Medical Provider support in your journey - a survey

[Natkat]

I'm getting a report together on what support you were able to get from therapists, endocrinologists, family doctors, surgeons etc during your transition.

Were you satisfied?

Dissatisfied?

What support?

Any of the issues you had.

Can you also say what country you are in.

I want to write this up as a report to be presented so please be specific about issues both good and bad.

Thanks

Cindy

I live in Denmark where it all very difficult to get threatment. transgender here will call there threatment inside or outside the system. How your threatment works depends which way you go or how you mix them if you do that.
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Inside the system, is what it's called if you seach threatment though the main hospitals sexologic clinnic which here are seen as the only right choise. the people there got the status of "sexual experts" from some historycal background (since christine jørgensen did her surgery in denmark and became pretty famours) unfurtunate they haven't got much much better as the years passed and only upgrade there pracsis the last few years since they got a lot of critisism.

the clinnic deal with sexual problems of a wide spectum from hardness problems, handicap sex, sex with illness, people with thought of children, and so on. Because the patience are manly there due to a sexual issue transgender people are also somehow been asked to talk alot about there sexlife as a part of the obsevation period. this obsevation period or therapy have for many years not been clear to have a certain endpoint but told to last 1 year as a minimum. Now after the practise changed the minimum is half a year but theres still no clear definition how long it can take. The waiting period to get a apointment can also be very long and is 1 year for the current moment, in that way it take at least 1,a half year to figure out if you can get permission to threatment or not. If you get the permission this will be covered by the healthcare like anything ells in the healthcare system, but if not you can only go outside the system and pay for it all yourself. many people get denyed threatment if they got other dignoses beside being trans, or if the arn't binary enough, and other reasons. because of this many people are very aware of what they will say or cant say, the doctors arnt really to help you find yourself you are there to prove to them that you are trans enough and need the threatment, so they wont reject you.
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outside the system include everyone which have refused or been denyed to seach threatment for the sexologic clinnic.

not many doctors have got the knowlegde or courage to deal with transgender but theres a few which usunally you would find contact with though other transgenders. I personally have been on the sexological clinnic and did not like it and was denyed even before I came due to my background, so I find peace in finding a provat doctor outside the system which took in his own patience without this year of waiting period. the issue with being outside the system if firstly that you must pay for everything, and when it comes to surgery (and somethimes also homones) you will also need to travel alot (maybe abord) to get it. It can be very expensive for someone from one part of the country to go to a doctor living in the other part, and then travel to germany or thailand for surgery later on, specially when you consider the fact that many transgender also are unemployed, therefore its not an option to get threatment outside the system for everyone but only for those who can pay it economically.

the danish healthcare minister have been very critical of these doctors and want sexologic clinnic to be the only place where people ask for permission to transition, by that there have been alot of presure and many place are threatned or have been threatned to close down if the doctor where not to lose his job.
these are very big problematics which have gone around for a few years now, at the current moment it so that everyone who already have been threated by a doctor outside the system can continue but people who are new and havent got homones before must go to sexological clinnic. the minister are in the current moment trying to change this so everyone must go to the sexologic clinnic to ask for permission to get threatment or continue there threatment.
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trying to get to a conclusion on what suport I could get:
the system dose not work because only 1 system in the whole country which are not optimal and where people neither can complain or change to another doctor if they are unsatified are not good enough. it also means people who have been refused have no option at all unless they know one of these doctor I mention outside the system but these are few and are probably going to be illigal by the new guides.
its diffrent what transgender wants, some people want a better practise inside the system (at sexologic clinnic) while others want the threatment of transgender to be more general for more doctors to handle and insteed of psykiatry focus on informed concent.

I have been satified with my doctor, and the threatment I got when I traveled to germany for my topsurgery, I think they are very profesionel. what im not satified about is how transgender in general are threated in the healthcare system. When you are outside the system you are threated like a criminal, and when you are inside the system you must agree that you are mental ill by the dignose and they will threat you that way. I know many people which find this to be so extremly frustrating that it makes them suicidal and its a very big problem that people outside the trans/queer comunity dose not take these issues seriously.

if im to say something positive they have change the law for changing your legal gender this september.
Before you where forced to undergo sterilization and general destroy anything which could make you reproduce somehow, this low is FINALLY gone, and insteed you must sent in a paper saying your trans, and then wait 6 month and agree that you still want your legal gender changed. this is a big step.

