Home from Dr's appt: frustrated and sad

[LJH24]

This is my first day at Susan's. My son had his appt today with his Dr. where we were hoping that he would be getting a rx to start HRT. But that didn't happen.  The Dr. said he didn't think my son was ready for that step based on his conversation with my son's therapist.  My son is so sad. I'm worried he is going to sink even further into depression now.  I "kind of" understand the Dr.'s reasoning.  Admitting he is transgender is fairly new to my son.  He is 19 and just told me 3 months ago. He has not wanted us to start using feminine pronouns yet and still seems "uncomfortable" about himself. Also, the Dr. is concerned that he hasn't come out to very many people yet and wants him to build that support group before he starts HRT.  But still, I'm worried. Is this typical for Dr's to make patients wait?

[Elis]

Yep pretty much unless you go the informed consent route. Most gender therapists want to make sure their client has thought through the pros and cons and have a solid support network first. The former I can understand the latter is can be very difficult if a trans person is uncomfortable because of dysphoria; so not quite fair imo.

[Megan.]

HRT is only one part of a transition. There is much your son can do that will built their confidence in this path.
Facial hair removal is something I think you've already discussed on the forum. Makeup skills,  fashion and style,  mannerisms,  vocal training, getting out in public if possible.
Many of us get disheartened at the slow pace and delays on this road,  but there are always things to do, that help reassure us we are still moving forward. X

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[LadyGreen]

My doctor was hesitent at first as well, i too had only realised that i was trans a few months before and i wasnt using a female name or pronouns in public at the time, neither was i dressing yet. In my case i got the ok for HRT the first  time i took a bus to an appointment wearing a skirt and a little makeup. I would suggest your son( possibly daughter) tries experimenting with female clothes and possibly makeup( maybe start just around the house or wearing womens undies in general life). I found it really helped with the disphoria and made me more comfortable with my identity.

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[Bari Jo]

I agree with Megan, there's really no reason to be sad, it's just a slight setback.  There is sooo much to do.  Once he starts, he will feel better about himself.  I found that I could throw myself into electrolosis, skin care and perfume.  My first trip out as Bari Jo was to pick out perfume for myself.  That is a great field trip you can do together.  Then wearing it reduces dysphoria daily too.  He will need help with skin care products, another trip together.  Choosing a style is fun research time and working toward it.  All of these will help reduce the sadness of not being on hrt now, plus prove that he's committed for later.

Bari Jo

[warlockmaker]

There are TG experienced Drs  and Drs that this is a fairly new experience, also the therapist should be a gender specialist. I say this because you mentioned that the Dr said he had not come out to enough people. Coming out to people should never be a necessity for determining the readyness.

19 years old is no longer a minor and is a wonderful time to start HRT, It will avoid many of the strong maculine physical looks that develop with age. I do suggest that a sperm bank be used to store the sperm in case later in life she will want a child.

A 3 month try at HRT could help confirn her gender, HRTs greatest effects is changing how we think and its hard for people who have not experienced 2 lives like us to understand. If we are mentally female we will find estrogen to be a bliss and give us peace. If not mentally female it will be quickly evident to her.

We tgs take time to accept what we are, some suffer greatly,  and HRT is the first confirmation on our long journey to be who we should always have been.

I wish, your soon to be daughter, the smoothest journey to become who she should have been. Have a wonderful holiday season.

[AnonyMs]

I've been on hrt 9 years and have only come out to 2 people who know me and are not doctors. Pretty sure I'm trans.

[Roll]

You could certainly go for a second opinion(and as others have said, make sure the therapist is a gender specialist!), but perhaps it may be better to address the doctor's concerns directly and work on making your son feel more sure and comfortable about where he is going. Spending time on forums such as these or presenting as female online in general may help, allowing him to get more used to feminine pronouns to see if they feel right. Even better though, encourage him to spend time in a female role in person, even if just with you. Makeup and clothing are cliches, but any physical presentation can go a long way in helping sort things out.

I know that presenting as female in therapy was a game changer for me, and helped show my therapist that I was serious about my feelings. While requiring "real life experience" varies country to country, if it is practical and not harmful to the individual, those sorts of experience do help therapists and doctors in feeling more comfortable that the person is on the right path.

