[This is my first post, so thanks for reading. I apologize for the length, but I think the details are important.]
So I've been seeing a very good therapist for the past three months, and last Thursday she agreed to write me an HRT letter and forward it to the endocrinologist she's been working with for the past decade. Fantastic, right? Not quite.
I give the endocrinologist's office a call on Friday and get an answering machine. I left my name and number and asked for a new patient appointment (no mention of being trans). After a lot of telephone tag, I finally get to talk to a real person late this morning. She first asks me for my insurance, of course (luckily, no problem with that), then asks whether I want an appointment for diabetes or endocrinology.
Me: Well, actually, my therapist recommended your office. I am interested in being treated for gender dysphoria.
Receptionist: Oh. Well we have those patients speak to the manager. Hold on.
So I wait a couple of minutes, and finally the manager decides to talk to me.
Manager: Let me ask you a couple of questions. We follow the Harry Benjamin Standards of Care, so we need patients to present two letters, one from a social worker and one from either a psychologist or psychiatrist. I know you've been seeing Tina (my therapist) and she's very good, but have you seen a psychologist or a psychiatrist for three months?
[Of course, at this point I realize that something fishy is going on.]
Me: No, but the standards of cares don't require two letters. Why do you need me to see a psychologist or psychiatrist?
Manager: Well hormones don't just affect you physically, they affect you emotionally. Do you need me to slow down and explain the Harry Benjamin Standards of Care?
[Note to readers: she said the last part very condescendingly. I was not amused.]
Me: Actually they're not called the Harry Benjamin Standards of Care anymore, and I'm pretty sure that there was never a requirement for two letters for hormones. Why are you requiring more than the Standards of Care?
[At this point, I think she's figured out that her song-and-dance about the standards isn't working, so she changes her tune.]
Manager: Well, we just find that we have better outcomes this way.
Me: So you want me to find an MD or a Ph.D. level practitioner, meet with that person for three months, and come back to you?
Manager: We know you've been waiting a long time, but it's just another three months.
Me: I'm sorry. No. Have a nice day. [Click.]
Coincidentally, I had an appointment with my therapist right after this conversation. So I tell her what I just went through, and she gives the endocrinologist's office a call right in front of me, asking to speak to the manager. The manager gives her the same song-and-dance about needing two letter, and my therapist flat out tells the manager "that's not part of the standards." Then she says, "if you insist on this, I can't send you any more referrals." Apparently the manager was not concerned about this, so now my therapist is no longer working with the only endocrinologist to which she has sent referrals for the past decade.
Even better, she doesn't have another endocrinologist for me to call, so I'm left with an HRT letter but no practice to send it to.
Our best guess is that the endocrinologist doesn't want to have trans patients any longer, but she doesn't want to admit to ending this part of her practice, so instead she's putting up ridiculous obstacles to new trans patients. The crazy thing about this is that my therapist referred someone to her just last month, so this is a very recent change in policy.
So does anyone have a recommendation for a trans-friendly endocrinologist on Long Island, NY? I could go into NYC and find one there, but I live far enough away that the travel time alone would wipe out half of my day.
By the way, the name of the endocrinologist whose office gave me a hard time is Michelle Jardine, MD at Long Island Diabetes and Endocrinology, PC. Her practice's website lists HRT for gender dysphoria as one of their services, but my guess is that won't be on her site for very much longer.
Wow, Danielle, what an awful experience. We should pin your endo in the dictionary next to the definition for gatekeeper. Good for you for standing up for yourself.
I found my endo by connecting with other trans people in my area and asking whom they used.
Good luck. You don't deserve this.
Welcome to Susan's Danielle79
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Glad you joined our family.
Safe walk on your parh.
Izzy
I've been worried about this happening to me. I honestly don't even know what level my therapist is at nor do I care. She's helped me a great deal and seeing anyone else would be a waste of my time. It didn't occur to me to question what level her credentials are or anything like that. All I can do is hope she'll be good enough for whoever I end up seeing.
