Not happy with my GP

[sam79]

Please excuse my venting...

The short story is, I have been using my GP for HRT. The clinic I go to provides transgender care, and they apparently have a specialist working in the clinic. My GP was not this specialist, and I knew that HRT from him was a first for both of us. I accepted this given the backup ( colleagues ) he has immediately available, if required.

We started on a low dose of Estradiol, ran bloods and did the usual checks. After the first month, the dose was increased due to no impact on my T levels ( actually they increased ). After the second month on a mid level dose, T levels had fallen a bit, but still well within the normal male range. Since I was only on Estradiol, I requested to start on Spironolactone. I was given a few options at the time, this was one of them. So I started on a lowest possible dose of Sprio, with bloods run again after two weeks to check potassium levels. My potassium levels came back normal, as with everything else. And I've had nil effects

So I asked to increase the dose of Spiro considering it was such a low dose and that there were no effects ( negative or positive ). What followed shocked me. I was told by my doctor that he didn't know if it was safe to do so, and (paraphrasing), doesn't know anything about dosages of drugs for HRT purposes. He wanted me to talk to another doctor about dosage changes, then offered to ask on my behalf!

My god. What the hell is any doctor doing administering drugs without knowing all about them?!! It's not like there wasn't opportunity!

My decision to find a proper endocrinologist was made right there and then, fully supported by my therapist.

Just wow.

[Vicky]

Your doctor gave you an honest reply, and its the same one my Endo gave me.  It is also the same one that I heard from a panel of pharmacists at the World Professional Association for Transgender Health two years ago at their convention in Atlanta GA. USA.  There are few if any controlled studies of cross gender hormones and hormone blockers, and they are all small enough as to be inconclusive.  There is much legend and lore on safe doses and overdoses, but none of it boils down to a magic formulation for the largest and fastest change in gender. At least your GP was honest. I am a controlled research participant for my health plan which is one of the largest in my state, so I am doing my part. 

[JennX]

As a person who works in the science/medical field, you'll find more often then not, grey answers, instead of black and white. Everyone expects docs to give them absolute, black/white answers, but it is not always that easy. Your doc was being honest.

You also have to remember most all of the meds prescribed for MTF HRT are being prescribed for off-label purposes. Estradiol (Estrace) pills as produced by Warner/Chillcott were designed to be used by cis-females for birth control... Not by trans-females on HRT. Same with Spironolactone. It's was designed to be a high blood pressure med... And odd side effect was determined that it could block T production and receptor binding. As a matter of fact, Spiro is rarely prescribed for high blood pressure anymore, because there are many more effective and newer drugs on the market. So what these sort of drugs, used not for their original/designed purposes over an extended period of time which they also weren't intended for, is to put it colloquially... A crap shoot. There have been some long term studies to try to determine the long term effects of HRT IN MTFs... But not enough to be conclusive.

Also few docs have experience prescribing trans HRT... So unless they had a previous trans patient, they would have zero idea regarding dosages, blood work, et al. Find another doc, endocrinologist,  gynecologist, that has previously trans patient experience. You don't want to be any medical professionals first trial patient.