Robby's Journey

[Robbyv213]

Thanks @Lori Dee I really hope it goes better than what I am expecting.

Good to know. I'll bookmark that page and check it frequently.

[Robbyv213]

Took an hour to get to my VA's office where my endocrinologist is located. Now I'm waiting to be called. I need to figure out how to get a endocrinologist more local to where I live. This 1 hour drive one way for an appointment (that's prob going to go bad) is b.s.

I know multiple veterans who refuse to go see a VA doctor and have all their health care done at in network non VA facilities. So I know it can be done.

[ChrissyRyan]

I hope it goes well!

Chrissy

[Robbyv213]

Finally had my Endo appointment. I learned that my endocrinologist is basically new there and like an understudy because today I had or my endocrinologist had the department head sit in with our appointment. And he actually had to explain a lot of things to her that she was just under certain assumptions so to speak if you will. He had to remind her that this is my journey and transition and that there's no one way right way or wrong way to do it. And that they're there to help me along the way and be as safe and healthy as possible while on this journey. So that was nice and refreshing.

The department had actually agreed with me when I said that what was previously prescribed was too low or infrequent of a recommended dosage for estrogen. Which was previously once every 2 weeks. They decided to change it to one injection once a week.

So that I'm happy about. Obviously the doses change from one week versus the two week but I feel even at the different dose the hormone should be more steady and consistent in my bloodstream than once every 14 days.

They decided to for the time being not prescribe any androgen blockers and told me not to take any of the ones I still had left. They said they wanted to try estrogen only therapy to see how that affects my mood energy levels libido and my concerns about being able to still function.

I know estrogen on its own can eventually suppress testosterone but I don't see that happening at the doses that they prescribed even for weekly injections. But I feel it's definitely a move in the right direction and at the very least I still have a prescription or I should rephrase inactive prescription in my name so that if things do worse in with the new administration they have to at least continue what they already prescribed.

The department head explain that it usually takes about five injections or five half lives of the hormone to become steady enough and or more dominant in your body and once that happens that's usually when most of the initial negative side effects from suppressing testosterone and introducing a new hormone fade away.

So now I have my next appointment in about 8 weeks which should be enough time for five injections they want to see where my levels are on estrogen only therapy and see how well or not it is at suppressing my testosterone on its own.

I did ask about testosterone gel since some endocrinologist prescribed that for individuals specifically in the adult film industry to maintain function and he said that while that that is true they typically only prescribe it once an individual has reached their optimal dose and hormone levels so he didn't exactly say no he pretty much just said that at this time it's not recommended because my body will be trying to do too many different things hormonally at once versus getting set in my ways on estrogen and then re-adding a small dose of testosterone and or lowering any anti androgens at that time. Odds are they're probably going to play around with any anti androgens first before they prescribe even in a small amount a hormone that will go against my hormone replacement therapy.

So besides having to drive an hour to my appointment I feel the air has been cleared and it's went as well as it could have gone.

At the very minimum I'm happy to have another active prescription for hormone replacement therapy. They said they'll consider reintroducing a anti-androgen once I become more clear on what my goals needs and wants are with transition and hormone replacement therapy. Which is going to have a lot to do with my therapist and I putting in that work.

Which unfortunately because I was paying for out-of-pocket for therapy sessions I had not had one since September or so. So there was a lot of time especially during my initial trial on hormones that I did not have a therapist to speak to and it was only until recently that I was able to get six weeks scheduled with the VA mental health therapist. So hopefully after these 6 weeks I'll be in a better position to move forward.

I apologize if some of this doesn't make sense I'm using speak to text so there might be some words or phrases that my phone is not picking up on.

That's pretty much it however I do not like having to rely on the VA for my healthcare or prescriptions especially this kind of care and prescriptions with the current administration. And the way the world is currently viewing a song I definitely feel like it's a good idea to have at least some sort of medical freedom or stockpile of hormones since it can be so easily canceled and taken away or constantly having pharmacies be out of stock on your prescriptions.

I have my first of six therapy sessions tomorrow on video appointment and I have my fourth laser hair removal sessions on Sunday. I know I should probably start doing laser on my face since it's a long process to get rid of facial hair but at the same time I definitely don't want to not be able to disguise myself with facial hair so that I can still not before to come out sooner than later.

