I went stealth before computerized records were common, changing name, gender, drivers license, SSN, etc. via paper.  For the last 30 years, I have worked for self insured companies as female, but I'm about to change insurance to obamacare and so have an opportunity to speak frankly with my GP about my situation.

I am in reasonable health for someone in their mid 50's but I haven't had an examination 'down there' since my last visit with my surgeon, and I went off HRT after 5 years (3 years post op) because of studies linking estrogen to breast cancer and have been flying E free since then with no masculinizing effects.  So, I don't think there are any real needs medically for me to come clean, and so I am not sure the risks would outweigh the benefits.  Specifically, I am concerned this presents a risk of propagating my status retroactively to all of the places I was able to get in as F in the past or maybe flagging me for special attention in future background checks,etc. 

Does anyone have experience with doing this?  Any advice?

I'm not a lawyer, but my understanding of the HIPAA law is that your doctor cannot divulge information about you without your permission. Maybe one of the Susanites who understands this law can verify.

The only study I know of following MtFs on estrogen found that the risk of breast cancer was no greater than that of an untreated male. I.e. practically non-existent.

Please talk to your doctor about being off HRT. My understanding that being without hormones of either gender for a long period of time has dangerous side effects. I believe bone density might be an issue.

Quote from: suzifrommd on April 23, 2014, 11:10:07 AM
The only study I know of following MtFs on estrogen found that the risk of breast cancer was no greater than that of an untreated male. I.e. practically non-existent.

Here is the link to that study.

http://onlinelibrary.wiley.com/doi/10.1111/jsm.12319/abstract

Thanks Suzi, that is an interesting stat.  As a post menopausal woman (in surgical history I always put hysterectomy in place of SRS), HRT is something insurance would cover... as a trans person, it would not be.  So that is an implication I hadn't considered.  Hmmm.

Re: the cancer risks, in those days numbers weren't available so while I did stop HRT out of concern over breast cancer, it turns out my family is prone to cancer, which I wouldn't have known then.   I don't know if stopping has given me a better chance to beat it or not, but my mom's doctor suspected her self medicating with E from mexico may have contributed to the two cancers that she had, cervical followed by colon.  So that is something to consider as well. (may I add here... F' cancer!)

Anyway, thanks again for your link and your council.

Since posting this, I have been researching non-stop.  I finally was able to find some studies that did say that MtF women are more prone to osteoporosis as they age without ERT therapy.  There are also some caveats to that that of course make it somewhat equivocal, the risk of clots goes up with  ethinyl estradiol versus other types of Estrogen for one, which of course is avoidable.  All in all there are few studies directed at aging MtF but those that are available say that it is safe and recommended to maintain estrogen levels at a normal female level for life.  None that I found say that the higher doses used during transition are safe for maintenance, but much of the data they find is for older MtF transitioning so it is hard to figure out exactly where they are getting data from and what levels are present when issues have arisen.

Nearly every general discussion says MtF should maintain for life but these are usually asides and final thoughts, not the core of the study.

One or two links if that is permitted - in case someone else is interested
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3720111/  "Long-term cross-sex hormone treatment is safe in transsexual subjects"
http://www.ncbi.nlm.nih.gov/pubmed/17986639/  "Long-term treatment of transsexuals with cross-sex hormones: extensive personal experience"  (Dr. Gooren is the most prolific and experienced researcher out there, his stuff is worth the read, search his name to find most of the credible publications)

My wife is some 25 years post-op and has always been deep stealth almost 40 years now. The only times she came out to docs was when she felt it medically necessary and that is only twice now. She never had an issue. Even with an ob-gyn and mammograms.

I did end up talking to my Dr. about it, I was concerned about osteoporosis and it turns out I am on my way to getting that dread disease... I was diagnosed with osteopenia which is a thinning of bone density that doesn't quite reach osteoporosis status. 

My doc prescribed estradiol right away and later alendronate when I got my results from the scan.  When I first told him I wanted to go back on E for the hot flashes and over my research about osteo risks, he said no, that my condition didn't warrant it, and there were other drugs for osteoporosis if I needed them.  I said what about MtF transgender? He said something like "I don't know how that matters" and I said "I'm talking about me"... he was blown away.  He just kept smiling, looking at me and shaking his head. 

After a bunch of insecurity by him about not knowing enough, he looked up the dosages and gave me the middle dose in the recommended range.  Since then we've gotten close but he does tell me that he's having trouble absorbing things, that I'm the first trans person he's met.  I hope he holds together!

One benefit from going back on E is that I've suddenly gained a cup size and my body has been reshaping from apple to pear shaped and my jeans started fitting correctly at last as my belly shrinks.  Not to mention that my libido has totally woken up!

Anyway, thanks to everyone for the support and advice!