[Natkat]

Cindy I hope its not too long but you said you wanted it specific so im trying to point out how our system works in general before you can see it from my point of how my threatment worked.

speaking of my own threatment story:

I came out as trans when I was around 12. im 21 today but back then there where no such things for youngsters, I just had to wait to I got old enough to this. I was very depressive and my famely did not suport me back then as they do today. as I became suicidal my mom took me to the doctor and after a couple of times I was sent to the sexologic clinnic senter. before I went there they said they could never offer me any kind of threatment since I back then went on a special school, but I could get 2 lections of theray, anything ells would be seen as a obsevation threatment.

I came to my first conversation and was to answer alot of questions, I was 16-17 back then and got asked if I had ever been abused sexually or violantly, if my parrent where divorced, if I played with boy or girltoy as a kid, had most male or female friends, what my sexual orientation was, if I got a lover, if I had sex or mastrubated and how often.

I had to answer these + some more and then she said it seams there was nothing wrong with me and they could probably put me in a obsevation for a year to see if I would fullfill the requirement for permission to get homones.

Later on I was denied again by the headmaster doctor due to my school and the autism dignose I had. I could not do anything about it and just had to accept it.

later on I got more open of being trans, I changed my name to a unisex one (since back then I could not change to a 100% male without undergoing a castration which I could not do before I turned 21)
I found out there where people which got homones from doctors outside the system so I went to one and had a talk with him and my parrents, He informed about homones and the worryes specially my parrents had. I got home and to read alot about it and was very clear thats what I wanted and then I got homones and went to him for years both for homones and healthcheaks. I could not get my surgery though, there was 1 doctor outside the system which had made a top surgery but he got in trouble with the goverment and had to close down, so I decided going to germany which I knew many did, I was very satified with there threatment, but my current doctor at the moment did not want to deal with me being trans so I had to change doctor and ask the other doctor which gave me homones to do some healthcheck on me which the other had refused. In general its mentally very frustrating not felling like your health is all valued. the 2 doctors I got, my main doctor and homon doctor are both okay but I know they all take a risk dealing with me. My homon doctor had to close down because of the rules which say I must go to the sexological clinnic to get permission for taking homones after 3 years, if I still cant get that permission I cant live in the country without getting the homones illigally. so its a very big issue.
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so well I been satificed with the doctors who have helped me mostly, and specially the threatment in germany, but the general health mininster are transphobic and make rules they dont know anything about.

[Cindy]

Fantastic replies so far but I need more!

[Jessica Merriman]

Cindy you know the only way to attract posters is to title it like this.

My breast are so sore and large - a survey! 

[Cindy]

Cindy you know the only way to attract posters is to title it like this.

My breast are so sore and large - a survey! 

So true!! I recall a thread of great titles a while back!

BTW can you pm me with the facts about not being able to access medicare/insurance entitlements. I'll speak to Gail Knudsen (President of WPATH) about it and raise some storm

I'm having dinner with her on Friday night

[Jenny07]

I'm getting a report together on what support you were able to get from therapists, endocrinologists, family doctors, surgeons etc during your transition.

Were you satisfied?

Dissatisfied?

What support?

Any of the issues you had.

Can you also say what country you are in.

I want to write this up as a report to be presented so please be specific about issues both good and bad.

Thanks

Cindy

For myself I have found the medical community to be very supportive and understanding.
They have gone out of their way to ease the fears that I have.
Satisfied? I had not thought about it like that but yes.

My GP has been the best. After almost freaking out before seeing her for the first time, she was so easy to talk to and open up. She organised my first session with the endo including all the paperwork and getting them to call me. Wow I was shocked.
Saw her today and has been so helpful I could not have asked for any more. She is great. Why can't we all have help like this?

My therapist has also been very good and has been helpful as well.

Thus very satisfied with their help

I think I'm in OZ last I looked.
Let me click my heels together.

[JLT1]

Hi Cindy,

I live in the US, I work for a major multi-national corporation that is "self-insured".  My company collects the premiums and pays the bills.  Invoicing and arrangements with doctors is made by a 3rd party company.  But the bills are paid by my company....

My policy states that it covers SRS, FFS, all psych visits, all medications, basically everything.  I have a $1000 deductable after which I pay 10% of authorized charges in network up to a maximum out of pocket of $5400 in one calendar year.  Out of network, I pay 50% of charges up to a maximum of $10,400 per year.  The policy states it follows WPATH standards of care.