Making other progress in the meanwhile may also help not only in alleviating depression but showing the doctors what they need to see as well.

Having said that, you could ask for some androgen blockers as a hold over. They are commonly prescribed for hair loss (Propecia, generic name finasteride, is an anti-androgen) and other things for men, so shouldn't be controversial for the doctor, and they may help delay any further masculine development since he is still young without causing any irreversible side effects in smaller doses.

[Dena]

Hormones and even surgery don't make that much of a difference. The most important thing is the life. Your child still fears the very thing that will effectively treat dysphoria. I would recommend a game plan like the following.
1. Pick a feminine name
2. Start using the feminine name and pronouns around the house.
3. Experiment with dress and appearance around the house.
4. Grow out hair if required.
5. Join a transgender site, possibly this one and learn from it.
6. Start laser hair removal or electrolysis on the beard.
7. Start making escorted trips out of the house with feminine presentation.
The important thing is to take a series of small steps. Looking transition as one huge task makes it look impossible. Doing a small amount at a time is doable.

[Jayne01]

LJH, I'm not sure I can add much more than what others have said here. So I will give you a brief run down of my experience which may be of some help.

There is no right or wrong way to be trans and each person's transition path is unique to them. I am 45, not out to anybody other than my wife, and health care professionals I am dealing with. I started HRT 3 months ago. I only go by Jayne on this forum, otherwise I use my birth name, male pronouns and always present as male (hopefully not for too much longer[emoji846]). My therapist and I discussed my transition process and this has so far worked best for me.

I would also recommend getting a second opinion and perhaps asking for androgen blockers as an interim measure. That would pause the masculinising process until there is more certainty and the doctors are happy to prescribe HRT. In the meantime, starting on beard removal will be helpful. The very first 30 minute trial electrolysis session I had did wonders for me psychologically. In that shirt session, only a handful of hairs were treated, but the knowledge that those hairs will never return really helped with the dysphoria.

All the other suggestions are also good things to do even though he is not on HRT. He already has a very supportive mother, that is a massive help.

Wishing you all the best.

Jayne

[Ellement_of_Freedom]

Find a different doctor.

[LJH24]

To everyone - thank you so much. You've given me a lot to think about. I will have my son read your responses tomorrow and we will talk about a game plan. 

[Laurie K]

 Transition is a process and, there are many tangibles that make a successful journey. Self-acceptance is a start. For me that came with baby steps of cross-dressing, learning to put a look together, and then getting good at makeup.  In my opinion, working on those and starting testosterone blockers for a bit would be a great place to start. I believe the small steps towards girlhood may bring a degree of happiness to your child for the short term, while you may look for more supportive health care providers. Although things are far better than my first coming out, this road is not for everyone.  It can be mentally grueling, with the societal issues that are attached to us.  That being said I have absolutely no regrets.
..... just my thoughts I hope you can take something from this.   Huggs

[MeTony]

You have gotten great advice already.

My journey was tough. Self denial. Depression. Admitted to psych hospital for 6 months because my brain crashed completely and I wanted to die.

I admitted to myself 10 years ago I am transgender. But it took 10 years for me to tell my husband I am a guy. 10 years of anguish and self denial.

When I finally came out this year, it was such a relief. I'm out to about 20 people by now.

To your son (daughter to be?) Why not register at Susan's and start exploring who you really are? We are a supporting community and you can get some of your thoughts tangled out. There is no right or wrong way to be transgender and everyones path is different. When you have some of your thoughts straighten out and written down it will be easier to talk to your therapist too. (Gender therapist I hope).


Tony

[LJH24]

I am reading over everyone's helpful and thoughtful responses this morning and writing out some options to go over with my son when he wakes up. One of the biggest obstacles we face is our location. The doctor we are going to took me a long time to find. He is the only dr in our area the works with transgender patients. He is a third year resident and plans to focus in this specialty in his own practice.

I really like him and so does my son. I just don't think he handled this correctly. It sounds like after talking with therapist that he decided my son wasn't ready. But we went into the appointment thinking that we were there to get the RX started. My son was in such a good mood going in - and then devastated.

