Susan's Place Transgender Resources

I'm curious, first six years of my transition, I had an aging endo. Sweet guy, totally focused on the trans community, but his age I think was catching up to him.
He retired, got a new endo who is maybe 35 years old. She is doing things my previous endo never focused on ie. Bone density, osteoporosis, discouraging vitamin supplements versus getting nutrients from foods etc. she just has a whole different set of questions that the older fella never asked.

So I'm wondering, would you have more faith in an endo with 40-50 years of experience but maybe isn't with the times, or would you believe in the newer generation endocrinologists who might be thinking times and assumptions have changed and that what might have been prescribed 10 years ago might not be the case today.

Nina

Thats a loaded question. Ideally, if you could take the best from each and make a Dr., and you would have it made.

Some of the changes may be medical policies. When I first started HRT, once you were stable, there was no checking on levels etc. Now the law here is a full CBC chem every three months.

I tend to trust experience because they have seen more and have a feel for you as a whole person. Though the younger generation of endos come out of school with more information and new options, but that doesn't mean they know how to deal with a transgender.

To get the most of your appointments with an endo, ask some tough questions and find out if they have treated other transgenders. Perhaps by asking the questions the new doc is asking is simply trying to get a feel for your overall health. My first Dr. was respectful and trustworthy. My new doc, well, he's a jerk. Sorry, there is no other way to put it.

Trying to get a good Dr. who knows about transgenders and is really good with both the people and the lab results is hard, but you can do it. Start by going online and seeing if there are any endos in your area that see transgenders and know what they are doing. It won't tell you everything, but its a good start. Most cities have a support group for transgenders, so contacting them and finding out who they use and what they think of the Dr. is also a good plan.

I wish you luck in your search.

sam1234

I'm no expert, and I'm certainly in no position to make an informed judgment based on what's been provided here, but in general, I'd trust someone with more experience. I think the best advice I can give is that if you don't feel confident in the competence of your current endocrinologist, do some research on others in your area and see if you're more comfortable with them.

Quote from: sam1234 on February 22, 2015, 01:53:31 PM
Thats a loaded question. Ideally, if you could take the best from each and make a Dr., and you would have it made.

Some of the changes may be medical policies. When I first started HRT, once you were stable, there was no checking on levels etc. Now the law here is a full CBC chem every three months.

I tend to trust experience because they have seen more and have a feel for you as a whole person. Though the younger generation of endos come out of school with more information and new options, but that doesn't mean they know how to deal with a transgender.

To get the most of your appointments with an endo, ask some tough questions and find out if they have treated other transgenders. Perhaps by asking the questions the new doc is asking is simply trying to get a feel for your overall health. My first Dr. was respectful and trustworthy. My new doc, well, he's a jerk. Sorry, there is no other way to put it.

Trying to get a good Dr. who knows about transgenders and is really good with both the people and the lab results is hard, but you can do it. Start by going online and seeing if there are any endos in youor area that see transgenders and know what they are doing. It won't tell you everything, but its a good start. Most cities have a support group for transgenders, so contacting them and finding out who they use and what they think of the Dr. is also a good plan.

I wish you luck in your search.

sam1234

Not sure you read my post, but thanks anyways.
I'm not looking for an endo, i posed a hypothetical question as to whether pone would want an aging endo who maybe is stuck in his ways, or giving a new endo, someone more likely to grasp new concepts and ideas.

I would go with the newer Endo myself. Mine is young and has a lot more exposure to transgender HRT because of our emerging visibility. On top of it all she has the latest options and information. A lot of times (I was a Paramedic myself) we do get set in our ways and tend to rebuff the latest procedures which were more complex than we were trained. It just happens. I am sure the older one was the best in his time, but I will take a recent graduate with some experience and passion for the job any day. :)

Quote from: Jessica Merriman on February 22, 2015, 02:50:11 PM
I would go with the newer Endo myself. Mine is young and has a lot more exposure to transgender HRT because of our emerging visibility. On top of it all she has the latest options and information. A lot of times (I was a Paramedic myself) we do get set in our ways and tend to rebuff the latest procedures which were more complex than we were trained. It just happens. I am sure the older one was the best in his time, but I will take a recent graduate with some experience and passion for the job any day. :)

Exactly Jessica, that's my thinking. While I appreciate the more experienced endo, I have to think they get set in their ways, maybe don't go to a lot of industry conferences, read up on new developments.
Lol, my past endo was like seeing my grandfather....big bowl of Werther's candy, his office was like 120f, and I think he was prone to napping.

I think medicine marches forward too fast to keep a doctor around who doesn't keep up with the latest developments. Age isn't the problem. Being out of touch is the problem.

I'd go with a newer endo too. I wouldn't want to be treated with outdated methods. If I were to go to a doc who is behind the times I wouldn't be getting the best care possible.

I think its quite tricky, but there's a few things I'd be looking at.

I'd not judge on age, or not age alone. Its good or bad depending on other factors.

An older doctor who keeps up with current medical practice and research is probably going to be very good. A few people are like that.

