood tests to be done every three months, so it might not be that bad after all. Can't this be done in Your location and then analysis sent to the endo?

[Theo]

In terms of lab results, your GP can ask for exactly the same data as any endo can. It is knowing what to ask for, and how to interpret it, that is a bit more difficult.

Would it be feasible for your GP to contact a specialist and simply ask them which factors they need to measure, and what the expected / ideal progression is?

Hoping not to be breaking forum rules, but my endo measures LH (luteinizing hormone), FSH (follicle-stimulating hormone), estradiol & testosterone (unsurprisingly... ), PRL (prolactin), SHBG (sex hormone-binding globulin), and DHEA (dehydroepiandosterone). Stuff like "free-T" can be derived directly from the T and SHBG values.

In addition she is monitoring liver factors etc. (TSH in my case, but that's due to me missing a good chunk of my thyroid gland ), but those should be familiar to your GP anyway.

[Keira]

I'm at a loss as to what to do...

Like I said, if I see an endocrinologist I'll probably just get referred to a Psychaitrist in Edmonton or Vancouver, which is totally not fair, and I won't be on hrt anymore.

Well at least going to my GP beats self medicating, which was what my original plan was (that or suicide).

[Theo]

I'm at a loss as to what to do...

Like I said, if I see an endocrinologist I'll probably just get referred to a Psychaitrist in Edmonton or Vancouver, which is totally not fair, and I won't be on hrt anymore.

Well at least going to my GP beats self medicating, which was what my original plan was (that or suicide).

*shoo* Scratch that last part right away. *nods*

First of all, you do not need to see an endocrinologist at all, it suffices if your GP gets in touch with one and innocuously asks about expected hormone progression values. Other than that they can also just dig through MEDLINE (helps if your GP is young, or at least young at heart, as natural inquisitiveness can spur research quite a bit). Let's face it, while it is not the most common thing on the planet, transgender HRT is neither super rare nor particularly complicated.

If you want / have to see an endo yourself to get a baseline, bear in mind that many men get their full hormone baseline done as well, albeit in order to ensure that they have "enough" T in their system to meet their own macho standards (which is silly even if you're not trans*, but nvm that for now). Maybe think of it as simply omitting certain bits of non-pertinent information...



P.S. On a lighter note: I'm actually not out to my GP and still had him measure my T value last time. When the results came in he told me not to worry too much, and that there are natural fluctuations during the day, that the levels can vary significantly between individuals, and that some types of food or medicine can skew the results. As it was on the phone he couldn't see my grin. The value was 30 ng/dl, which is right in the female range, but far removed from where a male level should be. He still hasn't caught on... 

[Keira]

*shoo* Scratch that last part right away. *nods*

First of all, you do not need to see an endocrinologist at all, it suffices if your GP gets in touch with one and innocuously asks about expected hormone progression values. Other than that they can also just dig through MEDLINE (helps if your GP is young, or at least young at heart, as natural inquisitiveness can spur research quite a bit). Let's face it, while it is not the most common thing on the planet, transgender HRT is neither super rare nor particularly complicated.

If you want / have to see an endo yourself to get a baseline, bear in mind that many men get their full hormone baseline done as well, albeit in order to ensure that they have "enough" T in their system to meet their own macho standards (which is silly even if you're not trans*, but nvm that for now). Maybe think of it as simply omitting certain bits of non-pertinent information...



P.S. On a lighter note: I'm actually not out to my GP and still had him measure my T value last time. When the results came in he told me not to worry too much, and that there are natural fluctuations during the day, that the levels can vary significantly between individuals, and that some types of food or medicine can skew the results. As it was on the phone he couldn't see my grin. The value was 30 ng/dl, which is right in the female range, but far removed from where a male level should be. He still hasn't caught on... 

I've been on Spiro for almost a month...so a baseline is pretty much impossible at this point. But I do still need to get the basic tests done.

I already gave my GP some basic information about hrt (dosages, precautions, etc.). And he is naturally inquisitive and was glad that he could learn something new. He is still quite young, so that helps a lot. I don't know what he specializes in, but I've heard that he treats cancer patients.

I'm just afraid that he'll back out when I get an appointment to get a prescription for E and the base tests...

PS- That's cool that your T was so low

[Ltl89]

Skye,

I wouldn't worry too much.  He's been working with you all this time.  Why would he back out now?  If he wasn't going to do it or didn't feel comfortable monitoring everything, I'd imagine that he would have said that beforehand.  Don't let it all scare you.  While it may be better to see an endocrinologist, there are people who go to their Primary Care Physician for hrt.  It's just a matter or whether their doctor is willing to do it.  In your case, the doctor is working with you.  Relax.  I think you're going to be okay. 

[Keira]

Sorry for freaking out...

I'm just so used to everything going wrong in my life...I guess I expect things to go wrong because its my coping mechanism.

Thanks for the support girls