I don't have my letter yet however I do want to make sure I understand how I can get going and where I got to go to do this. A little background first I live in Worcester I don't have a drivers license for personal reasons i'm unwilling to get one so going all the way out to boston is a hassle for me not impossible though just a 3 hr+ round trip. Is this something one of my local hospitals could do for me? We got quite a few here I have also looked into the planned parenthood center here however they don't do hormone therapy yet. I've researched just about everything else but this is still nagging me you should see my binder on transitioning i've made i must of printed over 100 different documents, maps, bus routes, train routes etc.

I do understand (i think) the whole informed consent thing and to go that route that is a definite train then buses into boston but if I could keep it all right here that 30 bucks id spend could go to other things like saving up for hair transplants or just stocking up on makeup and some clothing or just food (I don't make much so everything i get goes into food or rent pretty much).

As far as I understand informed consent = walk in with appropriate tests/physical done walk out with my prescription. Other route have to see a endocrinologist with a letter from my therapist am I right?

Thank you for your time and sorry if this has been asked before and answered i'm sure it has I just haven't found anything.

Hi Rylie, I'm from Weymouth! The last person who posted about Fenway Health informed consent said she got her hormones on the second visit. https://www.susans.org/forums/index.php/topic,204552.0.html  Good luck with whatever route you go!

Hugs, Devlyn

I got that part of it understood but that's 25-30 bucks each way so wondering if there's a way to do it right in worcester. Odds are i'm going to my next pflagg meet but thats still 3 weeks away and this will bug me till that day.

If your going to a local hospital or doctors office it could be very tough, many of them have never dealt with a transgender person, those that are willing to work with you will likely require many visits and notes from therapists and doctors before even considering it, and if something should go wrong, they wont really know what to do.

Informed consent is rare outside of places that do hormones regularly and few of them do total informed consent, most have there own method.

I started Hormones out of the fenway center almost exactly one year ago, I also choose a doctor there as my personal doctor as they understand these things. So I booked my first appointment, filled out a bunch of paperwork from there site to bring with me and went in for my first visit. I told my doctor that first session that I wanted to start HRT as soon as I could and she was ok with that but we had a few things to get out of the way first.

To start I had lethaly high blood pressure so my first few visits where to get me on medication to get it down. My first visit ended with me going down to get bloodwork done in there lab, to check my hormone levels, plus some general information. Fenway requires that anyone getting hormones there first have a basic physical either there or shortly before going there just to make sure you don't have any serious medical conditions that the hormones might cause problems with.

So my first session I had a physical, and blood work, I had to go back two weeks later and start medication for my blood pressure, then two weeks after that we added more blood pressure meds, and a few weeks after that my numbers looked good and I was able to sign the forms and start HRT. I went back two weeks later for a follow up to make sure I was not having a adverse reaction to them and we upped my dose to its current levels.

Aside from the physial and blood work from my first visit to make sure I was healthy enough to start something that taxes your body the only other requirements they had where I sign consent forms and bring them a letter from my therapist assureing them that I was of sound mind and that this was a decision I had made after serious thought. If I had not been seeing a therapist on my own I could have gone to a session or two with one at the fenway center and had them write my recomendation letter.

If I did not have blood pressure issues and I had a outside therapist who would write me a simple letter I think my time at fenway could have been shorter, One visit for a physical, and  blood work, a second visit with my letter to start a low dose HRT and one follow up a few weeks later. So two or three trips over the course of a month or so. With one appointment every 6 months for blood work and checking hormone levels.

One major upside to the fenway center, they will deliver your medication anywhere in the state via UPS or USPS, which makes refills much less stressful, when I am low on something I just go to there website, sign in and order a refill to be delivered to my house.

I will also say I have never felt as welcomed and comfortable as I do at the fenway center, from visit one, still presenting male, I was addressed as Serena and referred to with feminine pronouns. It is a bit of a pain to get there, I have a car and its still a hour drive in and out even with limited traffic but I have found it worth the trouble and cost to have a doctor who knows what I am dealing with and who has heard it all before.

Serena

Serena thank you that's exactly what I wanted to know I don't have a licence so public transportation is the only way into and out of boston short of a ride from family and I don't want to let the cat out of the bag so to speak just yet. I have no clue who my primary is yet I had to swap my insurance via mass health from celticare to fallon to see this therapist that dont happen till tuesday I will definitely be going to see him/her for a physical and to get some chantix asap part of my plans are to 1) stop drinking up to 4 liters of soda daily that's going good 2) loose weigh big time i'm 220 now i want to be 150 but this year goal of 170 and may go further but 150 is a healthy weight for a man or woman of my height 3) quit smoking 4) start hrt. Until I feel comfortable with coming out (or cant hide it anymore) to my father I need to try to avoid given him any ideas something like this is going on that includes getting rides to a known transgender treatment facility. He may not have the faintest idea of what fenway does (at least part of the faculty) but if word got to my sister she will her ex transitioned and went there before moving out to california  simply because our state is behind the times a bit from what i've learned we don't even have a single srs surgeon still. Some of her decision to move was also because her family completely rejected her but she has told me it was more over the support out west she could get was better was quite a few years ago now however.