I wonder if its more the staff then the doctor doing the gate keeping?
I would call other Endos in the area and ask them you have a referral for cross gender hormones and would like a appointment.
Wow! That sounds horrible! I'm sorry that happened to you. I have my first endo appt on Wednesday and is a similar situation -- therapist has referred to endo for years.
Like Mrs Izzy, I wonder if the doctor knows that the staff is doing that.
I wish you the best in finding an endo that is helpful.
Kim :)
That's a really cruddy experience. I hope you can find another endo soon who is relatively close by. Good for you for standing up for yourself.
Superior type attitudes is why I quit going to an endo years ago. I'd rather stay on my own than deal with the bs associated and trying to please someone who likely can't be just to get hormones.
Quote from: awilliams1701 on August 11, 2014, 07:07:06 PM
I've been worried about this happening to me. I honestly don't even know what level my therapist is at nor do I care. She's helped me a great deal and seeing anyone else would be a waste of my time. It didn't occur to me to question what level her credentials are or anything like that. All I can do is hope she'll be good enough for whoever I end up seeing.
I'm sure your therapist's credentials are more than adequate, and if she's helping you, that's all that should matter. And there is nothing wrong with my therapist's credentials, either: she has a masters and is licensed. She's run her own practice for twenty years. This wasn't about credentials. This was about putting up roadblocks. I mean, really, a psychiatrist? For what? I'd be wasting his time.
Quote from: mrs izzy on August 11, 2014, 07:08:15 PM
I wonder if its more the staff then the doctor doing the gate keeping?
I would call other Endos in the area and ask them you have a referral for cross gender hormones and would like a appointment.
It's possible that the staff is to blame and not the doctor, but that's academic to me now. If my therapist wants to speak to the endocrinologist directly and get her take on this, that's fine for her, but hormones are serious business, and I'm not putting my health in the hands of a doctor with a staff like that.
After a lot of searching online, I found a couple of practices that are rumored to do cross gender hormone treatment, but I won't be sure until I call them tomorrow. It's frustrating because endos rarely list trans HRT as one of their services online. It's always very hush hush, like it's something shameful. I'm tired of it.
Welcome to Susan's
Do you go to group? If you do they will know where to go. Also, try a LGBT center, they may have a few suggestions.
I hope you will all forgive me for asking a seemingly dumb question. Over the course of my life I have had a number of different doctors. Not one of them, to my knowledge, specialized in gender issues. Why not just go to your own GP, or just any MD, explain your needs, and then carry on from there?
I understand the physicians must adhere to "best medical practices", but as I said above, I have had my hormones prescribed by any number of various MD's, in a variety of states, even with a minimal history of care.
What am I missing here?
Quote from: Susan522 on August 11, 2014, 08:31:07 PMWhat am I missing here?
Nothing.
Basic HRT isn't rocket science. It does require medical supervision, but there are many family docs out there who are more than capable of prescribing spiro and estradiol patches and ordering a few blood tests once in a while. That said, a trans-friendly endo will have seen countless times more trans patients than your average family doc, and you'll benefit from that expertise and experience. I guess it's like taking your car to the local do-it-all mechanic or the dealer for maintenance: the do-it-all can probably handle anything you need, but the specialist will be able to deal with the more unusual situations.
If you can go to a trans-friendly endo, then go. But if not, hit up your local family physicians to see which one wants to take on the challenge of a trans patient.
Sounds like the doc was more concerned about covering her butt against any sort of law suit down the road if you change your mind, as opposed to providing the best and most appropriate care she could.
There are docs that prescribe after online consults. Google it.
Quote from: Cynthia Michelle on August 11, 2014, 07:57:52 PM
Welcome to Susan's
Do you go to group? If you do they will know where to go. Also, try a LGBT center, they may have a few suggestions.
