Gatekept by doctor, don't know how to proceed.

[Lauren5]

So as some of you know, I've been denied HRT at a re-eval by my GP yet again. First the reason was that the letter "wasn't written right." Then she changed her mind and said "Well the Harry Benjamin standards say you have to be full time for a year," and then yet again changing her mind that I needed to come back in 2-3 months for yet another re-eval to see if my depression was "under control" by then. Personally, I don't know of a single trans individual who didn't experience severe depression. So I've decided she doesn't know what she's doing and am going to search for another doctor.

But I don't know where to go from now. According to Transgender Michigan, there's only 2 other doctors in the Lansing area qualified to prescribe HRT, and one won't do it for new patients. Nothing further is said about the other doctor. I'd also be willing to bet my entire tax return check that the one remaining doctor doesn't take my insurance, but I'll go ahead and give him a call anyways. THe other option would be a trip out to Chicago to Howard Brown, where it seems like they are the only place in the entire midwest who does informed consent. Fitting that into my schedule may be difficult though, as well as finances, since I'd surely at least have to stay overnight in Chicago, if not two nights, and at this point, cannot afford a hotel without parental help. And then there's the issue of their sliding scale, which doesn't help me for two reasons; it's not applicable if you have insurance, which I have even though it's not accepted by them, and my household income is through the roof. In short, although being the more sound option, it's also the less financially simple option, as it would involve a train trip, and then the city bus as well, while staying in Lansing allows me to just take the city bus.

I'm running out of options unless I want to put timelines back, does anyone know of any other way (besides self medding, which I absolutely REFUSE to do, although it does seem to be the only way to get a prescription for HRT from my current doctor, as per my trans friends) that I could get a prescription from HRT? If necesary, I'd be willing to travel as far as Detroit or Grand Rapids, but without my own transportation, it's difficult to even go that far.

Any suggestions? I'm starting to get to that desperate level.

[LordKAT]

You are a household of one atm. I have friends who use Howard Brown. It isn't much less to Chicago from here and there was no overnight stay at all. Once papers are signed and blood work taken, due to distance, they will call a script to pharmacy of your choice.

[Lauren5]

The big deal with overnight stay is due to the train schedule, and not knowing if I can fit all three visits required into one day.

[suzifrommd]

It might be worth showing her the latest version WPATH Standards of Care (they're no longer called the Harry Benjamin standards).

Found online at (http://www.wpath.org/uploaded_files/140/files/Standards%20of%20Care,%20V7%20Full%20Book.pdf).

For HRT, there are no requirements for RLE or even psychotherapy in the latest version.

[Lauren5]

Quoting directly from the guidelines:

1. Persistent, well-documented gender dysphoria; 2. Capacity to make a fully informed decision and to consent for treatment; 3. Age of majority in a given country (if younger, follow the SOC outlined in section VI); 4. If significant medical or mental health concerns are present, they must be reasonably well controlled

I guess what she's getting at is that I fail #4 due to being severely depressed (and being denied HRT for the third time, even more so,) however, can a GP make that call when my therapist said in her letter that starting HRT would help alleviate my depression? I wouldn't think so. It seems that she is oversteppinh her bounds.

[TaoRaven]

Don't know how close this is to you, but here is an Informed Consent prescriber in Michigan:

http://www.wellness.com/dir/2223556/family-doctor/mi/macomb/mark-sikorski-farmbrooke-family-medicine-do

[Lauren5]

Don't know how close this is to you, but here is an Informed Consent prescriber in Michigan:

http://www.wellness.com/dir/2223556/family-doctor/mi/macomb/mark-sikorski-farmbrooke-family-medicine-do

I've looked at him before, unfortunately, the only way I could get there is by car, which I don't have. Intercity busses and trains don't go nearly close enough.