So ill talking to my pcp when I get to meet him/her and see if I get lucky I don't mind waiting a few more months it wont kill me infact I want to have noticed some change in my weight and have quit smoking entirely before i start hrt anyways. Frankly speaking I started smoking when i was just 14 quit when i went into the army but guess what when I got the boot just 2 yrs 8 months in I started up again and have since. Since I decided to start this journey i've been wayyy happier then I have in 16 years and have finally started to care about not killing myself way younger than need be indirectly. That's kinda been the idea since I was booted I had no reason to live other than my folks so mistreating my body was fair game as per if you die because of lung cancer or something else because of a big soda drinking habit and smoking habit then its not really suicide now is it? Granted yes it would of been a more painful way to go but to me more dignified and wouldn't (maybe not sure) of caused my bipolar mother to suddenly renter server depression again and try to kill herself again we've had to lock her up over it before.

Quote from: Valwen on February 27, 2016, 01:08:02 AMSo my first session I had a physical, and blood work, I had to go back two weeks later and start medication for my blood pressure, then two weeks after that we added more blood pressure meds, and a few weeks after that my numbers looked good and I was able to sign the forms and start HRT.

Spironolactone, a commonly used anti-androgen in the US for transwomen actually LOWERS blood pressure, it's antihypertensive due to its antimineralocorticoid actions. Bio-identical estradiol does not adversely affect blood pressure and can even have a beneficial effect as it is a vasodilator. Older forms of estrogens (not bio-identical) did have an adverse effect because of their significant effect on the renin-angiotensin system. Bio-identical progesterone can also have a positive effect in those with high blood pressure. Similar to spironolactone, it exerts antimineralocorticoid effects. 

Hence, the right HRT may actually improve blood pressure or at worst, have a neutral effect. High blood pressure wouldn't appear to be a contraindication to HRT if the HRT used is adequate.

Here, just a few studies:

Ann Clin Res. 1983;15 Suppl 38:1-121. (oral estradiol was used)

"Estradiol-17 beta substitution decreased the systolic and diastolic blood pressure in normotensive, hypertensive and borderline hypertensive postmenopausal women."

"Irrespective of the pretreatment blood pressure levels, heart rate decreased during estradiol-17 beta substitution"

"Cardiac output increased in the normotensive test subjects but decreased in the hypertensive and borderline hypertensive subjects"

"Estradiol-17 beta substitution decreased the systolic and diastolic blood pressure in normotensive, hypertensive and borderline hypertensive postmenopausal women. The blood pressure of the hypertensive subjects decreased on average more than the blood pressure of the normotensive subjects."

Biochem Pharmacol. 2013 Dec 15;86(12):1627-42.

"Experimental studies supported vascular benefits of estrogen. Acute administration of estrogen in female or male patients improves vasodilator responses and ameliorates myocardial ischemia [4]."

"Estrogen also enhances the release of vasodilator substances such as nitric oxide (NO) and prostacyclin (PGI2), and decreases the production and effects of vasoconstrictors such as endothelin (ET-1) and angiotensin II (AngII) [1,2]."

Lancet. 1993 Jul 17;342(8864):133-6.

"Acute administration of oestradiol-17 beta therefore has a beneficial effect on myocardial ischaemia in women with coronary artery disease. This effect may be due to a direct coronary-relaxing effect, to peripheral vasodilation, or to a combination of these mechanisms. Oestradiol-17 beta may prove to be a useful adjunct to the treatment of angina in postmenopausal women with coronary heart disease."

Maturitas. 2008 Jul-Aug;60(3-4):185-201.

"recent indications suggest potential advantages for blood pressure control with non-oral estrogens"

"Recent evidence indeed shows that natural progesterone displays a favorable action on the vessels"

Horm Mol Biol Clin Investig. 2014 May;18(2):89-103.

"The cardiovascular protection observed in females has been attributed to the beneficial effects of estrogen on endothelial function."

"estrogen alone or combined with progesterone has been associated with decreased blood pressure"

"Estrogens physiologically stimulate the release of endothelium-derived vasodilator factors and inhibit the renin-angiotensin system."

Climacteric. 2012 Apr;15 Suppl 1:11-7.

"Micronized progesterone has a neutral effect on the vasculature, including a neutral or beneficial effect on blood pressure."

