When I recently had my primary check up a month ago. I ask my primary care doctor about any meds for thinning/receding hair. She said that they dont use any Rx meds for treatment of hair that it was not medically necessary.

Then later I emailed her and asked her specifically about meds that are commonly used in both hair treatment and HRT. And her response was that it was only used for prostate issues.

So my question is once I get going with the transitional gender affirming care, do I ask about those meds from my mentally health specialist (who seems to be the " primary " so to speak about putting referrals in for Endo, etc), or do I wait to see what meds they propose I start with for hrt?

I'm just wondering since my mental health apt is second weak of Sept, and I want to try and a list of things I should inquire about vs just waiting and seeing what happens.

Quote from: Robbyv213 on August 22, 2024, 04:32:24 PMWhen I recently had my primary check up a month ago. I ask my primary care doctor about any meds for thinning/receding hair. She said that they dont use any Rx meds for treatment of hair that it was not medically necessary.

Then later I emailed her and asked her specifically about meds that are commonly used in both hair treatment and HRT. And her response was that it was only used for prostate issues.

So my question is once I get going with the transitional gender affirming care, do I ask about those meds from my mentally health specialist (who seems to be the " primary " so to speak about putting referrals in for Endo, etc), or do I wait to see what meds they propose I start with for hrt?

I'm just wondering since my mental health apt is second weak of Sept, and I want to try and a list of things I should inquire about vs just waiting and seeing what happens.

I have a Primary physician and a dermatologist. The dermatologist prescribed Minoxidil. I get it from the VA.

My first Endocrinologist (in Minnesota) put me on Finasteride. After a couple of years of not seeing any improvement, and having issues with my hormone levels, my new endocrinologist (South Dakota) stopped the Finasteride as it affects hormone levels through the 5a-reductase enzyme, which affects estradiol, testosterone, progesterone, and others. The benefit of Minoxidil (Rogaine) is that it is topical so does not affect hormone levels.

The VA will authorize hair replacement through their prosthetics department. You will be permitted one wig per year. Here, the VA does not stock a bunch of wigs, so they referred me to a Care in the Community provider... i.e. a hair salon that sells wigs and is part of the VA providers network.

Yes, talk to your Primary about Rogaine AND a prosthetics consult for hair replacement (wig). They can do both at the same time. The prosthetics are the immediate treatment for gender dysphoria, the Minoxidil is a long-term treatment because it is slow to work and you must use it forever.

The Primary should be able to do the prosthetics consult directly. For Rogaine, they may refer you to dermatology and let the dermatologist write that prescription. Finasteride is an option, but would likely need to go through Endocrinology since it messes with hormones. I do not recommend it because it can be counter-productive.

Hope this helps.

When I first started HRT, I started using Finasteride as a T blocker.  I chose this because it would help with hair regrowth.  I used this for a couple of years, but I could never reach the proper levels of E.  I had to start taking Spiro as a T blocker, but I continued to take Finasteride for hair growth.  My Doctor just wanted to make sure that it did not lower my blood pressure too much.

Like Lori, my Dermatologist, prescribed Minoxidil, except she prescribed oral Minoxidil.  This has been very effective, and when I started taking it, I was paying for it out of pocket.  It is not expensive. The only draw back with oral Minoxidil, is it can increase the hair on other parts of your body.  It makes my beard a little thicker, and my arms a little hairier, which I don't like.  I had to shave any way, and I use Nair on my arms.  I am satisfied.

I am unable to use the VA at this point, but my private insurance covers all of my HRT meds.

I hope this information is useful.

Gwen

Well even if it's just rogain, at least it would not be out of pocket expense.

I'm still in the hurry up and wait category. Still waiting for my first visit with the wizard for mental health.

I did know about the wigs but I was under the impression that the rogain would be out of pocket, and everything else had to wait till after my mental health assessment.

Quote from: Robbyv213 on August 22, 2024, 10:19:30 PMI'm still in the hurry up and wait category. Still waiting for my first visit with the wizard for mental health.

I did know about the wigs but I was under the impression that the rogain would be out of pocket, and everything else had to wait till after my mental health assessment.

That is partially correct. Once you have the diagnosis of Gender Dysphoria from Mental Health, then you are transgender, and things that would normally be out of pocket or "cosmetic" become "medically necessary" in the treatment of gender dysphoria. Since it is a medically necessary treatment, it is covered. The wig is at no cost to you. Medications, including Rogaine, have a co-pay which varies, but it is much cheaper than out of pocket, so let the VA prescribe them and ship them to you.

If you haven't had the mental health evaluation yet, then just wait. Be patient until that happens. Your LGBTQ Care Coordinator can advise you on what services and medications are covered treatments for GD. With your diagnosis, you just tell your Primary what you want to do, i.e. hormones, wigs, hair removal, etc. and they will submit the consults to make it happen. If you get any static at all, talk to the LGBTQ Care Coordinator and they can talk to your Primary doctor to get things put in motion.

@Lori Dee thank you. That's kind of where I was not sure how things worked. So everything is covered once an official diagnosis has been made. And then it should be "easy sailing" and I use that very loosely, and until then it's just waiting for mental health and playing the game so to speak.

What if they decide I don't have gender dysphoria. Are there still routes to get things covered by the VA. I only say that bc I never really had any super great dis like for my body, as in being male with male parts didn't cause me a great deal of stress and anxiety, maybe a little but not to the degree others have had it. Granted In more recent years I have felt more stress, anxiety and depression about not being a woman than I have most of my early life,.