[Flan]

Planned Parenthood might have Informed Consent services around (in addition to low income care in general).
http://www.plannedparenthood.org/health-center/centerDetails.asp?f=2785&a=90630&v=details

[Ginny]

Growing up in the Midwest I understand your frustration.
(1) If your GP won't cooperate with your needs, find another doctor.
(2) Generally any endocrinologist will be able to prescribe you hormones.
(3) When I first talked to my therapist she told me straight after our first visit she only has had one case where she knew someone was denied HRT in the area. (Of course I don't really know how many people she sees with this diagnosis). She even told me I wouldn't even need to see her to start HRT.
(4) The HB standards have been tossed out the window for being crap and replaced with the moderately better WPATH standards. I'm not sure when WPATH went into effect, but I'm thinking at least a year or two.
(5) I would recommend seeking a support group in your area as they may know of some endocrinologists that are willing to help you. Therapy is not a requirement and a doctor should not be taking on the role of therapist when treating their patient (aka your depression, which I'm guessing has to do with not being recognized as the woman you are).
(6) I'm thinking you won't need to travel as far as Detroit/Chicago/Indianapolis/Madison/Milwaukee (I'm not sure where in the Midwest you are but those would be the major cities in our area). Also the smaller cities of South Bend, Battle Creek, Grand Rapids which are decently sized metro areas.

I wish you the best of luck in your endeavors and hope you find someone that will help you,
~Jen

PS I strongly advise you against self medicating unless you are a qualified healthcare professional.

[Lauren5]

Planned Parenthood might have Informed Consent services around (in addition to low income care in general).
http://www.plannedparenthood.org/health-center/centerDetails.asp?f=2785&a=90630&v=details

It's possible, but I'm not considered low income since my family makes quite a lot, even though I make nothing, being under 24, it still counts. However, it does seem to be within walking distance from me, so it can't hurt to try if all else fails.

I skip that BS altogether and self medicate.  Dangerous yes but I'm not at the mercy of some bigoted Dr. who just wants you to go away.

Nope, not going to do that. Not only is it a very gray area (and against the TOS of the site to talk about it,) I'd have no idea what I'd be doing.

Growing up in the Midwest I understand your frustration.
(1) If your GP won't cooperate with your needs, find another doctor.
(2) Generally any endocrinologist will be able to prescribe you hormones.
(3) When I first talked to my therapist she told me straight after our first visit she only has had one case where she knew someone was denied HRT in the area. (Of course I don't really know how many people she sees with this diagnosis). She even told me I wouldn't even need to see her to start HRT.
(4) The HB standards have been tossed out the window for being crap and replaced with the moderately better WPATH standards. I'm not sure when WPATH went into effect, but I'm thinking at least a year or two.
(5) I would recommend seeking a support group in your area as they may know of some endocrinologists that are willing to help you. Therapy is not a requirement and a doctor should not be taking on the role of therapist when treating their patient (aka your depression, which I'm guessing has to do with not being recognized as the woman you are).
(6) I'm thinking you won't need to travel as far as Detroit/Chicago/Indianapolis/Madison/Milwaukee (I'm not sure where in the Midwest you are but those would be the major cities in our area). Also the smaller cities of South Bend, Battle Creek, Grand Rapids which are decently sized metro areas.

I wish you the best of luck in your endeavors and hope you find someone that will help you,
~Jen

PS I strongly advise you against self medicating unless you are a qualified healthcare professional.

1. My therapist gave me a phone number for a doctor she personally knows, hopefully I can call them today and set up an appointment.
2. I don't know of any in the Lansing area that is easily reachable by city bus. Only two doctors were listed on the Transgender Michigan website, one of which doesn't prescribe hormones to people not already on them, and the other is not easily reachable.
3. You're very right, therapy is no longer a requirement, however, it does seem to be the doctor's preferance in this area.
4. WPATH is on its 7th version, which, IIRC, were revised in 2011. They've been around for a while. HB has been obsolete since the 80's.
5. Unfortunately, most that I know of are fellow students like me who have also had issues with this doctor and had to go around her into the grey areas, or started elsewhere. And yes, I'd say my depression is 99% trans related. The other 1% is insignificant in comparision and can be easily dealt with when the trans related depression is cleared away, which won't start to happen until HRT.
6. According to the Informed Consent website, the only providers within close distance who do informed consent are in Chicago, and another one an hour north of Detroit. Transportation is an issue for a student without a car.

Hopefully this new doctor will do it for me.