I've noticed young doctors in hospitals tend to speak with utter confidence in themselves, in a way which old ones don't quite seem to. And they have been totally wrong. I had the impression they have not yet had time to see how real life is different to books. Unfortunately it easy to fall into the trap of judging someone by the confidence with which they speak. Most of those young doctors will eventually turn into those old doctors who don't keep up.

I try to evaluate what kind of person they are.

Nina, you mentioned discouraging vitamin supplements, but taken too far that could be bad rather than good. One reason people take them is because they can't discipline themselves to eat properly. All the time I've been very overweight no doctor ever managed to get me to eat properly. I knew how, I just couldn't change.

I take notes and double check everything they say or recommend to see if its sensible. I may not know enough to treat myself, but I can have a good go a checking on what they say (prescribing premarin in the last decade for example, that was really bad). If I get a chance I try to ask the same questions from different doctors, and ask questions to which I already know the answer. Questions I don't even care about, but which I can use to evaluate them. I try to see if they are up to date. I've asked doctor about other doctors.

Perhaps ask about WPATH and see if they know about it, if anything. See how flexible they are about it (I don't much care for it myself). I asked my psych early on what he thought about WPATH and DSM and got a very shallow answer (and I like/respect him).

I like a doctor who's going to take my requests seriously, and if he thinks I want something I shouldn't be prepared to explain why or argue the point. I'm not interested in their moral objections over mine, or them thinking I can't be trusted to be responsible. I want a doctor open enough that I can work him out - it makes me worried if I can't read them.

I collect all the little bits together over time to get a better picture, assuming it lasts that long.

The bigger problem with Endo's with transgender experience is that there's not many around and not a lot of choice. Lucky I got a good one, or at least I think so.

I think I sound a bit crazy, but its a piece of how I view things generally.

I certainly agree with what you're saying AnonyMs.
When I mentioned supplements, my endo would prefer, for example - calcium - to be gained via drinking more milk, eating more yogurt rather than just taking supplements. I had a very low b12 three years ago, heck, didn't even know what b12 was or what risks there are. I'm increasing my intake of liver. So all in all, I just had to tweak my diet which hasn't been that hard. I'm a very disciplined eater, to a point of being rather anal in that I measure, weigh and scan every item I eat. It's the only way I can ensure I'm watching my cholesterol which had been a concern 10 years ago.

You mention WPath...I'll go on record, and admit, no idea what it is other than an acronym. Same goes with DSM. I know of their importance, but have never used them in any way

This really boils down to how you assess a health care provider, not just an endo.  There are numerous things to really consider.

1.  Years in practice.  The longer they've been at it, the more likely they will have seen what works and what doesn't.
2.  But point 1 only applies if you know this provider has been meticulous in their record keeping and tracking treatment results.
3.  Where they studied.  Some schools simply are better than others.  However, standards can change as well, and unless you know, it can be hard to assess this one.
4.  How much continuing education they attend.  That's proper conferences, symposiums, etc rather than just stuff run by commercial interests, although these do add to knowledge.  A good healthcare provider will go way over the required continuing education hours mandated to hold registration to practice.
5.  How well they communicate.  The better you understand your treatment, the options available and possible advantages and disadvantages the less likely you will second guess your treatment.
5.  Assess the staff.  Staff who genuinely seem to be happy to be at their work, generally mean that the boss is a decent person.

Unfortunately, if someone fulfills most the above criteria, be prepared to pay, but feel assured you're likely to be looked after well.

luna, I like your thinking a lot.

Muffineheart, you're well past the point of needing to worry about WPATH and DSM. I get the impression most people don't read them, but I can't really understand why not. I read them to partly to educate myself and partly know your enemy kind of thinking - I don't like either of them much. I tend to read a lot of things.

You're lucky with the diet, I'm the opposite to you. I eat food for pleasure, and far too much of it. I recently managed to get my cholesterol under control by losing a lot of weight though, which I didn't think was possible (the cholesterol drop). Now I eat almost nothing (literally). I'm not very good at the in between thing.

Quote from: Muffinheart on February 22, 2015, 01:29:35 PMHe retired.

Putting aside all the medical reasons for a moment, for matters that will require long-term treatment or in which a good doctor-patient relationship is required, I'd go with a doc who has enough career left to care for you for many decades to come.  Changing doctors is such an administrative mess that it's best avoided.  I chose a young GP many years ago, one of the primary reasons being that he would be unlikely to retire anytime soon and we could build up a relationship over the years where he knew me on a more personal level - it's important to me, and allows for a more holistic approach to treatment.  The same goes for my endo (although choices were admittedly limited), because my relationship with my endo needs to be stable and far more involved than, "Here's your pills, see you in six months."  For my FFS surgeon, I was more interested in his skills with the knife; there's no need to consider whether he'll still be in practice in a decade or two, so his age wasn't a factor.

In short, for lifelong medical needs, it's okay to use a doctor who will grow old with you.  Maybe not the most important factor, but it's worth considering.