It took me 10 months to get coverage for FFS.  Then, they would not agree to pay more than $2400 on a $73,000 surgery.  They would pay $3100 on a $20,000 SRS bill.  My psych visits are OK.  My HRT is not an issue.  They have not paid anything else.

Twice I have filed appeals of decisions to state agencies.  Twice I won.  They kept asking for things that were or are not part of WPATH. In the end, my company stepped in and told them to cover whatever I need.  However, every surgery/procedure requires a letter from two psychologists, my general practitioner and the surgeon.  Every little thing is a hassle.  The third party company is being petty and playing games.  But I'm winning.

I have a single nurse (a man) at the ithird party company who I work with.  He told me that anything I want is covered.  He further said he couldn't understand how my company could afford that.  I told him that the total bill will be less than the first week of medical bills for a person who has a heart attack.  In the ensuing conversation, it became clear he didn't understand that this is just as medically necessary as the care for the person who suffered a heart attack.   

However, I will say this:  There are 4 transgendered individuals at my company's "campus" where I work.  (The campus has some 19,000 employees spread around in 27 buildings on 480+ acres so 4 is actually a big number.)   It has been such a hassle to actually get money from the coverage that I am the first one who every actually got the coverage.  I'm working with the others to ge the coverage extended to them.

I suppose the moral is "Even when coverage is explicitly listed, actually getting the coverage exercised is extremely difficult."

Hugs Cindy,

Jen

[Jeatyn]

My struggle for treatment is well documented all over this forum but i'll try and summarise here.

When I first decided to contact a GP they "sent off a referral" for me - I assumed GIC referral (that's what I asked for) turns out they referred me for bottom surgery. Of course the reply was that I was nowhere near eligible for that. After explaining again what I actually wanted they "sent off a referral" again.

A few months of waiting later, I was told that the GIC does not have any funding for FTM's - they only provide treatment for MTF's

I wrote a letter to my MP asking why this was the case. My MP forwarded my letter to the department of health; who got back to me saying that there was no separate funding and having looked into the issue found that no referral was ever sent off for me in the first place.

I went back to see a different GP, armed with my official letters and a whole bunch of information to help them deal with me. The GP I saw flat out refused to look at the stuff I bought and wanted nothing to do with any of it, saying to me "you can't just take some pills and become a man"

This back and forth nonsense went on for a while with different GPs until I gave up and decided to go see a private doctor in London. They were happy to prescribe hormones after 2 visits. As it transpired, I was pregnant and couldn't go ahead with that.

Abridged version of my pregnancy adventure. Midwife referred me to social services the very first time I saw her. Social Services forced me to see their go to psychiatrist (the first time I'd actually been seen by an NHS doctor) she "diagnosed" me with a whole bunch of crap and wrote flat out lies about me in her report that social services used to try and take my daughter. (whilst misgendering me and acting disrespectful the whole time....at one point I was referred to as "a confused little girl")

I got a lawyer involved and saw two other independent NHS psychiatrists who gave me a clean bill of mental health (other than the GID) - legal aid also paid for me to go down to London to see Dr. Baratt at Charring Cross who was amazingly helpful. His psychiatric report is pretty much the whole reason I won my court case and got to keep my daughter.

Fast forward a bit after all that mess, I went back to Charring Cross (paid for by the NHS this time) to see Dr. Lorimer who prescribed hormone treatment.

By this point, I had moved from the Midlands to the North East and was on the waiting list to be seen at the local GIC. Once I got seen there it was all smooth sailing, I got top surgery and hysto less than a year apart and they give my GP's a poke if they mess me about with anything. I never made it past the gatekeeping to get seen at the midlands GIC but from what I've heard from other people I had a lucky escape - it only gets worse once you get in.

So in the UK it seems if you at the far north or south of the country you'll be treated fine. Anywhere in the middle you are screwed.

[Jill F]

So true!! I recall a thread of great titles a while back!

OK, I initially read this as "great titties".  Shows you where my mind is...

OK, Los Angeles here.