[Lilis]

So besides having to drive an hour to my appointment I feel the air has been cleared and it's went as well as it could have gone.

I'm really happy for you, Robin. It sounds like you're on the right track with HRT.

[ChrissyRyan]

Robby,

That sounds good. 

I have not experienced a shortage or outage of estrogen.  I have heard that others have, mostly overseas, but sometimes here in the USA.  Such as a patch was not available. 

Chrissy

[Lori Dee]

Took an hour to get to my VA's office where my endocrinologist is located. Now I'm waiting to be called. I need to figure out how to get a endocrinologist more local to where I live. This 1 hour drive one way for an appointment (that's prob going to go bad) is b.s.

I know multiple veterans who refuse to go see a VA doctor and have all their health care done at in network non VA facilities. So I know it can be done.

Just explain the situation to your Primary. They can send a consult through Care in the Community to see someone local.

[Robbyv213]

I spoke with my patient advocate again explaining the situation that I have no confidence in my current endocrinologist seeing as she had two different Drs sit in at each appointment now, and that those Drs were the ones that decided the recommendations for the prescriptions, and that I felt she had certain pre disposition to how trans care should be and what she was going to do and not do already decided in her head.

The advocate is trying to get me to be only a patient of the last Dr that sat in with us at my last visit, and if not then requesting I be sent out into community care to a more local facility, based on best medical interest of the patient (since I would not qualify for distance from the VA facilities or driving time which is calculated by a VA computer in perfect driving conditions).

So that's my most current update. I should here back in 7 days max, as to what they are going to do to rectify the situation.

[Lori Dee]

Sorry that it is becoming such a battle for you. Hang in there.

Hopefully, it will all get resolved soon.

[ChrissyRyan]

Robby,

I hope you get a satisfactory arrangement for your doctor.


Chrissy

[ChrissyRyan]

Robby,


Have a nice weekend too!


Chrissy

[Robbyv213]

They have moved me over to the other doctor that sat in with us on the most recent appointment. The Dr who came up with my current prescription recommendations. Next Endo Apt is March 31 a Monday, so I'll need to do labs on a Friday two weeks before hand.

[ChrissyRyan]

They have moved me over to the other doctor that sat in with us on the most recent appointment. The Dr who came up with my current prescription recommendations. Next Endo Apt is March 31 a Monday, so I'll need to do labs on a Friday two weeks before hand.

I hope it all works out well for you. 

Chrissy

[D'Amalie]

When I came out to my PCM almost 15 years ago as MTF, VA offered me gender affirming care (after psyche evaluation, suicide is a real problem in our population) and assigned me to a single PCM in the Women's Clinic. I find that in the VA system the patients are almost never seeing the same care giver, always someone new.  The turnover is atrocious in my experience.

She always has a young doctor in tow, whether in person or on video/audio appointments.  I use secure messaging to the clinic too and am not afraid to ask about changes to my regimen.  Early on the endocrinologists got involved, always 2 at each appointment.  After that 1st year PCM and I jointly consider where I am and where I feel I need to go.  I've learned to not be shy when I have ideas about meds and dosages, its my life after all.

VA has limits to what can be offered.  I'm hoping the current Executive Officer won't impact the VA support to our community.  HRT for me was Spironolactone first, then Estradiol 6 mos. later.  This is where you might get the feeling that medicine is a practice and we are research subjects.  I send my PCM research about other healthcare systems HRT programs, which she seems to welcome.  An example was progesterone. She is limited by what the VA approved and must be able to justify her medical opinions.  For 2-3 years she said there wasn't a definitive study available to support it, then after year 3 HRT she added it.  VA won't do any surgeries, but they will help with prosthetics (and bras to fit them), life test support and therapy, HRT and voice coaching. 

By the by, the progesterone seems to have helped round out my breasts.  I say it definitely has, but I'm sure I'm biased.  I wear the same bra sizes but the cups are well filled out C's.  There's nothing scientifically objective about how you feel, but visual results are clear evidence.

All I'm trying to convey is that the VA doesn't specialize in gender affirming care, but for the most part the VA doctors that volunteer to support us are maybe not the most experienced, yet they are well meaning.  If you find yourself up against it, ask for a referral to community care.
 

[Robbyv213]

Yea. I'm slowly learning everything that you and everyone else has mentioned.

It's a long term game with the VA for sure.

