Hormones Prescribed by GP?

[katiej]

The standard process is therapy for a few months > HRT letter > appointment with GP > referral to Endocrinologist.  But times are changing.  And here in Washington state, apparently things are done differently.  My therapist recommended HRT after the second visit, and she said that most doctors don't even require a formal letter anymore.

So today I saw my new GP.  She has worked with trans patients, but never one before starting HRT.  I figured I'd need to see an endocrinologist, because...well...that's what everyone else does.  But she said that she feels comfortable prescribing hormones, and an endo isn't necessary.  She works in a transgender clinic, and has access to experienced doctors to help with my treatment regimen.  But she said she is willing to refer me to an endo if that's what I really want.

I like the simplicity of having one doctor, and I like this one.  But I'm not sure about being her first pre-HRT patient.  Although I've read plenty of threads around here with people complaining that their endo isn't doing a good job.  So the specialty isn't necessarily a guarantee.  I'm inclined to stick with the one doc.

What do you all think?

[Dee Marshall]

Well, you have a lot of support and this doctor is in a good place to help you without an endo. Just keep close watch on yourself and report anything that seems strange to your doctor. Wouldn't hurt to report here, either. Someone has to be her first and I think it's great that, at least in Washington, our condition is becoming mainstream enough that a specialist isn't always necessary.

[MelissaAnn]

Although an endocrinologist isn't exactly necessary. I do find it a good thing because they are experienced with dealing with the hormones and all the different blood levels that are affected. Informed consent is becoming more readily available everywhere just not in Washington. There seems to be informed consent clinics opening up all over the country. I see this as a good thing because it does make the process a lot easier. I'm glad to hear you are seeing a therapist and it never hurts to have a GP watching over you also. But if like you say she is working in a transgender clinic she should have all the information available to her. The other thing that I like to do is a lot of research I like to know what I'm taking why I'm taking it. The recommended dosage and the side effects from said medications. I wish you nothing but the best of luck on your journey and may the Angels always look upon you and help guide you on your path.

Hugs,

Melissa Ann

[skin]

It's not that complicated of stuff to figure out.  The problem with bad endos is they don't care enough to learn.  Sounds like your GP is, and she certainly has enough knowledge to treat you properly.  If I were you, I would be happy that I didn't have to go through the whole process.

[ImagineKate]

Up here we have informed consent which is almost pretty much hormones on demand. There is a little gatekeeping, but it is very minimal and you sign paperwork saying you understand the risks, etc. and get a script after one or two visits.

[Rachel]

Sounds like she has all the information you need. I would get the info on the trans clinic; sometimes they offer a lot more than just hormones, mine does.

[katiej]

Thanks everyone!  I was already leaning towards sticking with the GP, and your advice has been really helpful.

In about a week I'll finally have estrogen in my system.  Yay!! 

[Sheila Grace]

Katiej- I am a retired physician. I was a nephrologist, or kidney doctor. However, because of the nature of the patients that were mine, I did quite a lot of primary care as well. I can assure you in this day of information sharing that common HRT protocols are readily available and explained in detail in the medical literature. For years I subscribed to "UptoDate" and every quarter, I got a CD with all new discoveries published in all medical subspecialties. I will also say, from your description, that if your primary is in a transgender clinic, that she should have the resources there to answer all of your questions both before and after starting standard HRT. Chances are that the endo may actually have less experience with the protocols than your primary. I know from my own practice that getting in to see specialists will be harder and harder as we move into medical care changes. It likely will not be uncommon for many of us to interface with a nurse practitioner or even physician's assistant for primary care in the future. I would like to qualify one circumstance, IF you have ever had a thyroid or parathyroid hormone issue or are a diabetic, then at least an early evaluation by an endo would be something I would suggest. As well, if you have been on any form of testosterone in the past, like me, then establishing levels and getting the correct dosing is critical and may best be done under the care of an endo. But, if it is a simple case of straight forward HRT with no qualifiers, I personally, would stick with the doc that knows you the best. Hope this helps, and is NOT a medical opinion, only experience from a transwoman who has been in the field. Hugs, Sheila Grace

[katiej]

Sheila Grace, that is really helpful.  I have no thyroid issues or anything else to speak of.  I'm in good health, and so I think I will stick with my GP.

My doc is a resident who works in a family practice clinic and also spends time working in the transgender clinic.  I feel comfortable with her for precisely the reasons you mentioned.  She's in a learning mode and will approach my treatment carefully and with a personal touch.  My understanding is that endos can sometimes get stuck in a rut and don't tailor the regimen to the individual patient.

[Missy~rmdlm]

My primary Dr has taken over my HT management from my ednocrinologist. I too am his first TS patient where he is managing the HT, though he has had post-op patients for some time.