Susan's Place Transgender Resources

I'm not on HRT yet, but aiming to start soon in 2018.  Anyway, I just had my first appointment (an annual wellness visit) with my new doctor.  I chose her because she specializes in transgender healthcare. 

I was discussing HRT with her, and telling her that I was thinking about starting next year.  She said that she didn't actually need to refer me to an endo because she can do all of the prescriptions/monitoring herself.  She then walked me through her approach for MTF HRT, and we discussed some questions, etc. 

I like her a lot.  She seems very knowledgeable, and like I said, she specializes in transgender healthcare.  But I guess I always assumed that I would need an endocrinologist for HRT.  Is an endo really necessary?  Or can I trust a doctor who seems to know what she's doing there?

Erika



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I got my hormones from my primary care doctor at Fenway Health, no endo, she prescribes. One week from first visit to meds in hand. In my opinion you only need an endo if you have issues with your endocrine system.

Hugs, Devlyn

My HRT doctor is actually a NP in a doctor's office specializing in LGBT care.  I have never even seen the doctor himself.  I don't think you would need an actual endocrinologist unless you have some unusual abnormalities.


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The Dr who does my hrt is a gyn.  But she had experience treating trans women. If your Dr is willing to do hrt for you stick with them. It can be hard to find a Dr willing to treat a trans person. My dad called a bunch of Drs before he found the one I go to.

I don't have any doctors at the moment myself. I would have an endo on my list of people to call on. I mean my thinking is that they know more about where hormone levels should be and how to maintain those levels. That is kind of their specialty. I am not saying other doctors can't be, but when that is your sole focus, I would think you should be better at it. As I said, I don't have any doctors at the moment though.

Is it really necessary? No..

But if there's an issue, I'd rather my endo have a full history on file, rather then have to ask me for it before they can treat me..

I see an internist doctor at a lgbtq health center who prescribes all my medication. I've only just started a little over a month ago but it's been good so far.

Would an endo be able to do different tests? I'm wondering if changing my spiro to another blocker would be more helpful down the line.

Quote from: dist123 on November 11, 2017, 08:17:06 AM
I see an internist doctor at a lgbtq health center who prescribes all my medication. I've only just started a little over a month ago but it's been good so far.

Would an endo be able to do different tests? I'm wondering if changing my spiro to another blocker would be more helpful down the line.

I don't know. My Dr didn't prescribe my hrt on my first visit. She checked my hormone levels , checked my thyroid function and did a genetic screening. Then she gave me hrt on my next visit. I don't know if all Drs do it but she wanted a letter from my gender therapist and she wanted to talk to my dad and he had to sign a consent form. I was only 17 when I started so I don't know if they require a letter from a therapist or not if you're over 18 and I don't know if they do the same tests on someone who's older.

Mine required a letter from my therapist and then she asked me a few pointed questions herself.  My answers must have been satisfactory. 

She gave me four blood tests during the first visit; Comprehensive Metabolic Panel, Complete Blood Count , testosterone, and estradiol.  She also gave me a prescription that day.

Since then she has asked me questions concerning the stability of my home life and given other blood tests to be sure I'm healthy.

I am extremely happy to have a Dr that seems to care about my well being rather than one who simply dispenses medications.


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Quote from: sf_erika on November 11, 2017, 07:27:27 AM
.....  Is an endo really necessary?  Or can I trust a doctor who seems to know what she's doing there?

Erika

I also am going to a clinic and a doctor that does their own blood work and monitoring. And it is ideal.

I too assumed that I needed to start with an endo and was nervous as I had just come out to myself only... it was a painful embarrassing moment when he informed me 'he did not know anything about making the conversions' (I.e. Male/Female markers and hormone levels during stages of transition). I asked him if he could recommend someone, he said 'he didn't know anyone... maybe in San Francisco'.  Of course we were nowhere near San Francisco I was experience stereotyping. 

-Jolie

Quote from: Deborah on November 11, 2017, 08:42:16 AM
Mine required a letter from my therapist and then she asked me a few pointed questions herself.  My answers must have been satisfactory. 

She gave me four blood tests during the first visit; Comprehensive Metabolic Panel, Complete Blood Count , testosterone, and estradiol.  She also gave me a prescription that day.

Since then she has asked me questions concerning the stability of my home life and given other blood tests to be sure I'm healthy.

This is exactly what my appointment the other day was like, though I didn't get the prescription same day because of waiting on bloodwork from a remote lab.

Quote from: Deborah on November 11, 2017, 07:34:44 AM
My HRT doctor is actually a NP in a doctor's office specializing in LGBT care.  I have never even seen the doctor himself.  I don't think you would need an actual endocrinologist unless you have some unusual abnormalities.