Or if they feel I'm more non binary than trans. Once they make that diagnosis am I stuck with what they believe, or can I get a second opinion. I def don't want to be damned by one person's opinion of me, when the next might be better.

I guess I'm probably just worried about nothing yet. As I'm sure we all have at some point.

Quote from: Robbyv213 on August 23, 2024, 12:26:28 PM@Lori Dee thank you. That's kind of where I was not sure how things worked. So everything is covered once an official diagnosis has been made. And then it should be "easy sailing" and I use that very loosely, and until then it's just waiting for mental health and playing the game so to speak.

This. Exactly.

Quote from: Robbyv213 on August 23, 2024, 12:26:28 PMWhat if they decide I don't have gender dysphoria. Are there still routes to get things covered by the VA. I only say that bc I never really had any super great dis like for my body, as in being male with male parts didn't cause me a great deal of stress and anxiety, maybe a little but not to the degree others have had it. Granted In more recent years I have felt more stress, anxiety and depression about not being a woman than I have most of my early life,.

Or if they feel I'm more non binary than trans. Once they make that diagnosis am I stuck with what they believe, or can I get a second opinion. I def don't want to be damned by one person's opinion of me, when the next might be better.

Gender Dysphoria is experienced differently by everyone. Some are not particularly bothered by it and do nothing about it. Some are mildly bothered by it and a little bit of cross-dressing is enough to satisfy them. From your previous posts, it is a big thing to you. Do not downplay it. Gender dysphoria is gender dysphoria. Remember that VA Healthcare is patient-oriented. That means you are in the driver's seat. If you tell the mental health guru that you are bothered enough that you are interested in starting hormone treatment... that is gender dysphoria.

They may ask questions about how long it has bothered you. The goal here is to determine if you have had it since you were a teenager, or if this is new due to a recent head trauma. Either way, it is still covered treatment. In my case, my earliest memories of disgust with my body were before I hit puberty. I remember waking up with "morning wood" and was horrified that this thing was trying to attract attention. Down boy! Down! Later, it was finding the first black hairs on my legs. Again, I was so disgusted, I stole my mom's razor and shaved them off. My point is that you say that you were not bothered much about it before, but if you really think about it, you may have experienced something similar.

My way of coping was to join the Army to become a manly man. Perhaps, that is why you got into bodybuilding. Maybe subconsciously, you were already trying to shape your body to compensate for something you knew deep inside. I am just guessing here, but I am trying to get you to think about things that may have been indicators you never thought about before. Maybe there were none, or maybe there were a lot more than you can immediately recall.

Don't confuse non-binary with transgender. They are separate things, but not mutually exclusive. You can be transgender AND non-binary at the same time. It is not either/or. You can be non-binary as is our VA LGBTQ Care Coordinator, who is not transgender. Long-time Member here, @Asche is a non-binary MtF transgender. They might be able to describe it better than I can. I am hardly an expert in that arena.

I hope some of this helps. I know the anxiety can build and we get to overthinking, but that is ok. If I can answer more questions, I am happy to help.

@Lori Dee

All that makes a lot of sense. And now that you have mentioned some things, it has got me thinking and I do see correlation to things that could have been me compensating for gender dysphoria from an early age.

I know I am not not most educated on non binary, trans or even the community as whole. I know I def need more education on it. I apologize if I had offended anyone.

I don't think anyone was offended. We all have to learn somehow, and sometimes all we need is a small explanation about things we are unsure of.

Since everything is only covered after mental health has established a diagnosis for gender dysphoria, I guess my next question is (in everyone's experiences) how many sessions can I expect to have before the mental health therapist comes to their conclusion for diagnosis?

I know that's a question that can't really be answered, and I know everyone is different and dealing with different things and how they deal with it etc. So now I'm wondering how many sessions I'll have with mental health before it becomes official, especially now that I'm just sitting and waiting like Beetle juice (when he is in line to be seen in the afterlife) with a ticket number thats not even possible while the clerk is on patient 2. Lol

I had one visit and got the diagnosis to start hormones. When I asked about beard removal, I was sent back for another evaluation to confirm that having facial hair was triggering my dysphoria. The psychologist, my Primary, and my Endocrinologist agreed it was medically necessary and the Chief of Medical Staff authorized the treatment at a local dermatologist. The dermatologist could only do laser and wrote in her report that laser would not work on a gray/white beard. So we went around again with this new information and again, the Chief of Medical Staff agreed that electrolysis is medically necessary.

You should only need one session to get the diagnosis. That should get you going for hormones. It is possible that any other specific needs (even though the VA website says it is covered) may need another session just to confirm that it is medically necessary as a part of gender dysphoria treatment. You know the government needs to document everything and that is how they do it. They need to cover their butts to justify funds for budgeting, etc., etc.

Lori,

You are such a wealth of knowledge on this, and may other, topic(s).  Thank you for your willingness to share your knowledge and experience.

Hugs Gwen

Quote from: gwenf369 on August 24, 2024, 10:42:21 PMLori,

You are such a wealth of knowledge on this, and may other, topic(s).  Thank you for your willingness to share your knowledge and experience.

Hugs Gwen

I have been transitioning through the VA for almost five years. I am just sharing my experience to help other vets. Over that time, I have encountered many obstacles, so I kind of know how to get around them. Each VA Clinic is run a little differently, but they all must follow the same regulations. So if a problem arises, I know who to contact to get it resolved. Hopefully, I can save some aggravation and frustration for someone else. That's why I'm here.

Thank you for your kind words.

Hugs!