Susan's Place Transgender Resources

After reading so much about this I thought I had a pretty good understanding of what was going to happen, but I'm left with some confusion. The doctor said I would have to take Depo Provera before I started T. Our conversation went something like this.

Dr: If we start you on testosterone now, your body will just convert it into estrogen.
Me: Only if I'm prescribed an excess amount of T, though, right? That's why you do the bloodwork, to figure out which dosage I should use?
Dr: Well, ANY amount of T would be excess to your body right now; that's why you need to do the Depo Provera first.
Me: ...wut

So tell me, is this true? Or is it just the policy at the place I went to? I really don't want to have any unnecessary shots, and from what I've gathered, birth control like that isn't a necessary prerequisite to getting T. I was under the impression that T was all I needed. Do I suck it up and deal or is there something I can do?

If it matters, I am 18. In fact I'll be 19 at my next appointment.

Never heard that before. Does this doctor have trans experience? Pretty sure he just doesn't know what he is talking about.

I've also never heard of a doctor suggesting this route before. The pamphlet on trans health I got at my last endo appointment said that Depo-Provera is a type of progestrogen, and that if 3 months after starting Testosterone an FtM's periods don't stop it can be injected every 3 months until the T 'kicks in'.

Things might be different wherever you live, but you're definitely gonna want to look closer into this before going back to that doctor, I think..

Yeah, apparently she's worked with lots of trans patients before.

Also, I never told her that my periods made me uncomfortable. They do, but I can deal with them and I know the T will take care of that when the time comes anyway. For some guys, periods are horrible, but I'm just fine ignoring/putting up with mine... so I don't see a use for the birth control anyway. I even told her this.

Quote from: phoenixflorida on April 18, 2011, 05:02:47 PM
Dr: Well, ANY amount of T would be excess to your body right now; that's why you need to do the Depo Provera first.

Unless you have some ridiculously high natural T levels, I don't see how this could be true. I've never heard this from anyone before. How odd   :-\

Edited to add: I don't think your age should have any effect on this. I'm younger than you are, and my doctor never said anything about Depo Provera. She just prescribed me T like she would with a patient of any other age.

I've never heard of this before, and I've had contact with dozens of transguys IRL and maybe a hundred online.

Maybe look it up on Hudson's FTM Guide? Or that guide to trans health...can't remember who wrote it...

ETA: Gorton, Nick Gorton.

when i was reading this I thought maybe you were younger and thats why the dr was saying that, but you are 19, and you dont have any current hormone problems now right? long crazy periods or anything?

I dont know why your dr would say that if you are a healthy 19 year old.

I have plenty of FTM friends and a spouse (female at birth) who is on T. I have never heard this one.
But....follow the doctors orders. Maybe he knows something about something we don't know.

Oh man, that would suck! Depo shots cost an arm & a leg here!  >:(

I discussed my history at length with this doctor, and she knows I have regular periods and no crazy things seem to be going on with me hormone-wise. The way she talked about it, it just seemed like standard procedure for FTM patients. I see no reason to take it and am actually really uncomfortable with the idea, so all I can do is just ask for more information and clarification. I don't know how I'll be able to handle it if there's no real reason for it. I already felt weird 'correcting' her about the necessity of the depo shot.

I just want to start T. I meet the criteria. All this looks like is another unnecessary hoop to jump through. I don't want to have to find yet another doctor, I'm hoping things will just smooth out with this one.

I have my labs tomorrow so I'll ask about it then.

I'm not understanding this whole thing with testosterone and birth control? Why take birth control while on testosterone?

Quote from: Dominick_81 on April 18, 2011, 09:58:25 PM
I'm not understanding this whole thing with testosterone and birth control? Why take birth control while on testosterone?

You can still get knocked up on T. Besides stopping pregnancy and controlling periods, I can't think of a reason why you would need to take it. It's certainly not necessary.

Quote from: Sharky on April 18, 2011, 10:18:58 PM
You can still get knocked up on T. Besides stopping pregnancy and controlling periods, I can't think of a reason why you would need to take it. It's certainly not necessary.

ic. Thanks.  Another thing I don't understand in taking birth control is if you don't plan on getting pregnant, why take it? Why take it if your not planning on being with a guy? I can see it if you wanna be with a guy and get pregnant, but if you don't wanna get pregnant I don't see why you would have to take it?

Phoenix we're in the same area and I've only heard of two docs who work often with trans people. I know people who go to both so most likely I know someone who sees your doctor for T. Would you like me to ask around and see if she has done this to anyone else? Would be helpful if I knew who it was though. I understand if you aren't comfortable with saying so no worries if you're not comfortable with telling me, just trying to be helpful.

I call BS.

http://www.endo-society.org/guidelines/final/upload/Endocrine-Treatment-of-Transsexual-Persons.pdf (http://www.endo-society.org/guidelines/final/upload/Endocrine-Treatment-of-Transsexual-Persons.pdf)

The above is a link to one of the best endo resource available.

This is also a great resource
http://www.transhealth.ucsf.edu/trans?page=protocol-00-00 (http://www.transhealth.ucsf.edu/trans?page=protocol-00-00)

Quote from: Dominick_81 on April 18, 2011, 10:29:38 PM
ic. Thanks.  Another thing I don't understand in taking birth control is if you don't plan on getting pregnant, why take it? Why take it if your not planning on being with a guy? I can see it if you wanna be with a guy and get pregnant, but if you don't wanna get pregnant I don't see why you would have to take it?

To regulate periods.