As of right now I'm content with the current change from bi weekly to weekly doses, and no anti androgen for now seems to be the right path for now. I'm sure I will have an anti androgen added back in here at some point. But I'm in no rush. Transition is a marathon not a sprint and I'm here to enjoy the journey as much as the destination.

Just going to sit back and enjoy the ride, deal with what ever happens as they come up and cross those bridges as I get to them.

Weekly therapy sessions seem to be going good. I feel like I am on the right path and affirmed everyday that goes by. Slowly accepting my truth and my true self.

I have my first vacation voice therapy session/consult this week. Curious to see how that will go.

I have been waiting since early Dec for a wig from the VA or at least for someone to call me and set up the appointment for it.

My new endocrinologist gave me more refills on my estrogen so thats good. Going to have them refilled as often and as much as I can to build a stock pile for myself. Lol I also had one of the lower level personnel in the endocrinologist office change my prescription to say for hormone replacement, from gender affirming hormone replacement. So that's good. Probably would not have happened under my first endocrinologist.

It's funny how once the patient advocate gets involved everyone becomes much more willing to work with you and listen to suggestions lol.

My current plan is to just go with the flow, and ride this roller coaster and continue tp live life as normally as possible for the time being, while taking steps to allow my to get closer to my goals in transition every day, until I have to come out or deal with the many unpleasant hurdles that transition always throws at us.

My wife has the expectation that I will know and have a more clear idea of who I am and what I want to do in terms of my gender identity and what direction I want/need to go in in order to be me around the beginning of March which is when the last of my 6 week block of VA therapy is ending before they set up another 6 weeks.

We will see how that goes and what kind of curve ball transition throws my way when I tell my wife that with each passing day I feel I need to transition and live life as woman in order to be true to who I am. She will def be upset. But once things calm down after the initial shock (which I doubt will be shock, in sure she is feeling that this is what was going to happen) that maybe we will be able to come to a compromise or something that will allow me to continue to walk towards my truest Version of myself while allowing us to maintain a marriage and relationship. But we will see. Prepare for the worst and see what happens I could be surprised. Lol and I know that I can't control how others feel, or what they do. All I can do is control how I show up in every circumstance I find myself in.

I have been trying to work on mindfulness and positivity and being grateful for everything. It really has helped my mindset alot. Which I am sure will come in handy in the future.

So that's it for now.

[ChrissyRyan]

Robby,


It is nice to see your updates. 


Chrissy

[Robbyv213]

Had my first voice lesson today with the VA vocal therapist. It was not bad. Can't complain. I was pleasantly surprised that they offer more than just voice training but also mannerisms and body language as well as speech patterns not just for trying to raise/lower pitch and resonance.

I was even more pleased to hear that my pitch is already somewhat high for a typical male, that I'm more in the gender neutral non-binary area, boarding feminine, but my resonance is deeper more in my throat vs being higher.

So we plan to work more on my resonance more so than my pitch for now. Also my pitch has some room to go higher as well. So all in all I am pleased with how it went.

Now it's just a matter of finding time to practice and get to a point where my body naturally starts out at a higher resonance.

[ChrissyRyan]

Had my first voice lesson today with the VA vocal therapist. It was not bad. Can't complain. I was pleasantly surprised that they offer more than just voice training but also mannerisms and body language as well as speech patterns not just for trying to raise/lower pitch and resonance.

I was even more pleased to hear that my pitch is already somewhat high for a typical male, that I'm more in the gender neutral non-binary area, boarding feminine, but my resonance is deeper more in my throat vs being higher.

So we plan to work more on my resonance more so than my pitch for now. Also my pitch has some room to go higher as well. So all in all I am pleased with how it went.

Now it's just a matter of finding time to practice and get to a point where my body naturally starts out at a higher resonance.

Robby,

Practice does help.  It has not been easy for me.  I persist though.

Chrissy

[Robbyv213]

Finally after 4 months the VA final pushed through my request and I was contacted by a local wig shop to get fitted for a wig. I have up to 500 for a new synthetic wig. The appointment is in a few weeks. I can't wait.

I also had ordered a nice light blue bikini top and bottom, I absolutely love, but I doubt that I'll ever get the chance to wear it out in public.

[ChrissyRyan]

Robby,

That is nice that you will be getting a wig!

For additional modesty, you may wish to consider adding a swim skirt.


Chrissy