Doctors Completely Messing Up My Treatment

[Muscle Matt]

I started on hormones in November (with a month+ break for top surgery in February/March). I've been worried that the Medical Assistants giving me my shot every two weeks were doing something wrong, but I began to notice some changes, so I assumed I was being given the correct amount (except the one time the woman blatantly gave me half my dose for no reason). I've still found it strange that my voice hasn't begun to change in all this time, and the changes that I have noticed, I felt should have been more drastic.

Well, I went back to see my doctor on Monday to talk about increasing my dose. Yada yada yada, long story short, I found out I've been receiving HALF of the STARTING DOSE all this time. HALF. Unfortunately, if we were allowed to post doses on here, I would have caught this mistake a long time ago, but I did search some other websites when I found this out, and what everyone says does show that I've been on the half dose. Apparently what happened is my doctor prescribed me a weekly dose, but didn't change the amount when she realized I would be getting the shot every two weeks. These women give these shots to trans patients all the time, and not once did any of them realize, "Huh, this is really, really low for a two-week shot". The last girl I saw even told me that none of the workers there even open up the computer to look at my patient file/prescribed amount, so they just look at what's written on the bottle, and that's what they give me. I almost had to start flipping out (and boy do I know how to flip out) when the doctor increased my dose to 3x what I've been getting and the MA tried to inject me with that amount.

Somehow, on half the starting dose, I have noticed:
-Female monthly patterns have stopped, if you know what I mean
-skin cleared up like a boss
-facial and body hair growing in/growing longer/darkening
-mental clarity
-slight improvement at the gym
-while my voice hasn't dropped/changed, it has been naturally hitting lower notes when I talk (voice got higher again when I went off hormones)
-clit went from "where is it?" to 1 1/2 inches

I got them to give me a 50% increase on my dose instead of multiplying it by 3. So I'm still under the starting dose, but almost immediately after receiving this new dose, my voice has been getting lower. I honestly hadn't even realized I've been on hormones this long already (I keep very busy with my life, unfortunately), and now I feel like I've lost potential progress due to the drs' incompetence. The biggest things I'm looking for are voice and facial changes, and I'm WAAAAYYY far behind in those aspects because of this.

Unfortunately, I've been looking for a new doctor for a while, and my insurance is horrible, so it makes it difficult. Besides the mistakes with my dosing, these people don't care at all what my current T levels are. I have never even seen a single lab result from this place. They're just prescribing me the same thing the prescribe everyone else. I asked the doctor this last time to increase my dose slowly and see how it does before we maybe increase again, and she told me she would increase me from the starting dose to basically the max dose they typically prescribe (which I absolutely will not do). I don't think they even listen to the words that come out of my mouth. -_-

Now I'm wondering, if my voice is changing, and I've seen all these other small changes already, how will I know when I've found a good dose for myself? I'm sure I'll still end up getting up to the normal STARTING dose, but how will I know when I've found a dose that gives me what I'm looking for? How do GOOD doctors determine what dose a person should be on?

I feel so helpless because of how effing awful my doctor's office is. I'm not at all involved in my treatment plan (and why should I be, when my doctors aren't even invested in it). I hate just blindly going along and wondering whether or not these women are even dosing me properly. I just have no idea what to do.

[Elis]

Wow, I can't believe doctors could eff up this badly. If I were you I'd share this story on Tumblr and other social media sites so this doctors office doesn't screw over other trans people. At least then other trans people won't lose potential progress. Do they do informed consent where you live? At least it was only 5 months you wasted and you've increased your dosage now :/

[FTMax]

Yikes, that's awful. The thing about dosages is that they'll vary for everyone. So while there may be a standard full starter or half starter dose that you see repeated a lot, it often gets changed within that first year depending on how your body is adapting. So for conversations on dosing to be really effective, you'd need to know a lot more information than just the amount, concentration, and frequency. That's why lab work should be done often, patients should keep track of what effects they are and are not experiencing, and providers should have a good understanding of where to find the balance between good changes and unwanted side effects.

I don't think there is a good way to say using external means that you've found a good dose. Lab work should form the base of the dosage conversation, and it should then be coupled with what changes you're experiencing. The goal is for you to be somewhere in the male reference range for T, and have low E but at the same time not be experiencing any issues with fatigue, shark week, downstairs dryness, excessive acne, etc. For many guys, it is likely that they will find a good dose in those half or full regular amounts that you read online. But everyone's body chemistry is different, so without the lab work, you can't truly be sure how you're doing.

As far as what my doctor does, I had quarterly lab work my first year on T (and it's looking that way for my second year too, but only because she's having to sign off on so many things and do tests for my bottom surgery). Once a quarter, I have a CBC, Metabolic Panel, T Serum, and Estradiol test done. About a week after that testing is done, I meet with my doctor to go over those results and discuss how I'm doing - changes I've had that were good, changes I've had that I didn't like, any concerns I have, etc. From there, she decides the dosage and frequency and writes up my prescription.

I would give your insurance a call and see if they can refer you to anyone who does HRT for transfolks. I've heard it is much easier to find someone to continue your treatment than to start you out initially. You could also look into Planned Parenthood locations near you and see if they are currently offering HRT. Not all of them do, so you would need to call ahead. I think the issue you'll likely run into is how soon someone can get you in as a new patient. You may have to keep going to the place you currently are, especially if you're having them inject you vs. doing it yourself.

[Laura_7]

Here is a link to a medical reference which could help you and your doctor:
https://www.susans.org/forums/index.php/topic,80762.msg564084.html#msg564084

Plannetparenthood might be a good idea for hrt ... and you might ask at the next lgbt center near you for endos.
Or you might google transgender endo and your place .

Btw there are renowned clinics who also do not much level testing.
They look for overall health, how the patient feels and how people progress.

*hugs*

[Mr.X]

It's bad when doctors prescribe the wrong dosage, no doubt about that.
But I wouldn't worry too much, if I were you. Dosage is not everything. For example, when I started using the standard dose for testogel, my T levels were sky high. I had to cut down a lot in order to get acceptable levels. Also sustanon normal dosage gave me very high T levels, so taking half a dose was good for me.

What I'm more surprised about is that your blood T levels weren't checked. That's what it is all about, and if it had been done, they might have picked up on the low dose. Or if you are like me, your T levels might be just great with half a dose. Have that checked, I say. And of course liver and kidney function and the like too. That's something to keep an eye on.