Quote from: phoenixflorida on April 18, 2011, 08:42:28 PM
I discussed my history at length with this doctor, and she knows I have regular periods and no crazy things seem to be going on with me hormone-wise. The way she talked about it, it just seemed like standard procedure for FTM patients. I see no reason to take it and am actually really uncomfortable with the idea, so all I can do is just ask for more information and clarification. I don't know how I'll be able to handle it if there's no real reason for it. I already felt weird 'correcting' her about the necessity of the depo shot.

I just want to start T. I meet the criteria. All this looks like is another unnecessary hoop to jump through. I don't want to have to find yet another doctor, I'm hoping things will just smooth out with this one.

I have my labs tomorrow so I'll ask about it then.

Depo stops your periods pretty much instantly. It can be useful for guys who find that T doesn't stop their periods for a few months.

Quote from: xAndrewx on April 19, 2011, 12:46:22 AM
Phoenix we're in the same area and I've only heard of two docs who work often with trans people. I know people who go to both so most likely I know someone who sees your doctor for T. Would you like me to ask around and see if she has done this to anyone else? Would be helpful if I knew who it was though. I understand if you aren't comfortable with saying so no worries if you're not comfortable with telling me, just trying to be helpful.

I appreciate it, but I don't live in Florida anymore; I moved to Wisconsin in the beginning of the year. Makes my username moot :p Thanks anyway though, if this had happened in FL you would've been a great help.

As far as periods go, I gave every indication that I really didn't mind them, but maybe she's used to having trans patients who would like to stop their periods ASAP and just assumed I was the same. This is why I dislike having so many standards and stipulations. Not every trans person feels the same way about the functions of their body.

Some doctors like stopping periods/cycle first because it can make it easier to identify complications when you start T. Also, there is a theory that if you take either depo provera (cheaper) or a GNrH agonist (expensive hormone blockers), you see more androgenic effects from lower dose of T earlier on.

It's not unheard of. However, the idea that it prevents your body from converting T into estrogen is absolutely false. That's the part that is worrisome.

Either way, I think you should just talk to her more specifically about how you feel about it. Depo provera can have some benefits as well as some side effects, and if you're not interested in those effects and the risk of it, you should have the option of declining without it compromising your access to T. In fact, you're likely to get a better reaction from the doctor if you phrase it as being about the side effects and not "questioning" her on the need for it.

Quote from: Sean on April 19, 2011, 11:14:05 AM
It's not unheard of. However, the idea that it prevents your body from converting T into estrogen is absolutely false. That's the part that is worrisome.

I agree with Sean here. That would make me question the doctors knowledge a bit.
One of the things you have to remember is just because a doc has worked with some trans patients does not mean they are 100% knowledgeable about how to provide care to every trans patient. They should design your care around your needs unless you are trying to do something unhealthy.  I was just prescribed T and had a lengthly discussion about what I wanted in regards to my treatment/dose. I have made the decision to go on a lower than typical dose we discussed the issues associated with that and she wrote the prescription. It wasn't what she typically does but, it is my transition, my health and my decision. If your doctor is saying that you HAVE to do something that you don't want to do feel free to say no. If your doc will not prescribe you T without doing it "their way" you should try to find another doctor that will suit your needs. Good luck man!

Quote from: JohnR on April 19, 2011, 09:15:35 AM
To regulate periods.

ic. Thanks John.

Quote from: phoenixflorida on April 19, 2011, 10:50:25 AM
I appreciate it, but I don't live in Florida anymore; I moved to Wisconsin in the beginning of the year. Makes my username moot :p Thanks anyway though, if this had happened in FL you would've been a great help.

Sorry man, just so you know, you still have your profile location set to say Orlando, FL

Quote from: JohnR on April 19, 2011, 09:17:20 AM
Depo stops your periods pretty much instantly. It can be useful for guys who find that T doesn't stop their periods for a few months.

This is what I just read at Hudson's--they have a guide to trans health that says that if the T fails to stop your periods within a few months, you can take Depo as well. But I have heard that Depo doesn't perform consistently and that you can wind up spotting for months.

Quote from: Arch on April 20, 2011, 05:37:36 PM
This is what I just read at Hudson's--they have a guide to trans health that says that if the T fails to stop your periods within a few months, you can take Depo as well. But I have heard that Depo doesn't perform consistently and that you can wind up spotting for months.

Wait what do you mean by not performing consistently?  Do you mean not working as a form of birth control correctly?  Because I've been on Depo Provera since may of last year and I'm still bleeding on it, though not consistently.  And now I still have that monthly thing, but it's so light I basically only bleed when I use the bathroom and push either for a number 1 or a number 2.  There's only a few drops on my thing in my underwear.  And sometimes it's red and sometimes brown.

Does that mean I'm not fully protected or just that I'm really unlucky when it comes to Depo?  Also does me still bleeding mean that I am more *ahem* fertile then most?  ???

Quote from: Tyler90210 on April 20, 2011, 06:18:27 PM
Wait what do you mean by not performing consistently? 

I've gotten the impression that some people love it and some people hate it...and that different people have very different physical responses. So some get immediate relief and others spot for months, that sort of thing.

You also have a right to decline your doctor's recommendations.  She can't MAKE you take Depo if you do not want it.  That said, she may then decline to prescribe T.  But, as stated, she isn't the only doctor out there.  If you are uncomfortable (I would have been in your shoes) then decline until you can inform yourself (as you are).

It is not a standard or required thing.  It may be her preferred way of doing things, but if you do not want it, you do not have to have it.  It is YOUR body.


Jay