Seeing NPs and PAs while never even meeting the doctor is the new norm, sadly. I've met my dermatologist once, and I've been going to his office for over 2 years. (And it's actually my father's entire business model, but he makes sure to see patients constantly and not just leave them to the NPs.)

The big concern is for people taking Spironalactone. It is a potassium sparing diuretic. High levels will put a person to sleep, stop their breathing and then their heart. It's what they inject into someone who is being executed. Primary's GT insists all of his patients on Spiro (pretty much every old guy with high blood pressure) get quarterly bloodwork done to check their levels.

I have always seen my GP, who has access to an endo for advice if needed.  My GP also conducts my regular blood tests. 

I'm sure your primary care doctor is more than competent to handle HRT, all it requires is a solid understanding of the effects of estrogen on the patient's liver, which isn't all that complicated. Any doc who specializes in trans patients is going to be up to speed on all that.

My health group Kaiser does not require me to go to the Endo but she oversees the GP's who do administer HRT. She also happens to be transgender so she understands our needs.

As long as a GP has an interest and experience in transgender healthcare, checks your bloodwork regularly as well as blood pressure etc then there is no need for an endo.

I personally preferred moving from my GP (who did the job very well as mentioned above) to my specialist as she is trans herself and has a tonne of experience. Also does implants which my GP didn't, and got me to the correct hormone levels much faster.

It's a case by case basis.

This is very helpful... thanks all!

I do think it'll be nice to have one person (who knows what they're doing) overseeing everything.  Starting to get excited now as I prepare to take that step :)


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I think its about managing risk. If there's any problems an endo is more likely to notice and properly manage it than a GP.   They should have far more knowledge than any doctor. You could ask the question, is a doctor really necessary, because its much the same answer only more so.

To complicate things some doctors and endo's are not competent, some doctors would be better than some endo's, and some doctors are outright dangerous. Personally I'd check out the endo and see how they compare to the doctor.

Same here.. I am seeing a local OB/GYN for my HRT. She has been treating trans patients for over 10 years now. Checkup every 6 month after the initial adjustment of meds.

Actually pretty affirming having to schedule GYN appointments...

Quote from: Julia1996 on November 11, 2017, 07:39:40 AM
The Dr who does my hrt is a gyn.  But she had experience treating trans women. If your Dr is willing to do hrt for you stick with them. It can be hard to find a Dr willing to treat a trans person. My dad called a bunch of Drs before he found the one I go to.

My Primary care NP referred me to an Endocrinologist when I asked her for a Bicalutimide script. Since it's not listed on their Callen-Lorde protocol, she wouldn't prescribe it and set me up with an appointment for the endo.
Seeing the endocrinologist was my worst trans-medicine experience to date.
She "sir-ed" me on the first visit, and cut me off every time I tried to get a word I edgewise. I told her I wanted to get on injections, because my estrone to estradiol ratio was too high on the pills. She told me my estrone had nothing to do with it.
I asked her how many transgender patients she's had and her reply was "many".
She prescribed me a whole bunch of blood labs and a follow up.
I got the labs done and went back. I also printed out some of what Dr. William Powers has written about Estrone to Estradiol levels inhibiting transition and she told me "I follow my own protocols and I don't have time to read that."
She told me my oral Estradiol dosage was "very high". I was on a very standard dosage for transgender women and had to tell her it wasn't high, it was normal for a Transwoman on oral Estradiol for over a year.
So then she looked at my estradiol level on my lab and the level was 58 pg/mL. She said "See... That level is high!"
I shook my head and said "what protocol are you following?".
She pointed to the "H" next to the level and said "right here it says it's high!"
I nearly lost it right there..."Well of course it says it's high since the range they are showing is for MEN!"
So then she looked up the female estradiol range. Right here it says you're right in the middle of the female range... 27-123... Which is the mid-follicular range for cis women, because it was the first one listed.
"Hello! That's the lowest range in a woman's cycle!"

She ended the visit with "I don't want to prescribe you IM Estradiol, it's too risky" (I'm a very healthy 42 year old none smoker with perfect BMI).
She then told me she'd increase my oral Estradiol dosage by half of what I was already taking.
Then she looked at me and said "I don't know what you're complaining about, you look like you're doing pretty well for being a man."
That was the last straw.

I told the secretary not to bother setting up a follow up as I wouldn't be returning.

I picked up the script she wrote for me and the dosage was double what I was already taking....
So she told me oral Estradiol dosage was very high, then told me she'd increase it by 50%, but actually wrote the script for double what I was already taking!

