Doctors appointment.

[LexPromise]

I have a doctors appointment tomorrow to discuss medically transitioning. I want to start taking testosterone, have top surgery and a hysto. What questions should I ask? Any advice?

[FTMax]

It really depends what kind of doctor you're seeing.

My first appointment to discuss transitioning was mostly my primary care doctor at an LGBTQ clinic asking me questions and making sure I was mentally ready for it. She gave me an informational packet about testosterone and we discussed doses, methods, etc. She made notes about my transition goals, but we didn't go too in depth about it. I had blood work done on the same day. I came back 3 weeks later once the lab work was ready, and I got my prescription and started T.

Around the same time I also started speaking to a therapist to get a referral for top surgery. There are a few surgeons who don't require a mental health referral, but for the most part it is required, especially if you're using insurance to pay for it. So expect at some point that you'll have to speak to a therapist for at least a few sessions in order to get referred.

For me, hysterectomy is a part of my bottom surgery procedure so that referral is also coming from a therapist. If you want it to be covered by insurance, you will need some kind of reason for it to be seen as medically necessary. So you may want to ask whoever writes your top surgery referral if they will also write you one for a hysterectomy.

Overall, it's good to know the route you want to go down, but it is a process. Expect this visit to mostly be about getting to know you, your goals, and figuring out how the resources that you have access to can help you. Be as honest as possible about your life, your circumstances, etc. Don't withhold anything. I can't remember really asking any questions, but I had been investigating transitioning for about 7 years by the time I got around to starting, so I was fairly familiar with what needed to happen.

[LexPromise]

Thank you. The appointment is with my general practioner. I want to know more about my options for testosterone. If injections are best; etc. I am scared of needles, but I am definitely willing to go the injection route if necessary. I am needing insurance to pay as this is my situation. For the mental health referral, does it need to be from a gender therapist?

[FTMax]

Hi,

I was also afraid of needles before starting to transition. I started out on gel when the price was low. In the US, there are injectables, gel/cream, and pellets. Pellets have to be implanted in a doctor's office each time, and I'm not sure what the cost on them is. Gels/creams are the most expensive option. I very quickly got over my needle fear. There are some good resources online to read about overcoming injection anxiety.

It can be from any therapist. The key is that they are willing to work with a trans patient. Many people find it helpful to speak with a gender therapist, as they typically have more experience helping people find resources. But it isn't necessary, any of them can help you.

Have you told your doctor what your appointment is in reference to? Not all doctors feel comfortable working with trans people (mostly due to a lack of training and experience, though sometimes bias).

[Magnus]

No, it doesn't. You'll be VERY hard-pressed to find one of them locally anyway. And it likely isn't required. Most are happy to accept pure informed consent. Others, a general "evaluation" will suffice, rather than 'proper' therapy. And it's more a legal formality than anything else (if a "group practice", they don't want any liability should, for any reason, one 'regret' transition later... it happens). It's basically just to ensure there's no actual "mental health" problem influencing your desire to transition. Perfectly reasonable 'condition'.

'Best', is entirely subjective. For affordability? That's virtually always going to be IM (original/oldest patents). For results? That's really indeterminate (and regardless of how it gets there, as long as it's there, it will be used and you will see results). However, IM is as close as you can get to how it otherwise happens for 'cismales'... so... there's that (and you can forget about it for 1-2 weeks, which is real nice IMO).

Injections aren't so bad at all if someone else is administering them (especially if sticking glutes IME). I don't like sticking myself any either, but I will when I have to. And it sucks, feels a bit chit, but you gotta do what you gotta do. I just clear my mind (music really helps), bite my tongue and sink it. You can't think about it or you'll sit there for hours procrastinating lol. Ah right, 23-25G are ideal needle gauges for IM (don't let them try and give you any of that 21g+ much too thick for quads).

Personally, I wouldn't be happy with pellets, patches or gels (and THEE more expensive options). Was recommended I try switching to gel because the IM is affecting my hemoglobin a bit (54% at highest. 60% is the danger zone), but elected instead to donate blood every 3 months (perhaps more frequently if required). Don't want to deal with the other administration methods (and really couldn't afford them anyway... I mean, gel is practically $300/mo!).

Oh, but, ask about SubQ administration. It's better, in so far as you can use a really small, short needle and there's also then no muscle scarring, no risk of hitting nerves/veins etc. It's just, apparently, a pain to find a doc/endo that's informed enough of it to monitor that properly. Otherwise that's what I'd be doing.

[LexPromise]

Thank you for pitching in advice and input. I appreciate it greatly. I am in the waiting room now. A bit nervous. Needing people to hear me. I have had a difficult go of it.

[FTMax]

Good luck! Don't be too worried. The worst thing they might say is that they can't help you, but there are plenty of professionals out there who can.

[LexPromise]

Thank you. It was disappointing. They don't treat transgender people. The closest doctors I can find are two or more hours away. I am in Santa Barbara, CA. I made phone calls and looked up what I could today. I am going to call the clinic back that I belong to in a day or so.

[FTMax]

I'm sorry to hear that. What are you looking for initially? Therapy? HRT?

There are online therapists that are relatively inexpensive. My mental health co-pay with insurance was $50, and that was how much my online sessions were with a therapist who specialized in gender. I'm happy to share his contact information with you if you'd like, just send a PM.

For finding HRT resources or local therapists if that's what you'd be more comfortable with, I'd recommend making a thread on those specific boards (we have a Therapy board and an HRT board) with your city/state in the subject line. We've got thousands of members. I'm sure someone can point you in the right direction for what you're looking for.

Best,
Max

[LexPromise]

Thank you Max. HRT is the first thing and most important for me right now. I would like to see a gender therapist. I put in a call yesterday to someone in town and I will see. Reaching out to other online support as I don't have much of that in person.

[Bimmer Guy]

Thank you Max. HRT is the first thing and most important for me right now. I would like to see a gender therapist. I put in a call yesterday to someone in town and I will see. Reaching out to other online support as I don't have much of that in person.

Call all the endocrinologists in the area and see if any of them provide HRT.

For a therapist:

Check out this therapist listing: https://www.susans.org/links/Healthcare/Therapists_&_Counselors/

Or check out wpath.org providers.  I would suggest calling the closest one (no matter how far away).  Ask them if they know someone near you.

Another list:  http://www.drbecky.com/therapists.html

The reason why I think doing the above 3 approaches is that every single one of these lists requires the person to ask to be put on the list.  That means they are truly invested in working with transgender people.

People always suggest the Psychology Today route.  I personally do not.  The majority of therapists profiles that say they treat "transsexuality", actually don't.  There is a serious glinch in their system.  No one ever knows how that gets checked off on their profile.  If you do go that route CALL the person first and make sure actually do work with transgender individuals, don't just make an appt. through their web page.

[LexPromise]

Thank you. This is helpful. I am really struggling and stressed about this. I contacted a point person in town and they are working on training clinics in the community. I am going to speak with one of my social workers Tuesday. I see her for PTSD. I will call the endocrinologist department at my clinic directly this week, but I don't know if they will help. Hoping.

[Bimmer Guy]

Thank you. This is helpful. I am really struggling and stressed about this. I contacted a point person in town and they are working on training clinics in the community. I am going to speak with one of my social workers Tuesday. I see her for PTSD. I will call the endocrinologist department at my clinic directly this week, but I don't know if they will help. Hoping.

I'm glad it was helpful.  Good luck to you.  Keep us updated.