Climacteric. 2013 Aug;16 Suppl 1:44-53.

"The addition of micronized progesterone to CEE has been reported to abolish the increased daytime blood pressure of normotensive women and potentiate the CEE-related decreased daytime systolic blood pressure in hypertensive women26."

CEE= conjugated equine estrogens (older form of estrogen; not good)

Endocrine Reviews, April 2013, 34(2):171–208

"Interestingly, no changes were observed in blood pressure with progesterone administration
to normotensive postmenopausal women, although a slight reduction in blood pressure was observed in hypertensive women (198)."

QuoteAside from the physial and blood work from my first visit to make sure I was healthy enough to start something that taxes your body

The right HRT is beneficial to your body, reduces risk of atherosclorosis and CVD (cardiovascular disease), improves blood pressure, etc. This idea that female hormones and HRT is taxing comes from decades ago when the wrong forms of hormones/drugs were used. Ciswomen fare better than men, live longer and are exposed to the same hormones we take for decades, sometimes in very high levels (during pregnancy).

One of my blood pressure meds is spiro but it was far too high for spiro alone to fix like it was on average 180/120, when I first got checks I was running late a bit stressed and it was up to just over 200/130. I found it very reasonable to deal with my blood pressure a bit first my biggest fear was that between my weight and blood pressure they would not want me on hrt at all thankfully they just wanted to make sure I was ok first.

I am around 240, I got it down to 235 for a bit but hrt is taking it's toll on my weight loss and it's been going up again.

Massachusetts it's a fantastic place to transition the only thing we lack is a grs surgeon but that could change any day now. Dr oates and Dr sloma over at Boston medical center are going to start up once they get the insurance companies on board. The only sad part is that will eliminate any choice of surgeon I have because insurance won't cover out of state surgery if there is a in state option.

Over all HRT has been wonderful for every aspect of my life, accept sleeping on my stomach and losing weight. Stupid ouchy nipples. :-P

Serena

Restricting carbs is a great way to reduce blood pressure. The reason being that insulin, stimulated by carbs because its function is to reduce glucose levels in the blood, significantly increases sodium retention.

Nutr Res. 2013 Nov;33(11):905-12.

"Statins positively impact plasma low-density lipoprotein cholesterol, inflammation and vascular endothelial function (VEF). Carbohydrate restricted diets (CRD) improve atherogenic dyslipidemia, and similar to statins, have been shown to favorably affect markers of inflammation and VEF. No studies have examined whether a CRD provides additional benefit beyond that achieved by habitual statin use."

"In conclusion, these findings demonstrate that individuals undergoing statin therapy experience additional improvements in metabolic and vascular health from a 6 weeks CRD as evidenced by increased insulin sensitivity and resistance vessel endothelial function, and decreased blood pressure, triglycerides, and adhesion molecules."

Am J Physiol Heart Circ Physiol. 2013 Jun 15;304(12):H1733-42.

"Previous studies reported that diets high in simple carbohydrates could increase blood pressure in rodents. We hypothesized that the converse, a low-carbohydrate/high-fat diet, might reduce blood pressure."

"In conclusion, a low-carbohydrate/high-fat diet reduced blood pressure and improved arterial function in SHR without producing signs of insulin resistance or altering insulin-mediated signaling in the heart, skeletal muscle, or vasculature."

Arch Intern Med. 2010;170(2):136-145.

"Two potent weight loss therapies, a low-carbohydrate, ketogenic diet (LCKD) and orlistat therapy combined with a low-fat diet (O + LFD), are available to the public but, to our knowledge, have never been compared."

"In a sample of medical outpatients, an LCKD led to similar improvements as O + LFD for weight, serum lipid, and glycemic parameters and was more effective for lowering blood pressure. »

You can also read Gary Taubes's book "Good Calories, Bad Calories", check out Eric Westman or the Diet Doctor website.

Quote from: Devlyn Marie on February 26, 2016, 08:38:50 AM
Hi Rylie, I'm from Weymouth! The last person who posted about Fenway Health informed consent said she got her hormones on the second visit. https://www.susans.org/forums/index.php/topic,204552.0.html  Good luck with whatever route you go!

Hugs, Devlyn

Hey...that's me! lol...I did get hormones on my second visit to Fenway. My first visit was really just a consult because I had just had a yearly physical with my primary and the on the second visit I sign the inform consent and was prescribed estriodol and spiro. Fairly low beginning doses but that is very reasonable and I believe my doctor will double both at my next visit which is in less than 3 weeks. Now I had done my research before I walked in the door. I knew about informed consent. I had an MD, a psychiatrist, and a therapist for which I signed releases for.. Now I had just come out to all three of those maybe a month or so before so it wasn't like gender dysphoria was something I have been treated for for a long time, but the fact that I had come out to all 3 along with the fact that I knew everything about HRT and informed consent and went to both appointments presenting as female (I wasn't taking any chances) and my girlfriend came to my first appointment to show that I had support at home. All of this helped. They prescribed the hormones and spiro the same day they did their first blood test, before the results were even back. I was surprised but I got an email the next day from my doctor that all was normal. Fenway is pretty awesome.