IMO... most doctors are useless for transgender medicine. They really don't know what they're doing, and try to "wing it". They have no desire and/or incentive to actually learn how to help us transition the best way.
They just want our levels to mirror cis-women of the same age, which doesn't actually translate to a true transition.

Try to find a GP that is actually interested in treating transgender people or risk getting sub par treatment.

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Quote from: LexiDreamer on November 13, 2017, 07:37:22 PM
Then she looked at me and said "I don't know what you're complaining about, you look like you're doing pretty well for being a man."

OMG... your whole experience sounds like a nightmare, but especially this part!!!! I feel very fortunate that I found the GP I have.  On my very first visit, she asked my preferred gender pronouns- even though I was clearly presenting as male at the time.  I think I'm even more persuaded now to stick with her rather than risk forging a new relationship with someone who may be less sensitive to trans issues.


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Yeah...
And I've only ever presented as Lexi to her.
I introduced myself as "Lexi" from the beginning and was clearly offended when she "sir-ed" me.

It was a very demeaning and belittling experience.

Luckily I was able to get the IM Estradiol Valerate prescription from my primary care center after I told them about the horrible experience I had with the endocrinologist they referred me too.

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Fear of what you posted is part of the reason I just went with the doctor I did, as she runs a purely trans-centric practice out of Atlanta doing telemedicine to most of the southeast (where there aren't many local specialists pretty much anywhere apparently...). She is a GP, but her experience with HRT is probably well beyond 99% of endos.

Quote from: AnonyMs on November 11, 2017, 08:04:20 PM
I think its about managing risk. If there's any problems an endo is more likely to notice and properly manage it than a GP.

Only if they monitor more aggressively.  Keeping drug levels within a therapeutic range is basic medical management.  You certainly don't need an endocrinologist--just a careful practitioner.

I'm not anti-endocrinologist at all.  I personally see one because I am given that option within my health system and I appreciate his service.  Still, if the question is whether this is absolutely necessary versus another physician experienced in providing and monitoring medications, I'd say no.

I just work with an NP at Planned Parenthood in Portland, who's super enthusiastic and friendly about transitioning; in fact everyone there couldn't be more welcoming.  Last time it took about 1 1/2 hours to get to see her, they were just swamped, and we just plowed through a whole mess of questions about how I was progressing, and then bumped my E up a titch.  It was just like visiting any other doc, really.  I'd like to sign on with an endo if I can get on a better insurance plan.  Would you gals recommend working with an endo if you're going for pellets or shots?  My NP can supply those as well, but was curious.

I'd recommend seeing an endocrinologist if there was an unexpected and/or unexplained turn of events during the (highly) routine process of managing your hormone levels.  Endocrinologists don't usually spend their training or professional time managing HRT for transsexuals.  Odds are, unless your endocrinologist is highly involved in a comprehensive transgender medicine program, he or she is likely learning on the job. 

Quote from: Lucy Ross on November 14, 2017, 12:07:33 AM
I just work with an NP at Planned Parenthood in Portland, who's super enthusiastic and friendly about transitioning; in fact everyone there couldn't be more welcoming.  Last time it took about 1 1/2 hours to get to see her, they were just swamped, and we just plowed through a whole mess of questions about how I was progressing, and then bumped my E up a titch.  It was just like visiting any other doc, really.  I'd like to sign on with an endo if I can get on a better insurance plan.  Would you gals recommend working with an endo if you're going for pellets or shots?  My NP can supply those as well, but was curious.

I'd take "super enthusiastic and friendly about transitioning" over an endo any day.
I really don't think endo's are versed in transition. Sure they're knowledgeable about hormones, but not knowledgeable about what makes for positive transition results. They're primary focus is to keep people's hormones in check, not inducing female puberty in adults.
Remember, the bulk of their patients are diabetics.
What we are doing... that is cutting off our natal reproductive hormones and flooding our bodies with estradiol, goes against "normal" physiology and medical practice. They just view us as "high risk" patients.

If you have other underlying health concerns, than seeing a endo probably makes sense. But for transition, you want the GP or NP that wants to help you transition.


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My Therapist and Doctor will monitor my transition process.

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I got lucky. I have a fantastic endo who has thousands of trans patients, two decades of experience and is very flexible. He didn't say anything much when I told him I wanted a transitioning level of HRT, but had no intention of ever socially transitioning. It doesn't get any better than that.

The main thing is to find someone good. An endo has a potential advantage, but only if they are good. There's doctors, and no doubt endo's that I'd never go to, no matter what.