Susan's Place Transgender Resources

I'd like to think that most actually studied in school and know what they are doing, but sometimes I wonder... HRT is serious stuff and I get a bit nervous sometimes when I read some of the threads about what some Dr.s are offering and/or having their patients do

Other times I suspect that the person asking the questions is self medicating and just guessing what a Dr. might say or do based on people's responses

Not sure what to think sometimes... Please friends, HRT is serious biz.

BE CAREFUL, BECAUSE YOUR LIFE COULD VERY WELL DEPEND ON THE CHOICES YOU MAKE REGARDING HRT

Said my piece

Love and Hugs

Virginia

I know this much: if I don't get satisfactory answers on the 17th, I'm finding a new doc. :(  I'm incredibly dissatisfied that mine has one treatment regimen, and if it doesn't work, she gives up.  That's what's happening in my case.  I'd personally love a doctor who's not afraid to get experimental with HRT, because my body is incredibly tough to medicate.

Please remember that I am not making reference to anyone particularly, I am reflecting upon the threads I have read over the past few years

Admittedly, my Dr. was somewhat unsure and made no promises, but she was the only one in my area who was willing to help me... Luckily, she studied quite a bit and her decisions and advise have worked out rather well... She specializes in women's needs

Unfortunately you won't find any medical schools that offer a course of study on HRT for transsexuals. A lot of this has been trial and error and doctors sharing with each other what they have done. There are some books on HRT out there for doctors, but I have my doubts whether they are totally as they should be.

Problem lies therein even if theoretically some of these threads lie, there are honest doctor situations like this, and denying help can be harmful to the overall HRT attempt. D: Isn't the theme of some of these questions about the doctor doing strange things that wouldn't be done by a self-medicating anyway? o.o; (For example, when I posted on my thread being confused about lack of anything to deal with testosterone XD )
That and it's like Lisbeth said, it's not like there's crash courses on this, at least yet...

Thankies for worrying about people, though, V M ^^

HRT is not an exact science.  Competent providers will let their patients know that and know that there is a component of trial and error to it just because of the differences from one person to the next.  The medical profession is no different than any other profession that does not rely on absolutes...and as an example, there are things that I do in the legal realm that are not covered in law school.  We carved out our niche just like a lot of the doctors doing HRT have managed to do...

My doctor is awesome. He's very flexible and open to new information on HRT, but he also has plenty of experience. I really couldn't ask for a better doctor. His bedside manner is great, too. He doesn't have a God complex and genuinely wants to help people.

That said, doctors are like all other people. Some of them suck and some of the are great. I'm convinced that there are plenty of people who self-medicate and know more than their local physician would.

Quote from: Sunnynight on August 04, 2011, 11:45:20 AM
My doctor is awesome. He's very flexible and open to new information on HRT, but he also has plenty of experience. I really couldn't ask for a better doctor. His bedside manner is great, too. He doesn't have a God complex and genuinely wants to help people.

Mine has all of those qualities except for being flexible in her approach to HRT.  She's already told me that since my body's having problems with both of the HRT regimens she prescribes, then HRT probably won't work on me, my lack of breast development is probably genetic and I shouldn't expect much, and that's it.  I know there are plenty of other options out there, but my doc simply won't try anything else.

Quote from: Zoë Natasha on August 04, 2011, 12:04:17 PM
Mine has all of those qualities except for being flexible in her approach to HRT.  She's already told me that since my body's having problems with both of the HRT regimens she prescribes, then HRT probably won't work on me, my lack of breast development is probably genetic and I shouldn't expect much, and that's it.  I know there are plenty of other options out there, but my doc simply won't try anything else.

It sounds like you already have an idea of what to do in your situation. Will you have to go very far to find another doctor?

Quote from: Sunnynight on August 04, 2011, 12:20:43 PM
It sounds like you already have an idea of what to do in your situation. Will you have to go very far to find another doctor?

Yeah, I have an appointment with her on the 17th, and if it's the same old story, then I'm finding a new doc.  Shouldn't have to go far to find another because I'm in a major metropolitan area with loads of trans resources.

Quote from: Zoë Natasha on August 04, 2011, 12:25:25 PM
Yeah, I have an appointment with her on the 17th, and if it's the same old story, then I'm finding a new doc.  Shouldn't have to go far to find another because I'm in a major metropolitan area with loads of trans resources.

That's good. I hope things work out well for you.