ER doctor told me that I needed a therapist right away so I didn't end up there again.  I did some homework and found a gender specialist with a PhD who was expensive but didn't waste any time.  She asked some rapid-fire questions and had me pegged for a severe GD case right away, even when I didn't want to hear that.  She is in cahoots with a psychiatrist, endo and SRS surgeon.  The psychiatrist basically concurred with the assessment, and treated me for depression and anxiety.  The endo is a great, caring doctor, but he's hard to get an appointment with, often forgets things and needs to be reminded frequently.  I had to wait 2 weeks between my physical and my E.  My pharmacy is awesome.  They compound my E as directed my my endo and are trans-friendly.  I can literally walk there from my house.  The surgeon who did my orchi was Dr. Gary Alter, who was Beverly Hills pricey, but did a great job.  I recovered inside of a week without much swelling, bruising or having my nutsack fill up with blood.  I think his bedside manner is pretty craptastic and I find him fairly obnoxious (and this is coming from me!), but he wants me back for SRS (which he still calls a "sex change", BTW) next year.  I haven't heard a lot of reviews of his work, so the jury's still out.  Last I heard, he doesn't deal with insurance any more, so after everything my bill would be to the tune of $41K.  OUCH!!!  I'm still considering Bowers and Crane up north.

[judithlynn]

Hi Emma;
I am also in Victoria. Can you PM me with the name of your Private voice therapist? Also it sounds as though you don't need a beauty therapist for anything, but if you do mine are very Trans friendly . Also depending on your dress and shoe size, I have a couple of great stores I use in Melbourne
Judith

[skin]

Milwaukee, WI, USA

Primary - She's clueless on trans issues, but is supportive and respectful.

Therapist - I have had a couple because they tend to designate their interns as the LGBT specialists.  Both have been fantastic.

Endo - Respectful but incompetent.  I am essentially self-medding.  I tell him what he should prescribe me and what tests to order and he puts them in the computer. 

Therapy, speech therapy, and hormone therapy are all covered for me.  Any type of surgery is not.

[Yukari-sensei]

Although my transistion may currently be on hiatus, I hope my information can be useful...

McAllen, Texas - USA

Therapist - University system therapist(s). The only issue I have here is that I had to go through so many. Everyone has been nice and accepting, but I had to go through layers of therapy. Started off being treated for depression, when it seemed to be GID I got referred to the next one up the totem pole until I was assigned someone who specialized in the appropriate area. Said therapist is now in private practice and I have to get reassigned after yet another assessment from a completely unknown psychologist. We'll see where this is going as I have yet to have been given a followup appointment.

Primary Physician - University system health provider. She is very sympathetic and nice, somewhat knowledgeable on trans health issues (I was not the only trans person she has treated there), and eager to learn more. Sadly unable to prescribe HRT due to it being a specialty that the University system could not followup and monitor. Gave me a referral letter to specialist with no difficulty and worked with my therapists office well.

Specialty Physician - She was very nice and extremely competent. Her office was on my health insurance plan (something I have since lost), so my visits were only  $30! I was most likely her only trans patient though and people seemed confused about me. An important note though - I had to go through more than 5 different endocrinologists before I found her willing to take my referral. Most endocrinologists refused to take a trans patient and the verbal abuse I suffered from the staff still makes me angry. The only good thing to come from this is I formally notified the university and have had them removed from the referral list. If any trans person after me gets a referral, they will have a much more streamlined path to care.

Pharmacists - This was rather interesting. The big box retailer I obtain my prescription from has multiple pharmacists. One pharmacist recognized my pride earrings and I ended up having a nice conversation with her about her recent marriage to her wife. We got along great and she was very knowledgeable about my prescriptions. Another pharmacist, an import, was very nice, knowledgeable, and to his credit never was anything but pleasant. Unfortunately, despite his best efforts to hide it, his discomfort was obvious. All I have to say is that it is a crap shoot, when it comes to pharmacists.

Something else that should be added in all fairness. Rolling Stone magazine has released an article where they labeled my community as one of the least LGBT friendly cities in America.

When it comes to being unfriendly to LGBT people, Texas' cities have the rest of America beat by a country mile. Eight Longhorn towns rank among the worst for LGBT people, with a whopping four (Lubbock, Mesquite, McAllen and Irving) receiving a zero score from the Human Rights Campaign.

Read more: http://www.rollingstone.com/politics/news/the-5-worst-states-for-lgbt-people-20141124#ixzz3Q168dOb3

To be fair, there are many other places I felt less safe than in McAllen - which is an oasis of tolerance compared to my hometown!

