The endocrinologist I saw is out of the University of Kentucky Health Clinic (Lexington, KY).  Here is what I gathered from her.  Keep in mind that I am MtF, 41 years old, in very good health, and have been on HRT before (had to go off for financial and child custody reasons). 

* their office no longer does injections, she said the only reason they were doing injections before was because they were cheaper.  Said "injections are only slightly more effective than pills...."  she said that pills are $4 per box.  she never explained why her office no longer does injections, and only pills or patches. 

* said there is nothing you can do about hairloss, "it's genetic", that "all the stuff you hear out there about stopping hair loss or recovering some of is pure junk".  She finished by telling me "just go buy a wig...".  When I mentioned stuff like Propecia she said it was all a joke.

* I don't smoke but she said that she won't even prescribe HRT to someone if they are smoking and in their 30's or older

* she never mentioned what dosages of estrodial she starts MtF out at, but I didn't think to ask her.

* told me that bloodwork (without insurance) to see if I am in condition to go on HRT "ranges from $100 to $600".

* told me that "most insurances don't cover anything for transgender services, but if we can get a diagnosis on your thyroid I can just bill everything under that..."

Your thoughts?  I am seriously contemplating following through with my appointment later this month with Dr Dain Wahl in Cincinnati, OH (another one who doesn't require a letter of referral for HRT), and even though I stand a chance of spending money again to hear the same thing, I can't help but think that transgender care is just a lot better in Ohio than it is in Kentucky.

She doesn't sound very supportive, especially about the age thing. I'm 48, the endo didn't have any problem starting me on HRT once he saw my blood tests. Maybe a second opinion is in order.

Injections for E are a bit overrated (in my experience anyway, they put me on an emotional roller coaster, not fun at all - my endo has me on a pellet under the skin, works wonders but I think you need to be on orals for a bit first)

Hairloss recovery can depend on how far gone it was to begin with. I was pretty bad but not not still the shiny scalp stage, on HRT and using minoxidil I've had some regrowth after six months...not enough to make me passable so I need a wig for now at least (maybe forever) but I don't really mind as much as I thought I would...it's a great wig, doesn't look like a wig and is generally guaranteed to help me pass.

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Quote from: thevaliantx on March 14, 2014, 11:13:48 AM* their office no longer does injections, she said the only reason they were doing injections before was because they were cheaper.  Said "injections are only slightly more effective than pills...."  she said that pills are $4 per box.  she never explained why her office no longer does injections, and only pills or patches. 

My doctor swears by pills. I've been taking them and my levels are good, so I wouldn't be concerned about this.

Quote from: thevaliantx on March 14, 2014, 11:13:48 AM* said there is nothing you can do about hairloss, "it's genetic", that "all the stuff you hear out there about stopping hair loss or recovering some of is pure junk".  She finished by telling me "just go buy a wig...".  When I mentioned stuff like Propecia she said it was all a joke.

Sorry to say, but that's right. Once hair is gone, it's gone. AAs will prevent further hair loss, but that's about it. It's surgical hair replacement or wigs. Not a happy situation, but it's our reality.

Quote from: thevaliantx on March 14, 2014, 11:13:48 AM* I don't smoke but she said that she won't even prescribe HRT to someone if they are smoking and in their 30's or older

This seems dictatorial and paternalistic. Cis women get HRT when they smoke, so not giving it to you is discriminatory.

Quote from: thevaliantx on March 14, 2014, 11:13:48 AM* she never mentioned what dosages of estrodial she starts MtF out at, but I didn't think to ask her.

There's a lot of info about dosages on the Internet, but talking about dosage on these forums is not permitted.

Quote from: thevaliantx on March 14, 2014, 11:13:48 AM* told me that bloodwork (without insurance) to see if I am in condition to go on HRT "ranges from $100 to $600".

That sounds high, but bloodwork isn't cheap. There might be some clinics that charge based on ability to pay if you call around.

Quote from: thevaliantx on March 14, 2014, 11:13:48 AM* told me that "most insurances don't cover anything for transgender services, but if we can get a diagnosis on your thyroid I can just bill everything under that..."

That's what my doctor is doing. The diagnosis doesn't mention transgender. "Hormone deficiency/imbalance" or something like that. Not completely a lie...

Quote from: thevaliantx on March 14, 2014, 11:13:48 AMYour thoughts?  I am seriously contemplating following through with my appointment later this month with Dr Dain Wahl in Cincinnati, OH (another one who doesn't require a letter of referral for HRT), and even though I stand a chance of spending money again to hear the same thing, I can't help but think that transgender care is just a lot better in Ohio than it is in Kentucky.

Well, I'm a great believer in shopping around. The only one that sounds alarming is the smoking thing.

I don't know why I feel this way, but I feel if you have to take a pill each day, then it's like deciding  between being a boy or a girl for the day.  With a shot, it's a once every two weeks kind of thing, and I can go about my everyday business, not having to worry about whether I took my pill or not. 

If I look at my scalp under a light and see a lot of peach fuzz, does that mean that with meds I can possibly regrow that hair? 

Would you all go see the other endo, if you were in my situation?

