Quote from: Robbyv213 on October 02, 2024, 05:38:11 AMMy appointment with endocrinology is about a week away. Is there any questions that I can ask that would tell me if the Dr is experienced in gender affirming hormone therapy vs just chasing numbers from lab results?

Obviously I will ask all questions I personally have, but wanted to know if there was anything else I should ask to determine their experience level. Thanks

As long as they treat you with respect and don't misgender you, you should be ok. You can even ask them how many transgender patients they have treated.

They should balance your hormone levels to get them into the female range. They may start with a low dose of E and Spiro for T-blockers. That is okay to start so you can adjust to the effects. If they do not volunteer it, ask to add progesterone to your meds. Many prescribers don't prescribe it. Some may want you to wait six months after starting E to begin. If they question it, remind them that ovaries produce progesterone and yours do not... therefore you need replacement hormones for that.

It is important that when the lab results come in they are not compared to what is normal for a male. You are trying to get into the female range and not the post-menopausal one. I had to remind my old endos that I might be over 60 years old but I am trying to get through puberty, not menopause.

The key is that they will start slow. People who start at too high a dose have stunted their development. Studies have shown that slow and steady is best to start especially for the first six months. Any signs that this doesn't feel right, mood swings, depression, etc. STOP immediately and call your doctor. After the first six months, you will be on your way and they can increase the dosage to get to the levels where you need to be.

This is all from my experience, so YMMV.

Thanks @Lori Dee

I was told spiro is not the greatest for t blockers, and that it's the one that just used most commonly. Would there be anything better to ask for instead of spiro?

Quote from: Robbyv213 on October 02, 2024, 02:51:38 PMThanks @Lori Dee

I was told spiro is not the greatest for t blockers, and that it's the one that just used most commonly. Would there be anything better to ask for instead of spiro?

Finasteride is stronger than Spiro, but like Spiro, it is not a T-blocker. It affects the 5a-reductase enzyme that affects all hormones, so not an ideal alternative.

I get leuprolide (Eligard) injections every 90 days. It blocks T production at the source.
I was also taking Bicalutamide (Casodex) tablets daily. These are androgen blockers that block androgen receptors. They have no hormonal activity so do not interfere with hormones. Both of these together serve as a form of "chemical castration" that shuts down T production and any in your system will have no effect.

Your body needs testosterone for other uses. It converts it into other steroids that are needed. As a consequence, your body will convert some E to T to fill that need. With Casodex (bicalutamide) in your system, any T being converted will have no androgenic effects and can be used for other things as your body needs.

After a year on Casodex, my labs showed that my T-levels were stabilized with the Eligard, so the Casodex tablets were no longer needed and I stopped taking those.

I hope this helps.

Just FYI, Eligard injections are expensive. I think they said $400 per dose. Fortunately, the VA has it available and I have a VA nurse give the injection every three months. If you try to do that through a non-VA doctor/pharmacy, they may not have it available to prescribe, and it would be expensive to do if they can get it. Definitely get it through the VA.

@Lori Dee thanks for the information.

So I completely did not know I scheduled my endocrinology appointment on national coming out day.... Go figure. If the universe isn't trying to tell me something. Lol.

This year has been a ->-bleeped-<- show. Excuse my language. First we have a house fire, then my wife's dad has been in and out of the hospital and nursing homes, then my wife's step dad finds out he has cancer, then my wife's brother finds out he has cancer, and just last night my wife's brother died. Like how much more worse can this year get for my wife, and now she gets to also deal with feeling like she is losing her husband on top of it all. Like the timing of all this (yes obviously out of my control) but seriously just the worst year of our lives and it's the first year of our marriage. I would be extremely astonished if our marriage survives this year... Just saying, and of course I hope it does, but I'm a realist, and this year would make many people consider taking an exit strategy.