Quote from: Sunnynight on August 04, 2011, 12:30:59 PM
That's good. I hope things work out well for you.

Thanks! :)  I just keep thinking it'd be nice to fill out a bra someday, but after 10 months with this doctor, I'm nowhere close.  I've lost confidence in her ability to help me get there when I hear of the wide range of treatment options that she won't consider.  I have the strongest liver any of my doctors has ever seen, but my hormone doc refuses to prescribe anything but oral E.  She was pleased that my E levels got over 100, which I'm finding from other people is kind of low.  And the AA she has me on is killing me with depression, so she prescribes antidepressants that cancel out the effects of HRT.  And she absolutely refuses to prescribe progesterone (unless it's the synthetic progesterone being used as my AA, which, like I said, is killing me).

It's mind-boggling...

Quote from: Zoë Natasha on August 04, 2011, 12:44:33 PM
Thanks! :)  I just keep thinking it'd be nice to fill out a bra someday, but after 10 months with this doctor, I'm nowhere close.  I've lost confidence in her ability to help me get there when I hear of the wide range of treatment options that she won't consider.  I have the strongest liver any of my doctors has ever seen, but my hormone doc refuses to prescribe anything but oral E.  She was pleased that my E levels got over 100, which I'm finding from other people is kind of low.  And the AA she has me on is killing me with depression, so she prescribes antidepressants that cancel out the effects of HRT.  And she absolutely refuses to prescribe progesterone (unless it's the synthetic progesterone being used as my AA, which, like I said, is killing me).

It's mind-boggling...

That's so strange. Injectable estrogen would be easier on your liver anyway, and it just has less bad side effects in general. It's all my doctor really prescribes. If I were in your position I'd find a new doctor. It really sounds like she doesn't know what she's doing.

Quote from: Sunnynight on August 04, 2011, 01:05:35 PM
That's so strange. Injectable estrogen would be easier on your liver anyway, and it just has less bad side effects in general. It's all my doctor really prescribes. If I were in your position I'd find a new doctor. It really sounds like she doesn't know what she's doing.

I'm going to try a new doc, but I just talked to a few people who said they don't know of any docs in Denver who prescribe injectables or natural progesterone... :(  I'm really confused as to why not.

Quote from: Zoë Natasha on August 04, 2011, 03:55:25 PM
I'm going to try a new doc, but I just talked to a few people who said they don't know of any docs in Denver who prescribe injectables or natural progesterone... :(  I'm really confused as to why not.

Because doctors get set in their ways and prospective patients tend to be reluctant to look outside of the box...my original provider for management of HRT was an MD I found through the gay and lesbian yellow pages and who had no real experience with HRT management (although he was an internist who did a lot of endocrinological work).   He was open to whatever I suggested...same provider also later agreed to do HRT for an F2M friend of mine, again on an informed-consent basis.

Although that was 20+ years ago, I have a feeling the same approach would work in the present era, especially with so many more people being able to find providers via the interwebs (instead of the bound G/L yellow pages that spent time on the top of my stack of phone books)... 

Quote from: Zoë Natasha on August 04, 2011, 03:55:25 PM
I'm going to try a new doc, but I just talked to a few people who said they don't know of any docs in Denver who prescribe injectables or natural progesterone... :(  I'm really confused as to why not.

Who knows. You might find a doctor that doesn't routinely prescribe them, but would be willing to try, especially if you make a good case for injectables (less dmg to the liver, less risk of DVT and clots).

Quote from: Ann Onymous on August 04, 2011, 04:03:00 PM
Because doctors get set in their ways and prospective patients tend to be reluctant to look outside of the box...my original provider for management of HRT was an MD I found through the gay and lesbian yellow pages and who had no real experience with HRT management (although he was an internist who did a lot of endocrinological work).   He was open to whatever I suggested...same provider also later agreed to do HRT for an F2M friend of mine, again on an informed-consent basis.

Although that was 20+ years ago, I have a feeling the same approach would work in the present era, especially with so many more people being able to find providers via the interwebs (instead of the bound G/L yellow pages that spent time on the top of my stack of phone books)...

I'm going to have to try that, because my doctor only does two extremely conservative approaches to HRT that aren't working well on my body.  She won't do progesterone, she won't do injectable estrogen, nothing.  Just one method and she says that nothing else will work if those two methods fail.  I'm not ready to buy that explanation, so I need a doctor who's willing to find something that works on my hard-to-medicate body.