[judithlynn]

Hi Cindy;
Judith in Melbourne:

First time around (30 years ago)
Family Doctor; - Great Support in Newport Pagnell referred me to Charing Cross GC
Gender Clinic : Tough going, then  Psychiatrist recommended seeing a Dr Russel Reed privately. Two appts changed everything. Diagnosed at TS and immediately prescribed HRT
Therapist: None sat that stage available, but Had Hypnosis Treatment - helped a lit in  re-learning  female upbringing and positioning as female cross dressing as male
Endocrinologist: None
Beauty Therapists & Electrolysis : Excellent. Great beauty team Helped a lot. Many weeks under the needle
Deportment Coach: Once found proved veryt helpful:
Colour Analysis and Style Coach: Fantastic - best investment I ever made. All MtF should do this as its highly recommended to get right colour for clothes and makeup to match natural skin colours

Second time Transitioning (last 2 years)
Family Doctor - Hopeless no understanding
Specialist Transgender doctor : Fantastic, good support, but will not prescribe pellets or Progesterone
Endocrinologist: None. Generally No Victorian Endo identified that will support Pellet implant
Therapist: Generally OK for first 5 visits, but would only see privately - No Medicare rebates
Beauty Therapists & Electrolysis : A fantastic team and very highly recommended. Laser Treatment has worked wonders on Upper Lip and Chin
Deportment Coach: A great step forward
Voice Therapist : Looking for Private Voice Therapist in Victoria
Surgeons - One visit to discuss possible Breast Augmentation. Very good session, but decided to give HRT more time to work.

One thing in Australia is that we now have a National Electronic Health Record (luckily its just voluntary now) where any Approved Doctor can go online and view your Health record, vista, prescriptions, pharmacists visits etc. This could be incredibly dangerous if it gets into the wrong hands

Judith

PS I may be in Glenelg in early Feb. Fancy dinner??

[Eva Marie]

I live in an outlying suburb north of Los Angeles, California.

I was able to make an appointment with a well known gender therapist in L.A. She had me pegged as a transsexual within 30 minutes of my butt hitting her couch on the first visit. She is a very cut-the-BS-and get-to-the-point kind of person which is exactly what I was looking for since I was paying out of pocket for her services amd I didn't want to fool around. She has a PHD and is very knowledgeable, and keeps herself up to date with trips overseas to the major transgender events and with constant research of medical publications. She follows WPATH.

I am thankful for her wisdom and advice as I navigated these uncharted waters - it was invaluable. Every time I tried to BS her about something that I didn't want to talk about she called me on it, and everything she told me would happen - happened - so I learned to trust what she said. She found out on my first visit that I had been self medicating and she immediately sent a request over to the endo for a script for HRT.

The endo she works closely with is a very knowledgeable, nice guy that's been around the block a few times and knows his stuff. He stays quite busy.

So - therapist - top notch - endo - top notch - Pocket book -  empty!! 

[AnonyMs]

I already answered earlier, but I have something to add.

So I'm in Sydney and I like my privacy. I don't like leaving records anywhere. My GP doesn't know, but I do tell doctors when I think it might be important.

I've been in hospital a number of times and told the doctors there, but its never actually been relevant to my treatment. Better safe than sorry though. I always ask them first not to write it down, which they have been perfectly happy with. I guess they are expecting drugs.

In the interests of managing my health better I recently got full copies of my hospital records and what do I find - every time they write it down.

I'm pretty annoyed with that and it certainly erodes my trust in them, although admittedly it wasn't very high to start with. Not sure what I'll do next time, but I'll be lot less likely to tell them anything.

Perhaps because of my trans issues, privacy and trust are very important to me. They way the medical system works here has caused me a great deal of stress, and is what made me go outside it for so many years. This is only going to get worse as records get more and more computerized and shared, and I'm just hoping that I can get past my own issues before things get worse.

I'm curious what people doing illegal drugs are supposed to do. Die?

[Tessa James]

I already answered earlier, but I have something to add.

So I'm in Sydney and I like my privacy. I don't like leaving records anywhere. My GP doesn't know, but I do tell doctors when I think it might be important.

I've been in hospital a number of times and told the doctors there, but its never actually been relevant to my treatment. Better safe than sorry though. I always ask them first not to write it down, which they have been perfectly happy with. I guess they are expecting drugs.

In the interests of managing my health better I recently got full copies of my hospital records and what do I find - every time they write it down.

