Hi all,

So kind of a long story.  I have been thinking very hard and researching transgender for several months now.  I have been thinking about myself who i am and who i want to be.  I have also seen a therapist for just over a month or so.  Friday last week i decided that i need to start HRT in order to get where i want to be.

I made an appointment at a clinic that operates on informed consent.  I saw a PA and gave medical history.  I am a bit over-weight right now and have a history of high blood pressure.   I had had coffee that morning and was also very nervous about the doctor's visit a little freaked out simply because I haven't told a lot of people I'm interested in transitioning. So I went in and the doctor had some interesting questions that were disturbing to me a little bit. he asked how long have you known and I said known that I was interested in transitioning. And he said known that you were a woman. this question was a little bit shocking to me because I don't really think of myself in that way. So I told him that I have I've been thinking about it a lot over the the past 2 months. I told him I've also been seeing a therapist. he also asked me if I present as a female.  I told him no. I didn't explain because I didn't really feel like it was his business but I have a professional career and a family and I need to go very slowly into the process and I feel like starting HRT is a good step and losing weight in addition to that will help. then I intend to take my time about things.

so they took my blood pressure and it was high. which is understandable considering I was freaked out about the visit and on coffee and probably it is a little high right now with my weight.

The doctor told me that they have multiple treatments spironolactone estrogen he told me that he couldn't do estrogen if I had high blood pressure. I said okay and I was a little speechless I was still a little disturbed by his previous questions also. he then told me that he recommended I come back in in 3 months I go and have some labs done and I keep track of my blood pressure and give him records from my other doctors So that I can show that the blood pressure is under control. he also told me it would be good for me to have 3 months more with my therapist because I still have questions and he prefers to treat patients who are 99% sure. keep in mind I never told him that I have any questions about it in fact I told him that I had done a lot of research.

so I'm looking for opinions

is this conversation normal and reasonable and are the stipulations and the reasoning behind them reasonable also. I understand that the high blood pressure is a concern and I feel like that is perhaps reasonable except for the fact that they only took my blood pressure once on one day and have made a judgement that I need to wait now 3 months because of it. What I have problems with our is the assumption that I have questions and I'm unsure about my choices. Especially when I haven't said anything to that effect and I'm in the clinic to see them specifically because I want to make these changes. does the situation seem like this doctor is putting barriers in front of me based on his own bias? Should I see a different doctor? Has anyone else had experiences like this?

If it is informed consent then I think those questions are to be expected.  My Dr. asked me many of them and I had a therapist letter with an HRT recommendation.  Perhaps you could take a letter from your therapist next time.

As for the high blood pressure, mine also sometimes goes way high when I go to the Dr.  What I do is keep a daily record and take a copy with me in case it becomes an issue.


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Quote from: Marcus O on December 18, 2017, 10:46:55 AMhe told me that he couldn't do estrogen if I had high blood pressure.

As long as bio-identical estrogen is prescribed, the scientific literature seems to indicate it's actually beneficial. Perhaps, you can share the following with them or go see another doctor who may be more familiar and up-to-date with ERT.

Menopause. 1998 Summer;5(2):79-85.

"The administration of (...) sublingual estradiol to 24 postmenopausal women (aged 48-58 years) was followed 60 min post-dose by a surge in mean estradiol serum levels (1759 +/- 704 pg/ml)."

"At rest a slight drop in systolic and diastolic blood pressure was measured after estrogen ingestion: 132 +/- 24 mm Hg versus 127 +/- 21 mm Hg, p < 0.05; 83 +/- 11 mm Hg versus 78 +/- 10 mm Hg, p < 0.02. There were no changes in resting heart rate, double product, or vascular resistance. The left heart cavities became smaller: the left atrium diameter decreased from 33.7 +/- 4 mm to 32.3 +/- 4 mm, p < 0.01; the end-systolic diameter decreased from 24.9 +/- 3 mm to 23.6 +/- 4 mm, p < 0.01; the end-diastolic diameter decreased from 44.5 +/- 4 mm to 42.7 +/- 4 mm, p < 0.01. The peak aortic blood flow velocity fell from 120 +/- 19 cm/s to 116 +/- 22 cm/s (p < 0.05), and the flow velocity integral fell from 26.3 +/- 4 cm to 24.9 +/- 5 cm (p < 0.01); the cardiac output underwent a small change, with borderline significance: 7 +/- 2 L/min versus 6.7 +/- 2 L/min, p = 0.06. Only minor changes in the hemodynamic and echocardiographic parameters were recorded after estrogen for both isometric and dynamic exercises. Analyses were also made for two subgroups: 13 normotensive women were compared with 11 hypertensive women. The post-estrogen decreases in resting blood pressure and in peak blood velocity were observed only in the hypertensive subjects, whereas the changes in heart dimensions and in flow velocity integral were the same in both subgroups."

Ann Clin Res. 1983;15 Suppl 38:1-121.

"Blood pressure, central hemodynamics and peripheral blood flow were measured at rest in 20 normotensive and 20 hypertensive postmenopausal women during cyclic placebo/estradiol-17 beta treatment."

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

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. 2013 Apr;16(2):265-73.

"Estradiol decreased systolic blood pressure, plasma aldosterone levels, and the expression of renal sodium transporters."

Obstet Gynecol. 2015 Mar;125(3):605-10.

"In transgender women, estrogen therapy, with or without antiandrogen therapy, was associated with lower BP."