Now it doesn't sound like you are ready to begin hormones just yet but while doing my research I found many, many doctors in Western Ma. It seemed like Springfield was the trans mecca of Massachusetts. Other than Fenway and Dr. Forcier at RI Hospital (she works mostly with adolescents but sees adults on Tuesdays). I'm on the Southcoast so Providence was actually closer for me and they required a referral from my primary (I thought that was odd since they are also informed consent) and I did that and got an appointment there and they seemed pretty awesome too but the Fenway appointment came up first and I was in a hurry to get started so I went with Fenway and am very happy.

There are a websites that list doctors who have experience treating transwomen, and like I said many were in Western Ma. A quick google search and I think you will find a doctor closer than Boston.

I would love to present as a woman however all I have right now is forms, bra, panities ive been dormant in my cd ways for 14-16 years but my living situation has changed and now I can be who I want to be without much risk of my father finding out before im ready to tell him hes homophobic and groups anyone who's a cder, ts, tg ect in with gays/lesbians so we all receive the same kinda rude comments from him and he wont hide when doing it. Frankly i'm scared of ever letting him know we have a rocky relationship as is only reason we still have one is hes still married to my mother. I was a unexpected child my grandparents forced him to marry her not to mention I was in special needs + couldn't walk or talk till almost my 6th bday and was born with a minor defect my hip was dislocated. Needless to say while he does still love me there's a lot of contention in our relationship we only get along when extended family is around or we work together otherwise hes usually saying something that's probably going to set me off (sometimes ofc its me that says something to set him off). As per im on mass health and don't have a permanent job haven't in years raking in the 23.15 each way to go into boston is hard I can do it but I live on less than 100 a week sometimes 20 bucks is all ill see.

Just to out my birth in some perspective imagine conceiving a child out of wedlock with very strict parents ( one of my grandmothers was going to become a nun before she met my grandfather) then being forced to marry a woman that while you love her your not sure you want to marry at just 18. Now the child is born with a minor defect the only way in 81 they could fix it was strapping my feet to the back of my head 24 hrs a day so now you got a near constant screaming child. This is a big reason why we dont get along that and ive been a failure at nearly everything ive tried in life im just now starting to realize part of the reason why and a really big reason for my depression and starting to try and fix it finally.

So had my first meeting with my therapist wednesday it went well i think she agreed I need to explore more before committing but admitted she doesn't know to much about transitioning she does work with transgenders though. I'm bringing in some of my printouts this wednesday so she can understand more about what masshealth requires me to do before I can start my journey officially

Now with my health plan swapped I get to pick a new primary theres 2 i'm looking at one is 1/2 mile from my house but she doesnt list if shes worked with transgenders before however the other one is a bit over a mile and his specialty is endocrinology. My train of thought since I will probably wait till summer to actually actively seek hormones is to go with Dr Sara Casey shes the closest one to me and seek a specialist when its time.

My final grand act as a male if I definitely transition has to be the best man at my brother wedding in no way to I want to overshadow him he gets married later this year dates tba he hasn't asked me yet but I know I will be up there with him hes promised. Ive discussed this with a friend and my therapist both agree 100%.

Part of my decision is because i've always been far more comfortable speaking with woman then men and to date only now 5 people who know me or have known me in some capacity know 1)jr high school counselor she helped me alot all those years ago however we never did breach the tg aspect of me I didn't know anything about gd,ts,tg at the time never heard those terms used back then 2) my current therapist 3/4) two gg's I know and are very good friends with in a mmorpg i play and lastly a male friend in the same game I knew I could trust those 3 are helping me alot with emotional support and the ladies are giving me tips they know. One of the ladies even is researching everything she can find just to help me more. We spent over a hour the other day running quests and discussing what im doing/planning to do yesterday we were talking makeup giving me tips.

At this point when i'm at home i'm living as close to a woman as I can get have been for the past week i'm definitely in a happier place granted for me that only means i'm wearing my forms with a bra and panties my legs, arms, chest are all as clean shaven as i can get and i'm practicing my female voice a lot. I even slept with my forms last night for the first time I cant remember the last time I fell asleep so quickly and slept so long even woke up with a huge grin on my face. Oh i've also painted at least my toenails no one can see em but me till summer.