Just on Wednesday night right as we were trying to go to bed she just starts talking about everything thats bothering her. Many things she was saying I could directly see how my gender dysphoria is affecting our relationship. When I try to lead into it and explain how gender dysphoria can cause or have a negative affect on relationships, once again shes not having it, thinking im turning it around and making it about myself when all I am.tryonf to do is tell her why the dysphoria is affecting our intimacy etc. eventually she starts to see what im trying to say. But after a conversation that needed to be had, we are still in the same place. Only progress is that we were able to talk and not get into an argument in the end, but we're still both left with nothing resolved. I guess at the least the elephant in the room is finally being addressed.

Now onto my appointment. My intention was for it to be just a talk and gain as much knowledge as I can about hrt, and the va's process for gender affirming care.  I learned a lot, and the VA covers a lot ( minus surgeries). I pretty much asked all the questions I could possibly think of. The endocrinologist and nurse practitioner said I came very well prepared with my questions to say the least. Thank you everyone here for arming me with the knowledge to be as prepared for this appointment as I could be. In the end when it came down to where the metal meets the road, I am one of those individuals who would rather have something and not need it, than to need it and not have it. So I left with a prescription of injection E, and spiro.

Now I know what alot of you may be thinking. Firstly this is how the typically start off, a form of e and spiro. Then at the next visit and labs thats when I can opt for something other than spiro, a different form of E ( like patches or orals), and progesterone. But they definitely made me feel like it will be very much personal and individualized care Vs a cookie cutter one size fits all program they give everyone. They want to start out as basic as possible, see how I feel and react and see what the next lab work comes back as before they start to adjust, add and or switch medications.

Now all that's left is when do I start? I told my wife many times I would not start HRT behind her back and I don't plan to. I know she won't be thrilled that I had an endocrinologist appointment behind her back yet alone got prescriptions too, but I feel I need to be upfront with her about it before I start. I can only hide it for so long before it becomes obvious and a pair of small breast buds will be staring her in the face. I know it's all my choice and don't own anyone anything and it's my journey and my pace as to what I feel I need to do and when I do it., but I definitely can't start without at the very minimum saying I was diagnosed with gender dysphoria and the VA mental health specialist gave me the green light to start hormones if I wanted and made the appointment to meet with the endocrinologist. And yes I know It would be a lie when I say my Initial consultation with endocrinology is. ...

I guess with how this year has gone so far, I mind as well set it all on fire and see what remains...

The endocrinologist also asked if I wanted to start anything else like voice therapy or hair removal services. Since she asked I said yes since I know those can take a long time to see results with so I figured that I mind as well get the ball rolling on those as well. At least that will help me feel like I am always doing something to be productive in terms of moving towards my end goal I envision for my transition.

Sounds like you are making progress despite the bad news. I am sorry to hear that.

Things happen, sometimes in waves of good or bad and that can have a strong impact on everything else around you. I think you are handling it the best you can (and doing a good job of it). By staying calm in your discussions you signal to her that it is okay to talk about it, it is okay for her to express her feelings too. That is how serious discussions start. I remember when you first came here you told us how everything exploded into an argument. Look how far you have come!

You will need to talk to her about your prescriptions. It is one thing to hide a couple bottles of pills, but needles and sharps containers and the meds are a different story. She needs to know why you need these things. They will have a prescription label on them, so it isn't like you are getting them on the street. These are presription medications that your doctor says you need. She needs to understand that.

I am really proud of the way you are going about this. I am still hopeful that she will want to stick around as much as you want her to. Just go as you have been. Gentle discussions and not pressuring her, asking her how she feels and if there is something she needs you to do to help her understand.

You got this. 

@Lori Dee thanks for the words of encouragement.

And I apologize for the language, I see my post has been edited which is good. I will do better about using bad language.

My wife is a LPN, so I know she would get and understand the medical necessity of an individual needing prescription medication, but I don't think she is able to understand why her husband needs them especially this specific type of medication.

In all our random talks about trans issues, her point of view and perspective is usually on the negative side. I don't think she'll understand until she has to watch me go through and deal with something extremely unfair and biased for her to have a change of perspective and heart on some of these trans issues were seeing more and more of.

