Informed consent and your regular doctor

[amandam]

Kaiser Socal only gives hrt if you are in transition. Some other places will give it to you to see if it helps your mood even if you don't know if you're going to transition or are nonbinary. I am seemingly nonbinary but I am sick of being on anti-depressants. I don't care if it changes my body as long as I feel good. A low-dose would take awhile anyway and I am interested in its therapeutic and diagnostic quality. I just wish happiness wasn't so elusive. Maybe I'm just a depressed person and the hrt won't help. But I'd know.

I am thinking about going down to The Center in Hillcrest and seeing if I can get a perscription. I also wonder what my primary care Kaiser doc would say if I did this and told her. Anyone have experience in this? Would it force her hand to give me a Kaiser perscription?

[Dena]

The difference would be who would pay. With informed consent, you would pay all costs. With Kaiser, a therapist would approve your need for HRT and then most or all of the cost would be covered by Kaiser. If you haven't already, you should discuss this with a Kaiser gender therapist and see what's possible. Depending on the approach, without kaiser it could get rather expensive for the lab test, doctor visits and the hormones themselves.

[amandam]

Been through therapy in Socal Kaiser. Seemed to be pegged as nonbinary. I'm just tired of the depression. If some hrt alleviates that, then why not.

[DawnOday]

Have you registered with transgender services? Were you assigned a Social Worker? Have you attended gender therapy sessions in Behavioral Health? That's the route I took. On my third visit the psychologist gave me my letter to proceed. The following week I was seeing Dr Lightbody for my prescriptions. 2 years eight months later here we are.

Sent from my Moto G (5) Plus using Tapatalk

[amandam]

That's the point of it. I did 6 intake appts. and about 10 regular appts. for gender dysphoria. So far, nonbinary. While I have GD, sometimes strong, it ebbs and flows. I'm just sick of being on Prozac for 30 years.

[AnneK]

I'll be on informed consent.  I just told my GP I wanted hormones and was given a referral to an endocrinologist.  My appointment is this Wednesday.  While my pills will be covered in here in  Ontario, my understanding is that they aren't that expensive to begin with.

[amandam]

OMG

What's wrong with what I said. If hrt is the "cure" for my depression, etc. then why not? Lot's of places use it as a diagnostic. When I read that, I think why not try it? Am I mistaken?

[Faith]

What's wrong with what I said. If hrt is the "cure" for my depression, etc. then why not? Lot's of places use it as a diagnostic. When I read that, I think why not try it? Am I mistaken?

I think she was referring to being on prozac for 30+ years

Anyways, I don't have insurance. I approached my GP first who was going to refer to endo. Well, the endo was hours away and would have been 'specialist' .. translation, very expensive many missed work days.

I went with informed consent via Planned Parenthood. I get blood work every 3 months for $275 including the appointment fee. My prescriptions are about $50/month due to injections. When on pills it was less than $20. So, doing the math, when I was on pills it was about $120/month for me to do informed consent.

[amandam]

Anyone have any experience with Socal Kaiser? If I tell my GP I will go for informed consent, do you think she will write me a prescription or send me to an endo?

[Dena]

It depends on the rules of the clinic where you're being treated. Some require regular therapy and others may only require an hour. When insurance pays for treatment, they want to be sure the treatment is required so they require more therapy and other guidelines. Informed consent normally means you pay out of pocket so if the money is wasted, it comes out of your pocket and not the insurance companies. In an informed consent clinic, they are only concerned about your ability to make a decision and not where the money will come to pay for treatment.

[Tessa James]

Hey Amanda,

I have worked within the Kaiser system for a long time up here in the NW.  While our clinicians are different the support of people who are non binary or have undefined or nominal transition goals should be unequivocal across regions. 

Our level of transition is ours to define and hopefully the gatekeeping concept is not being employed in any way that invalidates your desire for happy moods as a person who may be non binary.

It can be tiring yes but i encourage you to persist and be assertive about your needs.  Many of us had to make repeated  efforts and sometimes a formal appeal to get the care we need and deserve.

[AnneK]

If I tell my GP I will go for informed consent, do you think she will write me a prescription or send me to an endo?

Mine sent me to the endocrinologist, who gave me the prescription on Wednesday.  I started on it that same days.  It was a very easy process.  I gave my doctor the info on feminizing hormones that I downloaded and at the endo, the appointment lasted about 1/2 hour and I left with the prescription.