Quote from: Zoë Natasha on August 04, 2011, 04:07:35 PM
I'm going to have to try that, because my doctor only does two extremely conservative approaches to HRT that aren't working well on my body.  She won't do progesterone, she won't do injectable estrogen, nothing.  Just one method and she says that nothing else will work if those two methods fail.  I'm not ready to buy that explanation, so I need a doctor who's willing to find something that works on my hard-to-medicate body.

I wonder if you have a highly efficient liver, and oral estrogen is just having trouble getting past it.

Quote from: Sunnynight on August 04, 2011, 04:11:11 PM
I wonder if you have a highly efficient liver, and oral estrogen is just having trouble getting past it.

Oh, I do... it's medically proven.  Three doctors have said I had the strongest liver they'd ever seen.  My gastro back in the day said my liver was "a rock god."  It destroys everything that goes into my body.  Back when I needed pills to control stomach acid, we went through six different medications in three months, increasing the dosage until they stopped working and then going to the next-strongest pill.  At the end, I was on the highest dose of the strongest medication available and it stopped working in four days.

Turns out that any medication that's regularly taken doesn't work on me because my liver gets really good at destroying it and my body's natural processes (even bad ones like the one that could have turned to stomach cancer) take over.  What finally worked was taking the medication irregularly so that it shocked my system every time.

All thanks to my liver...

My HRT doc knows this about me and still refuses to do anything but oral estrogen, saying that if it doesn't work, then I'm one of the unlucky ones who can't expect any results from HRT.

Quote from: Zoë Natasha on August 04, 2011, 04:07:35 PM
I'm going to have to try that, because my doctor only does two extremely conservative approaches to HRT that aren't working well on my body.  She won't do progesterone, she won't do injectable estrogen, nothing.  Just one method and she says that nothing else will work if those two methods fail.  I'm not ready to buy that explanation, so I need a doctor who's willing to find something that works on my hard-to-medicate body.

When I started HRT, we went through a metric phucton (technical term there ;) ) of different meds trying to find something that my hyperactive metabolism would work with...he tended to have pharmaceutical samples of stuff that he would give me so we were not filling script after script of stuff that wasn't working.  Never did the injectables, but we did finally move to ethinyl estradiol when we came to the conclusion that synthetics were about the only thing that would do anything for me outside of taking giant mega-doses multiple times a day of the bio-identical estrogens. 

He also added the progesterone after I inquired about compounded P (this was before Prometrium hit the market and in a period where my insurance covered compounded prescriptions).

Oh, and he took all possible steps to code things in a manner that never caused a blip on the insurance company's radar...although some carriers may be more hip to such issues in the current era... 

Quote from: Ann Onymous on August 04, 2011, 04:16:53 PM
When I started HRT, we went through a metric phucton (technical term there ;) ) of different meds trying to find something that my hyperactive metabolism would work with...

Yet another thing I have going against me in my doctor's only method of prescribing hormones: my metabolism is insane.  I recently gained 25 pounds, but I had to eat 4000 to 5000 calories a day in order to do so (I gained the weight because I was 25 pounds underweight for my height).  If a pound is 3000 calories and a normal person eats like that for 4 months the way that I did, that's a gain of 80 to 120 pounds (factoring between 2000 to 3000 excess calories a day).  I only gained 25.

Quote from: Zoë Natasha on August 04, 2011, 04:14:30 PM
Oh, I do... it's medically proven.  Three doctors have said I had the strongest liver they'd ever seen.  My gastro back in the day said my liver was "a rock god."  It destroys everything that goes into my body.  Back when I needed pills to control stomach acid, we went through six different medications in three months, increasing the dosage until they stopped working and then going to the next-strongest pill.  At the end, I was on the highest dose of the strongest medication available and it stopped working in four days.

Turns out that any medication that's regularly taken doesn't work on me because my liver gets really good at destroying it and my body's natural processes (even bad ones like the one that could have turned to stomach cancer) take over.  What finally worked was taking the medication irregularly so that it shocked my system every time.

All thanks to my liver...

My HRT doc knows this about me and still refuses to do anything but oral estrogen, saying that if it doesn't work, then I'm one of the unlucky ones who can't expect any results from HRT.

That's terrible. Thank God you're one of the transwomen smart enough to know better.

Quote from: Sunnynight on August 04, 2011, 04:23:05 PM
That's terrible. Thank God you're one of the transwomen smart enough to know better.