"Both systolic and diastolic median blood pressures in this group dropped significantly from baseline to 6 months (130.5 mmHg (IQR 11.5) to 120.5 mmHg (IQR 15.5) p=.006; 78 mmHg (IQR 21) to 67 mmHg (IQR 12), p=.001 respectively)."

The anti-androgen prescribed was spironolactone and this usually reduces blood pressure.

Maturitas. 1979 Jun;1(4):287-94.

"Haemodynamic changes during a 3-wk treatment with oestradiol valerianate (...) were studied in 12 postmenopausal women by isotope 113Inm radiocardiography. Systolic blood pressure measured in the supine position decreased during oestradiol treatment by 3% (P less than 0.05) and the diastolic blood pressure decreased by 4% (P less than 0.01)."

Circulation. 1987 Oct;76(4):753-8.

"We conclude that both oral and percutaneous treatment with estradiol may provide protection against the age-related increase in diastolic blood pressure observed in early postmenopausal women."

Quotethey only took my blood pressure once on one day and have made a judgement

Blood pressure can fluctuate a lot and increase due to stress, being in the doctor's office. My doctor took my blood pressure 2-3 times, standing up, sitting down, etc...and admits that only taking once may not be reliable. The ideal conditions, in the opinion of my doctor are that one should take it when relaxed, at home.

Since spiro lowers blood presssure I'm not quite sure why it's a problem.

Before you start HRT, somebody should double check your decision. Had you presented a letter from your therapist, I suspect there would have been no  difficulty starting HRT. As it is, the doctor was doing double duty prescribing HRT and as a therapist.

As for the blood pressure, doctor office jitters are common and can drive up your blood pressure. My blood pressure often reads normal in the doctors office because away from the office, I might be as much as 20 units below normal. You should get a blood pressure monitor and record your blood pressure when you get up each day. If you have an history like this, the doctor will know if you have a problem or not. If it's high and not due to weight or other controllable issues, medication should be able to control it.

Standard questions. I went informed consent, too. As a comparison, I showed up nicely dressed as a mature, confident woman. I told the doctor I was non-binary, had been presenting as female for two years, was currently self medicating with supplements, and wanted to get on doctor supervised HRT. She immediately said I could start HRT in a week if my labs came back good. Then she asked me to tell her my story, how I came to be sitting in her office asking for hormones.

If you're questioning, they're going to try and help you find your answers. If you know your answers, they're just going to help you. 

Hugs, Devlyn

Quote from: Devlyn Marie on December 18, 2017, 06:50:58 PM
Standard questions. I went informed consent, too. As a comparison, I showed up nicely dressed as a mature, confident woman. I told the doctor I was non-binary, had been presenting as female for two years, was currently self medicating with supplements, and wanted to get on doctor supervised HRT. She immediately said I could start HRT in a week if my labs came back good. Then she asked me to tell her my story, how I came to be sitting in her office asking for hormones.

If you're questioning, they're going to try and help you find your answers. If you know your answers, they're just going to help you. 

Hugs, Devlyn

Devlyn, your experience at the doctors office echos my own.  I wasn't presenting, but I had a 40 year history of fighting including 20 years of off and on self medicating.  My doctors main concerns as that point was growing my support system so I wouldn't back out again.  I walked out with lab paperwork for that afternoon, and an appt for pellets the next week.

If you are sure this is for you, your doctor will see it and help.

I did IC as well and was asked many questions.  How long have you known you were female?  How long have you felt dysphoria over it?  Have you attempted transition before?  Are you seeing a therapist?  Are you aware of the risks and benefits of hrt?  How much of your mental health issues are related to gender dysphoria?  etc.  My Dr was very thorough and I appreciated it; it felt as though she wanted to help make sure I was doing what I needed to be happy.

Quote from: Deborah on December 18, 2017, 11:13:45 AM

As for the high blood pressure, mine also sometimes goes way high when I go to the Dr.  What I do is keep a daily record and take a copy with me in case it becomes an issue.


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It's called the "white coat syndrome", for obvious reasons.  I had to do the same thing at first.  Not so much at all since starting spiro.

I'd been doing DIY for some years and had a number of significant problems (unrelated to HRT) in my blood tests when I first saw my doctor. He pointed them out them and the consequences, but put me on HRT right away, which was the right thing to do in my case. Suggested I see a psych too - good call there.

I found all this allowed me to address a number of problems in my life that in turn fixed up my blood tests over time. Not sure what would have happened otherwise, but no doubt a significant chance of being fatal (and not from the medical problems).

I think the blood pressure thing is utter crap. He could have asked you to come back in the next day and try again, or gave you spiro and try again after that since it is a blood pressure medication after all. Not to mention that stress causes high blood pressure and not getting on HRT is extremely stressful.

I had a blood pressure test recently and it was around 165/? and dropped to 138/? when he did it again a few minutes later. When I'm relaxed on holiday its 120/80 or better.

I did IC and my doc only asked how long have I known I was transgender. She also went over the health risks of hrt (blood clots). I did blood work that day and was given an appointment in 2 weeks. I started hrt after my 2nd appt 2 weeks later.

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Thank you all for the great thoughtful and informative responses. It's good to know that my experiences weren't that different from what other folks have experienced even though I've been delayed a little bit I don't think it's necessarily A Bad Thing. I just have a different route laid out in my mind for myself than other folks have taken and so I think it's harder to understand that I am serious about the whole matter.

I'd like to hear about your route, Marcus. I'm a bit of an exotic hybrid myself. 

Hugs, Devlyn