I probably should go to a support group, but I haven't yet.
If the names I found don't work out, my next step was going to be to check with the local LGBT center.
Danielle,
Sorry to hear of your frustration in getting to the endo. But you are right, you're best off seeing someone else, even if you get an appointment - as your relationship with this dr will be salted from the start.
It could be one of many things:
1. The endo has got crummy staff. That happens more often than you think. Very often, a lot of enquiry phone calls to a doctors office are filtered out by the staff thinking "We don't want these sort of patients"
2. The endo is no longer seeing trans patients. If the dr concerned is down that due to declining personal interest, usually the referring dr are informed.
I find it strange that a dr would say goodbye to a referral source, so I think this is more a matter due to certain staff members. Your therapist should get in touch with the endo, just to find out exactly what the matter is.
Find a local support group, you'll have better access to resources.
omg yeeees zil goldstein shes amazing and trans
Quote from: Brenda E on August 11, 2014, 08:50:38 PM
Nothing.
Basic HRT isn't rocket science. It does require medical supervision, but there are many family docs out there who are more than capable of prescribing spiro and estradiol patches and ordering a few blood tests once in a while. That said, a trans-friendly endo will have seen countless times more trans patients than your average family doc, and you'll benefit from that expertise and experience. I guess it's like taking your car to the local do-it-all mechanic or the dealer for maintenance: the do-it-all can probably handle anything you need, but the specialist will be able to deal with the more unusual situations.
If you can go to a trans-friendly endo, then go. But if not, hit up your local family physicians to see which one wants to take on the challenge of a trans patient.
It is a reasonable question. I agree with what Brenda said.
Also, I recently changed my family practitioner. I am still presenting as male, but I made sure to mention to him my trans status at our initial appointment. He had one of those "deer in the headlights" looks at that moment, so I don't think he would be comfortable prescribing HRT. I might ultimately find someone else, but he's been a good doctor so far with the nuts-and-bolts stuff, so I'd like to stay in his practice for the time being.
I also have a couple of underlying health issues that may or may not be relevant to HRT. I would prefer to work with a practitioner experienced with trans HRT because I think they would have a more subtle understanding of the interactions between those health issues and the hormones.
Quote from: luna nyan on August 11, 2014, 09:25:39 PM
Danielle,
Sorry to hear of your frustration in getting to the endo. But you are right, you're best off seeing someone else, even if you get an appointment - as your relationship with this dr will be salted from the start.
It could be one of many things:
1. The endo has got crummy staff. That happens more often than you think. Very often, a lot of enquiry phone calls to a doctors office are filtered out by the staff thinking "We don't want these sort of patients"
2. The endo is no longer seeing trans patients. If the dr concerned is down that due to declining personal interest, usually the referring dr are informed.
I find it strange that a dr would say goodbye to a referral source, so I think this is more a matter due to certain staff members. Your therapist should get in touch with the endo, just to find out exactly what the matter is.
Find a local support group, you'll have better access to resources.
If the staff had simply informed me that the endocrinologist was winding down her trans practice, I would have understood that. It would be no different than any other doctor deciding to take their practice in a different direction. It would have been disappointing, but I wouldn't have blamed her for it. So, yes, I tend to favor the "crummy staff" hypothesis as well, and hopefully my therapist and the endocrinologist clear things up.
That said, if the staff is pulling stunts like this without her knowledge, she have big problems with her practice - certainly not unique problems in the medical world, but ones that should make patients pause before seeing this doctor.
I think I can help a bit but I am going to send it in a pm if you don't mind.
Quote from: learningtolive on August 11, 2014, 10:13:22 PM
I think I can help a bit but I am going to send it in a pm if you don't mind.
Yay! Definitely.
Quote from: learningtolive on August 11, 2014, 10:13:22 PM
I think I can help a bit but I am going to send it in a pm if you don't mind.
Got it. I can't PM yet, so I'll just say thank you - very helpful.