As I mentioned I have a capsule inserted under the skin, that stays in there for six months and it's awesome - I still have to take a couple of pills a day but to be honest I don't have that boy/girl dilemma, I look forward to taking them every morning because I know I have definitely decided girl

It sounds like she won't prescribe to you anyway, since you're 41, so I'd definitely be looking for someone else.

"their office no longer does injections, she said the only reason they were doing injections before was because they were cheaper.  Said "injections are only slightly more effective than pills...."

More or less effective depends on what dose is used and also on individual metabolism. Some poorly metabolize pills so that injections (or any non-oral form) are beneficial for them. At the doses typically prescribed, injectables do end up delivering higher levels of estradiol (E2) than pills so that if results were poor on pills due to inadequate (low) levels of E2 then injectables can make a difference.

"said there is nothing you can do about hairloss, "it's genetic", that "all the stuff you hear out there about stopping hair loss or recovering some of is pure junk".  She finished by telling me "just go buy a wig...".  When I mentioned stuff like Propecia she said it was all a joke."

Propecia is finasteride. Share these with her.

J Dermatol. 2012 Jan;39(1):27-32. doi: 10.1111/j.1346-8138.2011.01378.x. Epub 2011 Oct 10.
Evaluation of efficacy and safety of finasteride in 3177 Japanese men with androgenetic alopecia.


"The overall effect of hair growth was seen in 2230 of 2561 men (87.1%), in whom hair greatly (11.1%), moderately (36.5%) and slightly (39.5%) increased."

"In Japanese men with AGA, oral finasteride used in the long-term study maintained progressive hair regrowth without recognized side-effect."

Cutis. 2012 Aug;90(2):73-6.
Finasteride in the treatment of female pattern (androgenic) alopecia: a case report and review of the literature.

"We describe a case of a 44-year-old woman with biopsy-proven female androgenic alopecia (->-bleeped-<-A), or female pattern alopecia, who was nonresponsive to topical minoxidil. After careful consideration and discussion with the patient, the decision was made to introduce oral finasteride. After only 3.5 months of therapy there was a remarkable reduction in hair shedding and increased hair regrowth without any reported side effects."

J Investig Dermatol Symp Proc. 1999 Dec;4(3):282-4.
Measuring reversal of hair miniaturization in androgenetic alopecia by follicular counts in horizontal sections of serial scalp biopsies: results of finasteride treatment of men and postmenopausal women.

"In the male study, the terminal hairs increased from a mean baseline count of 15.5-20.9 after 12mo of finasteride, versus 17.3-18.3 in the placebo patients. The miniaturized hairs decreased from 26.7 to 23.6 with finasteride versus 21.3-20.3 with placebo. The terminal-to-vellus ratio increased more in the finasteride than in the placebo patients, suggesting some reversal of the miniaturization process with finasteride."

"Finasteride appears to be capable of reversing hair miniaturization in androgenetic alopecia in young to middle-aged men, but not in postmenopausal women."

Quote from: thevaliantx on March 14, 2014, 11:13:48 AM* I don't smoke but she said that she won't even prescribe HRT to someone if they are smoking and in their 30's or older

ORAL HRT is contraindicated in those who smoke BUT as non-oral bio-identical estradiol neither increases risks of DVT or pulmonary embolism or is affected by it, it can be prescribed to smokers. One needs only to read the studies, understand the mechanism behind clotting changes under exogeneous estradiol delivery to come to this conclusion. 

p.s.: had trouble with quotes and all so sorry for the format.

My take is: some of her "facts" are wrong. Did you think her opinion is better than her "facts"? Time to move on.

I would definitely think about shopping elsewhere. Each thing is only a minor red flag, but added up...

btw, my endo says she prescribes patches to anyone who is over 40 and smokers of any age, because of the DVT risk and need to avoid the first pass through the liver - but she WILL prescribe regardless of age and smoking status! She basically is just extra cautious with "higher risk" patients, and warns them to be more alert to signs of trouble.

Thank you all so much for responding.  Right now I've got a splitting headache, and some of it's got to do with my experience this morning.  I easily get depressed (and anxious), something I talked to the endo.  I mentioned to her that I was on an anxiety medication before and it did wonders for me.  She never said anything about it after that.

A little while ago I called the endo's office in Cincinnati, and spoke with them about my experience.  They assured me that Dr Dain Wahl will sit down with me and take the time to get to know me and what my goals are, explain everything and will be open-minded.  For example, they said that he, too, prefers to prescribe pills (but they didn't know why), but that he will gladly go with injections instead, but ONLY if the patient is either willing to come into the office and have the injections or if the patient is willing to give the shots herself (in my case my wife, a nurse, will do it....).  The lady also said that Dr Wahl has will listen to my concerns about my hair loss and will work with me to address it. 

I hate to say this, but I felt the endo I saw this morning only looked at me as a "man in a wig" and someone who might benefit mostly from HRT as an anxiety/depression reducer.  I told the endo that I felt that transgender support in Kentucky isn't nearly as good as it is in Boston (fact) and she said "well, it's better than other parts of the country".