I don't think finding another dr is an option. We could possibly look into another therapist but I'm sure we don't have any gender therapists in our area.  I like the idea of asking for testosterone blockers. And that might help my son to feel like things are still moving forward, although at a slower pace than he likes.

[Roll]

I know that I've been really, really anxious and borderline depressive waiting on the verdict for my HRT (though in my case it's an issue waiting on labs, which I really don't know where the ball is being dropped regarding), so I can relate. I'm going on a full month since my appointment and even just this relatively brief feeling of being at a stand still is just horrible. If he's anything like most of us, the sense of moving forward is integral to well being, regardless of the pace (though faster is better ).

[Dena]

One of the problems with modern HRT is it can reduce the dysphoria to the point where people delay feminine presentation. It can reach the point where they are having major male fail but are unskilled in feminine presentation so they may end up in a last minute crunch to do everything. I suspect the therapist would like to see some movement from a solid male presentation to avoid the last minute crunch.

Things like electrolysis take a year or more and you need to grow out your facial hair before the appointment so it can be held with tweezers. Voice therapy can take a year or more and just becoming comfortable in public can take a while. The point of treatment is to get out into the world and not hole up in the bedroom with a video game. I have seen a few of those on the site and it sad that they went through all the effort and aren't taking full advantage of it.

I think if the therapist sees movement in a feminine direction and if your child can present as feminine in the office, your child will walk out of the office with a letter for HRT. I am reluctant to recommend another therapist at this point in time because I suspect this one is taking a long term view and may be seeing things that you aren't.

[steph2.0]

Hormones and even surgery don't make that much of a difference. The most important thing is the life. Your child still fears the very thing that will effectively treat dysphoria. I would recommend a game plan like the following.
1. Pick a feminine name
2. Start using the feminine name and pronouns around the house.
3. Experiment with dress and appearance around the house.
4. Grow out hair if required.
5. Join a transgender site, possibly this one and learn from it.
6. Start laser hair removal or electrolysis on the beard.
7. Start making escorted trips out of the house with feminine presentation.
The important thing is to take a series of small steps. Looking transition as one huge task makes it look impossible. Doing a small amount at a time is doable.

Great list, Dena. I'd add underdressing (wearing women's underclothes) and painting the toenails. The last one, especially, helped me with my dysphoria. I called it my "secret weapon." Just knowing they were red would make me smile when other things were bothering me.

Good luck to both of you. Happiness awaits.

Steph

[josie76]

I can only add my experience here.

I started seeing a therapist who had some experience with transgender people in the past. To be quite honest her experience was not that many patients. However we developed a great relationship. I did want to get a referral letter from her to start HRT. She ended up making me wait nearly three months before she wrote it. I actually provided a sample letter from online. I think she just wanted to make certain it was the right thing for me.

Once I had an appointment with an endocrinologist all I needed to do was say I wanted to try hormones and give him the letter of recommendation. The doctor follows the WPATH standard.
He never spoke with my therapist. The doctor gave me a low dosage of estradiol and Spironolactone for an testosterone blocker.
I took that dosage for three months then returned to see the doctor. Honestly I knew about a half hour after putting that estradiol pill under my tongue that it was right for me. Not everyone gets immediate mental results. For myself, I already had very low testosterone. I think for your child, even a trial dosage might take a month or more for the testosterone to drop and the estradiol to become the primary hormone in the brain.
When I returned to m endocrinologist I told him I was good with myself. At first he asked if that meant I wanted to stay at the low dose. I clarified that I meant I was sure and ready to transition.

My doctor is one of only a few that provide HRT in St Louis MO. He is a professor of endocrinology at a major medical school. He is also very conservative in his hormone prescriptions. Not always ideal but he is here for us locally.

[LJH24]

So ... the 3 of us had a talk this afternoon.  Me, my son and my husband. It didn't go well.  We talked with him about the Dr's appointment and the suggestions from everyone here.  My husband and I tried to get some indication from him about where he would like to proceed from here.  Most of the responses were "I don't know."  If this is what his therapist goes through every week, I feel bad for her.  He just.won't.talk.  We asked him if he was sure about want to transition. He is.  But he's not happy about it.  He said he doesn't want to be transgender. He knows he is, but he isn't happy about it.  And now he's mad at me.