Getting your dose upped?

[xAndrewx]

So I have to go in for bloodwork which my insurance will cover if my doctor doesn't mind me being 2 weeks maybe a little less for it. My problem is that, while I have noticed some change, I've not noticed even half of what every other guy I've heard of has gotten at my length of time on T. I'm even passing less since starting T.

I have a feeling when they do my bloodwork my T levels will be low but since they did no starting bloodwork and they have no trans experience I'm wondering how I should go about talking about a dosage increase. I looked up the "standard" dose which I know it's different for everyone but compared to that my dose is pretty low so I know they could increase it if my bloodwork shows they need to.

Any advice on how to approach the convo when I go in? I thought about even calling my doctor and mentioning it but I just don't know exactly what to say. I'm thinking if I wait to go in until after my bloodwork comes back I will say "I'm having little change and I know I am on less than the average dose. I am wanting to find out if my dosage could be increased to see if that will work better for me." Does that sound alright?

[Sean]

The key is really not how much you are taking. Nor is it the rate with which you are seeing changes. They key is how much you actually have in you. Make sure the blood test measures your total testosterone level AND your free testosterone level (which is the functional amount your body has available for use). And make sure the test is taken at the "right" time in the cycle for measuring (standard is the trough - so right before you are due to inject again).

I think it is fair to go in to the appointment with:
- a list of changes you have had
- a list of changes you have not had
- a time frame in which these changes are supposed to be happening
- the expectation that they will be looking at your testosterone levels to see if they are hitting the average male range, for both total and free (bio available) testosterone

However, the key is really...are your T levels too high, too low, or just right. If your T levels are hitting the middle of the standard male range, then your rate of change is likely as good as its gonna be. Increasing your dose could actually increase aromatase, leave you with MORE estrogen, and hinder the rate of changes.

I'd want to see that the dr. has a reasonable sense of what the male range you're targeting SHOULD be and is willing to adjust you to aim for that. But I would NOT go in expecting a dosage increase just because some people are taking more. It could actually be counter-productive.

As for the passing thing, while it does suck, the reality is that this is very common for young transmen as they get older. Passing is all about context. It is easier to pass when people do not have to make judgments about your age/job/situation that might peg you as younger male/older female in their mind. The older you get without having more masculinization, the more people will default to thinking you are female. The timing may be annoying (now that you're on T, you'd expect to pass more), but I don't think it's related to being on T, and the fact that it is frustrating won't make your T changes happen any faster than your body can handle.

[Nygeel]

What you'll look at is your free testosterone and total testosterone levels (as well as bad cholesterol, liver and kidney function). You should try to get your appointment around the mid point between shots. Your free testosterone and total testosterone should be in the average male range. If they see that your liver, kidneys, and cholesterol is all good and your testosterone levels are in the normal/low range they can then increase your dose. Concerns about things that are easily noticeable (passing/changes) should come second to the health of your organs.

My thought is that when the blood work comes back, ask about your physical health. Make sure you're healthy. Ask what your free testosterone and total testosterone levels are and make sure to know what the male range is to compare. If you notice that your testosterone levels are low then point it out to your doctor and ask for an increase.

[xAndrewx]

Thanks guys. You both are right, my health is entirely more important to me than anything else. I know my current doctor has handled many cis males who have had issues with low levels so she does know what the average should be, what to look for as far as liver function, kidney function, and cholesterol when on cypionate, as well as other general things and those will come first and foremost. I guess the next question is, how soon should I expect to my levels to meet the male range? Will three months have been long enough to expect that?

Thank you both for your help. I'm just not the greatest with conversations and wanting to prepare in case it does happen that my levels are low and I'm physically okay for an increase if my doctor agrees. I'm just a little worried that I won't get my words right and she'll think I'm asking for something I'm not.

[Nygeel]

I guess the next question is, how soon should I expect to my levels to meet the male range? Will three months have been long enough to expect that?

Your milage may vary. They might be in the male range, they might not. I don't know the answer to that question.

[Robert Scott]

I don't know if this will help ... but there is a theory that to get the best effects from HRT it needs to mirror puberty as much as possible.

Thus, that is the theory my son's doctor works off of... he started off really low and every three weeks goes back and his dosage is increased a bit .. he is now at the six month mark and his dosage is only 1/2 a normal dosage.  The transmen in my community said (some who got the normal dosage to begin with) say that it's a much better route to go.  It apparently keeps your voice from getting into a strange squeaky crackling sound & less likely to get mood swings b/c your body is adjusting slowly

Just a thought

[xAndrewx]

Thanks Rob that is a pretty interesting theory. I have heard that's why some docs start people with low dose. Some doctors go the route of trying to get a person to catch up to where they would be if they'd been born cis male so they start out high dose and then go lower over time.

I think starting off lower was good for me but now I've just reached the frustration point. After having a good talk with Nygeel though I think I'll just wait and keep tracking progress like Sean suggested and then if my levels are not in male range and I get a clean bill of health when I see the doc I will talk to her about an increase.

[Randy]

If you're talking about the doctor I think you're talking about, judging from pronoun "she", you might sooner think of a hike up Kilimanjaro than expect her to respond adequately to a raise in dosage. I came to her repeatedly with complaints of painful and persistent bleeding, and I didn't get it until 8 months in. Even then, just barely enough to stop it. There was no discussion with me of any compromised organ function, just a "no".

[xAndrewx]

Hey man odd to call you Randy lol but nah I know who your talking about. She also wanted $215 cash just for my consultation so I went to see another doctor. She is actually a physicians assistant and the place has never had a trans patient before me.

[Randy]

Whew, good. Glad you aren't going to who I thought you were going to then. But then, going to a doc without trans experience presents it's own challenges. Yeah, about the whole Randy thing - when I first joined susan's I didn't want to use my real name (which is obviously pointless now because of the profile pic) so I just used Randy, the name of the first person I ever came out to.