Incidentally, I'm getting the impression, from both my own doctor and the endo's receptionist, that my doctor is not a newcomer to referring trans patients.   

If I'd known that, I might have started earlier, as I first mentioned hormones to her just over 2 years ago.

BTW, I've read in a few places that it doesn't take long to determine if hormones are appropriate or not.  If they are, you soon feel good on them.  If not, you feel lousy.  I feel great

[Kate.claire]

A little late on this post, but I'm at Kaiser in SoCal as well.  I actually started out of pocket through hand selected therapist and a doctor she recommended.  By the time I realized I could be using Kaiser, they sent me to a education session, and then a therapist appointment.  She recognized I was already 6 months on HRT and really made it quite simple for me to move forward into the Kaiser system after just the one visit.  No gatekeeping, went straight to the Endo, and he never challenged my intentions and just picked up my same prescription within Kaiser.  Same experience as AnneK, but directly in San Diego, so I think you'll find they are not gatekeepers either.

Also, not so sure on how fast you can tell if hormones are really right for, well in my case, I know they are right for me, but doesn't stop the competing guilt of impacts to those I love around me.  I'm happier internally, but anxious over what I am losing to get that.  Not necessarily a smooth road ahead. 

-Kate

[amandam]

I had a phone consult yesterday with my doctor about not sleeping well. She said she didn't know if there were any good info on whether or not hrt as a diagnostic is valid. I take that to mean "scientific studies". But she said she'd send me to the endo if I want. So, now the big decision. Do I do it and see if my depression and anxiety lift? It's one heck of a decision.

[AnneK]

There are many who take hormones and do nothing else, as the hormones make them feel better.  Also, estrogen may be prescribed to men for some medical conditions.

In my case, I don't know how far I'll take things, but I feel much better on HRT.  And yes, I've long wanted breasts and given a lot of thought to surgery of some sort.

[snbab]

I had a phone consult yesterday with my doctor about not sleeping well. She said she didn't know if there were any good info on whether or not hrt as a diagnostic is valid. I take that to mean "scientific studies". But she said she'd send me to the endo if I want. So, now the big decision. Do I do it and see if my depression and anxiety lift? It's one heck of a decision.

My personal opinion is yes, go for it. If it doesn't help, then you can stop the HRT is you choose to.
Nothings gained by not trying.

[pamelatransuk]

Hello again Amanda

My advice would be to "explore" HRT and see how you feel after 3 or 6 months as you would likely be put on a low dose to start anyway. I felt very soon after the start a clearing of my mind and a great sense of peace.

My depression and dysphoria remained and still remain now after 15 months HRT but at a much reduced rate. I am going fulltime public in Summer.

I wish you happiness and success whichever option you choose.

Hugs

Pamela

[amandam]

I'm probably going to go on finasteride for my prostate. I wonder what effect that will have. It lowers testosterone, right? I wonder if that will help with my little test?

[AnneK]

I'm probably going to go on finasteride for my prostate. I wonder what effect that will have. It lowers testosterone, right? I wonder if that will help with my little test?

My understanding is dutasteride is the better medication for BPH.  Talk to your doctor about it.

[Jennifer300]

I looked online for a local doctor who was LGBT friendly, and laughed when I found my own personal doctor was very LGBT friendly.  I knew he had the rainbow sticker around the office showing support of LGBT. On my normal appointment I asked him at the end if he did gender affirmation (which I already knew he did by reading it online).  He made me an appointment to come in and discuss it and gave me lots of web sites to read up on it so our talk would be more productive.  On my next appointment we discussed my Gender Dysphoria I told him I wanted to try HRT since so much I had read online how it helped many people with the feelings and might live a more stress free life.  I told him I had read most of the changes were reservable other than a pair of breast which many with gynecomastia live with anyway.  He asked me if I was ok with all the medical changes on the list, I said yes.  He asked if I wanted to do this?  I said, lets do it.  He wrote me a prescription for 90 days Spironolactone and Estradiol pills.  I would say the main part of my success was making certain I had a Doctor who was supporting of transgender patients.  One of the links he gave me was a network of Doctors who specifically make an effort to reach out to the LGBT community and show they support us.  The out care site lets you search for such a Doctor in your area.  Good luck on your quest, I hope you find yourself and get some peace of mind. 

https://www.outcarehealth.org/