Choosing a doctor when starting out on HRT

[OCTrisha]

Hi everyone,

I've finally decided to take the next step forward and start HRT  .  I am looking to begin with a low dose to help deal with the dysphoria and possibly help pave the way towards a full transition later on (if I decide to go that far). 

The good news is that I've found one or two endocrinologists in my insurance network with some HRT experience with transgender patients.  While my therapist has not had any experience with the in-network doctors, she does have excellent things to say about another local doctor that is not with my insurance.  Because I am pretty stretched financially right now, I am leery to pay out-of-pocket if I can avoid it... but this is obviously a big deal, so I also want to make sure I am receiving the right care for myself.

So that I can have some idea financially, how often should I expect to be seeing my HRT doctor both initially and in the long-term? 

Also, what are some of the questions should I be asking upon my initial consultation?  I know there are dozens of obvious ones, but are there other questions that you never thought of asking that you now wished you had?

Thanks so much in advance for any insight you can share... this is a fantastic board.  (I also did a search for prior posts on the same topic, but couldn't find anything... sorry if I missed them)

--Trish

[Pisces228]

My therapist recommended a family Dr that has lots of experience with trans people.  I went in for an initial visit and bloodwork and came back the next day for results and hormones.  While my Dr does informed consent, she still highly recommends seeing a therapist before hrt and continuing throughout, which is understandable.   Then check ups every 3 months for a year and then once or twice a year after. 

[Harley Quinn]

3 times the first year for me. However, if things feel out of whack, you'll go back in for blood work. So 3 is a bare minimum. As for interviewing, I would ask about their feelings on progesterone. Just in case it comes up down the line. Their experience with "low dose" therapy. Their preferred method of hormone therapy, ie.. pills, patches, injections, implants... ask about a "cash rate" they sometimes will give you a discount for not having to deal with insurance companies. Their preferred checkup time line, they'll tell you how often they will have to see you. Then just a general feeling you get from them... I prefer upbeat and fun doctors. If we can't Crack a joke or two it won't work out. You want a doctor who you feel you can talk to about anything, because they "NEED" to know what is going on with you mentally and physically. You don't want to be predisposed to "holding back".

[sarah1972]

The biggest question is if your insurance covers HRT at all. If they do not, it does not really make a difference which doctor you pick. You can look around, some posts do contain costs of out-of-pocket treatment (I think it was around $200 - $300 per visit and about the same for labs but I may be wrong)
You should also check on wait times for your first appointment. I had to wait a few weeks for an opening and have to say that I made a great choice. I really like my OBGYN (no Endo close by but a local OBGYN has been treating trans patients for the past 10 years).
I have decided to go all in network and so far the insurance has covered everything, including hormones. It is a financial decision. Most importantly is that they have some experience and know what they are talking about.

I agree about the treatment options being something to discuss. There are personal and medical preferences between pills, injections and patches. The progesterone question is a really good one too. My doctor did discuss that there are no conclusive studies on effects but she still recommends it.

Regarding treatment frequency: Most mentioned is 3 - 4 visits in the first year. Labs may even be more often. Then it usually ends up being 2 visits per year. Some of the visits may be replaced by a phone call (e.g. just to review lab results).

[Michelle_P]

Being in an HMO, choosing a trans-experienced doctor for HRT is tricky.  They tend to spin the Wheel-O-Doctors periodically and who you get might not be terribly appropriate.  I drew an endocrinologist who really doesn't have much trans experience, and as as result I've been on HRT 7 months, have no testosterone even on the low level of spiro I get (Yay DES exposure...), and have an estrogen level a bit lower than the detection level for this test, <= 50 pg/mL.

Yeah.  7 months and woohoo, I'm being managed like a postmenopausal female. "Age-appropriate levels" 

I can spin the Wheel-O-Doctors again and hope for the best, but what percentage of endocrinologists have MtF treatment experience or are willing to learn?

I'm with Kaiser Permanente Northern California.  They've lost therapists recently, including my gender therapist.  They have a transgender support program, but they won't talk to me, just my therapist.  I can't get a therapist because they are rationing care for crisis patients.

It looks like I get to do my entire transition out of pocket, no insurance support.  Oh, joy.


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[Devlyn]

Being in an HMO, choosing a trans-experienced doctor for HRT is tricky.  They tend to spin the Wheel-O-Doctors periodically and who you get might not be terribly appropriate.  I drew an endocrinologist who really doesn't have much trans experience, and as as result I've been on HRT 7 months, have no testosterone even on the low level of spiro I get (Yay DES exposure...), and have an estrogen level a bit lower than the detection level for this test, <= 50 pg/mL.

Yeah.  7 months and woohoo, I'm being managed like a postmenopausal female. "Age-appropriate levels" 

I can spin the Wheel-O-Doctors again and hope for the best, but what percentage of endocrinologists have MtF treatment experience or are willing to learn?

I'm with Kaiser Permanente Northern California.  They've lost therapists recently, including my gender therapist.  They have a transgender support program, but they won't talk to me, just my therapist.  I can't get a therapist because they are rationing care for crisis patients.

It looks like I get to do my entire transition out of pocket, no insurance support.  Oh, joy.


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But they're always working to solve our problems! Wheel-O-Doctors  

Hugs, Devlyn