I'm pretty annoyed with that and it certainly erodes my trust in them, although admittedly it wasn't very high to start with. Not sure what I'll do next time, but I'll be lot less likely to tell them anything.

Perhaps because of my trans issues, privacy and trust are very important to me. They way the medical system works here has caused me a great deal of stress, and is what made me go outside it for so many years. This is only going to get worse as records get more and more computerized and shared, and I'm just hoping that I can get past my own issues before things get worse.

I'm curious what people doing illegal drugs are supposed to do. Die?

Compassionate and trust worthy care are reasonable to want as is your desire for privacy.  I cannot stick up for your doctors trustworthiness but it is important to have an accurate history about you to help avoid mistakes, complications or dosage calculation problems.  Nobody wants you to die, we get there soon enough naturally.   If someone acknowledges doing illegal drugs it is a doctors imperative responsibility to offer support and the help one may need.  I don't know what drugs are legal down under in OZ but laws are changing here in the US.  Pot will be legal in Oregon next July, for example.  Sorry about the mini derail

[kelly_aus]

I'm curious what people doing illegal drugs are supposed to do. Die?

My experience is that OD's get treated and released.. Unless it's an obvious suicide attempt - then the psych department gets called for a consult..

And as to writing it in you patient records, perhaps you should check what's legally required to be recorded..

[stephaniec]

I'm being taken care of by a team of doctors in a hospital network that brought me back from the gates of hell and are probably the most professional in the universe.

[ImagineKate]

I'm getting a report together on what support you were able to get from therapists, endocrinologists, family doctors, surgeons etc during your transition.

Were you satisfied?

Dissatisfied?

What support?

Any of the issues you had.

Can you also say what country you are in.

I want to write this up as a report to be presented so please be specific about issues both good and bad.

Thanks

Cindy

New York City NY, USA (I live in NJ but I get my care in NY)

Therapists - had one not so good one and now I have a great one who is very knowledgeable, caring and competent and is also a committee member of WPATH. Extremely satisfied with this one.

Endo/family doc - my old family doc was supportive but really not knowledgeable about trans care. I switched to a new family doc and nurse practitioner. It is a LGBT specific program so they are well versed. I am extremely pleased. Full support for my transition. Cost is minimal, copay with insurance is small,  $15 per visit on my insurance plan. Medications are almost fully covered except for estradiol which I get discounted at Walmart for $10. The rest range from $0-$5 copay. Extremely satisfied.

Electrologist - very satisfied. She is trans, she is caring and understanding and does good work.

Can't speak for surgeons yet as I haven't embarked on any surgery.

Overall things are going swimmingly.

[spacerace]

Seattle, WA - not a bad place to be transgender

therapist - found his website, contacted him saying I was transgender from the get-go in the first email, scheduled a session, he would have given me names of doctors for HRT without another session, but I wanted to do therapy for other reasons. He did require that you meet with him once for informed consent before giving you a referral, so in essence if you didn't want therapy you were just paying for the referral from him, but w/e I understand the reasons for it. It was not gatekeeper-like. WPATH was not discussed.

getting on testosterone - first doctor I found here before I looked up therapists wanted a letter. So, I contacted the therapist above. Then, the referrals I got from the therapist basically did informed consent. I went two different places, as the first place did not work out because it was a clinic that operated out of a woman's health center, and that was too weird to deal with.

The second doctor is now my PCP and is fantastic. Dealing with her office is great, she is very laid back and informed. She helped me work out some initial issues I had starting injections, and she really helps me stay on top of my health. I've had to go to her for a couple of other issues, and it is so nice having a primary care doctor that I don't have to worry about being trans with.

There are several top surgeons in this area I am considering that seem not bad, and at least one I know who doesn't require any letters.

pharmacy - I order T from an online pharmacy in Oregon. They send needles and supplies with the T. It is really easy - you call in the refill, they ship it, you get it within a couple of days, and it lasts ~6 months.

other doctors - I had to change my dentist and a psychiatrist because they were awkward and weird about the issue when confronted with it. Not rude or anything, just obviously uncomfortable when confronted with the issue. Both were in areas outside Seattle proper, so I purposefully picked new doctors in the LGBT friendly part of the city, and so far so good.

All in all, I got on T and had it in my hands within 6 weeks of making the first phone call to a doctor, and I really only had to talk to a therapist once. I did wait for awhile after starting therapy, but that was my own choice.

my insurance covers my doctor visits and my blood work. possibly part of top surgery.