I do know one transwoman who did injectable, and when I see her next week, I'm going to ask her who the doc was that prescribed them.  Hopefully the doc was local and I can get in to see them.  Because I think that orals (even though I take it sublingually) aren't going to have the same effect on me that injectables might.  And I know HRT WILL work, because I got some changes and breast growth.  The problem is that it all stopped, just like my body stops reacting to anything I put into it for any length of time.  It's very common with my body.

So I see my current doc on the 17th and we'll see what she says.  I'm in a state of total panic right now. :(  What if I really never will develop or get hormones that work?  Ever since my doctor told me that, I've shed a great many tears of desperation.

One more avenue: I just got an appointment with my therapist tomorrow morning, and I'm going to ask if she knows any docs who prescribe what I need.  I am NOT going to take no for an answer here!  There have to be more options open to me than no HRT or HRT that makes me suicidal and seemingly doesn't work anyway.

I have been saying this all along that while I don't quite think that doctors are completely making it up as they go along.   I do think that they do a great deal of experimenting with HRT.    I would rather a doctor under prescribed than dished out a high dose with his fingers crossed.   
   I wonder what I would have been like if I didn't have my very negative experiences of medical science?   Perhaps seeing one person die because of medical mismanagement and others suffer unnecessarily with too invasive operations has given me what I believe is a very healthy dose of scepticism regarding medicine.    I am sure that without this history I would be today obsessing over surgeries and hrt and foolishly trusting my mind and body to medical experimenters.

Doctors private and NHS prescribed so many pills for my father that it was a wonder that he didn't rattle.   None of these pills cured his ailments but they did give him violent day long migraines and terrible nausea.  One lot of pills did do some good but they made him so anxious that he had to come off them.
Do you know that doctors and medical science have no idea what pill combinations do to the brain and body?   They are never tested because it is too expensive and too time consuming.  So no one can say that pill A, pill B and pill C combined won't harm the patient.   They may well be fine individually but taken together....Type 'Iotragenic' into Google and see what comes up.  Tens of thousands of people die and are permanently incapacitated due to dangerous pill combinations, each and every year.

To get back to my father, I believe that the pills greatly antagonised and weakened his body while doing little more than suppressing his symptoms 'papering over the cracks', 'sweeping the dirt under the carpet'.   The medicos decided that an operation was in order...the operation killed him, the stress of the operation upon a pill weakened body, combined with the anaesthetic was too much for his heart and he died a few days after.

This explains why I simply cannot be a Pollyanna cheerleader for HRT or a SRS, orchie, FFS, tracheal shave True Believer.

Hi Zoe

Just a quick question, is your doctor a general practioner or an endocrinologist? Maybe with your particularly difficult metabolism a specialist is in order.

I completely agree with your assessment that your current doctor hasn't tried all the options.

Good luck in your search. Just remember that you're only one appointment away from being back on track. The next doctor you see may be the one that gets it right, it's not unlikely.

Keep up the hope!

Quote from: caitlin_adams on August 04, 2011, 07:19:52 PM
Hi Zoe

Just a quick question, is your doctor a general practioner or an endocrinologist? Maybe with your particularly difficult metabolism a specialist is in order.

I completely agree with your assessment that your current doctor hasn't tried all the options.

Good luck in your search. Just remember that you're only one appointment away from being back on track. The next doctor you see may be the one that gets it right, it's not unlikely.

Keep up the hope!

She's a general practitioner, but she's the most-recommended doc in my area for HRT.  90% of the trans people I know have her (or had her) as their doc.  All the therapists know her and recommend her above all.  My therapist did.  The therapist who runs the gender identity center I volunteer with did as well.  Whenever you say you're on HRT, everyone asks right away if she's your doc.  Her clinic is booked months in advance.

And yet, I'm not satisfied with the answers I'm getting... and I'm stunned that someone with so much depth and experience only uses two treatment options, and refuses to do progesterone or injectable estrogen.

Zoe,

I know I'll be watching for updates on this quest.  I haven't started HRT yet, but that's the general geographic area where I'll be looking when the time comes. It'd be nice to know as much as possible about the options.

I really hope you find a workable solution soon.

Real quick before bed, I found out that my doctor does do injectable estrogen, but doesn't prescribe it until she get the dosage worked out with orals.  And given recent events, I'm not sure we're there yet.  To top it off, she only does three-month checkups so finding the right balance is incredibly slow (it's taken a year and we still don't have it figured out).  Just one more thing to bring up when I see her on the 17th.