I do truly hope she at the very minimum, educates herself, is more compassionate and understanding towards trans individuals. Not that she is a bad person by any stretch of the imagination towards everyone else, she just can't wrap her head around the fact that her husband is also one of those individuals. I see how conflicted she is when we have such talks about trans issues. She says something and then realizes that it's extended hurtful or making some major assumptions. Which i guess is progress as well but what ever the subject is and her stance/opinion/beliefs are she always finds a way to rationalize them to justify them.

As an LPN she will understand the medical aspects of it. Does she recieve any training at work in dealing with gender diverse patients? Many practices make that a mandatory training item, even if it is just watching a video presentation.

I can understand it is difficult for her to wrap her head around the idea that her husband is "one of those". Once she understands that you have the diagnosis, all medical protocols are then treatment for that diagnosis. She will understand that. She can even do her own research on what the various treatments involve. It all starts with the diagnosis.

I agree, and thats what my biggest push was for, the diagnosis, and now that I have it, I feel I am now more free to do more exploration, that nothing is off limits.

 I may not know what all I will eventually need or what my journey will look like but like I said nothing, not hormones, not even surgery is off limits (with obviously a tremendous time of reflection on more serious medical treatments such as hormones and or surgery) as I explore and discover my authentic self in my transitional journey.

Quote from: Robbyv213 on October 11, 2024, 06:41:20 PMMany things she was saying I could directly see how my gender dysphoria is affecting our relationship. When I try to lead into it and explain how gender dysphoria can cause or have a negative affect on relationships, once again shes not having it, thinking im turning it around and making it about myself when all I am.tryonf to do is tell her why the dysphoria is affecting our intimacy etc. eventually she starts to see what im trying to say. But after a conversation that needed to be had, we are still in the same place.

This sounds like a tough deal for you and your wife, for her mostly down to all the bad news and bereavements, while for you the timing couldn't possibly be worse.

It sounds as if you are saying she doesn't think your gender dysphoria is affecting your relationship? If I have that right, then she's sending a signal she's staying with you and it is worth picking up on it and saying thank you for her doing that.

Have you tried talking about all the places where you and she are aligned and can help each other? Giving a heads up you'll be supporting her through her family issues and will be there when you're needed will help with that. It might be worth getting a reset by taking the conversation off the track it is on, and running it along a different set of rails for a while before switching it back?

I've been through the same issues in my own relationship, but found it easier because my partner has always known I'll go through fire on her behalf if need be. If someone feels you being there is intrinsic to their well-being, then it's astonishing how much more accepting they will be.

Have you tried focussing the conversation on how you can help her through her family issues? That way you can build a track record of discussing emotions and it opens another door back into the convo you would like to have with her right now. Ultimately emotional intimacy is much more powerful at holding a relationship together than sex ever is.

I'm hoping to start first week of November. I've planted the seed in my wife's mind, and after having another "initial consultation"  I'll have prescriptions that she will now know about.

To catch up. I told her that the mental health specialist put in recommendations for Endo, laser hair removal, and voice therapy. And that Endo called me and wanted to schedule our first appointment. In which I told her I wasn't sure when I could get it scheduled, but wanted to try and get it done before Nov, and that it would be purely educational, a way for me to talk to an expert and ask all questions etc.

Which lead to a conversation that I know she struggles with. Which only confirms my suspicion that she's ok with anything as long as it doesn't involve actual change or transition.

I know she is torn, for a lot of reasons. I know she doesn't want me to transition for those same reasons. I know she loves me and wants me to be happy, and do what ever I feel I need to do for my health as well.  Starting hormones, even if it's a low dose trial run for 2-3 months before checking back in with Endo is the start of transition. Which it could very well be, but I don't know till I try It. For all I know I could get on HRT and feel even worse and decide it's not for me.  Who knows. I'm hoping things will be good on HRT. But I won't know until I try it.

And I'm trying to give her time to adjust, but if I don't move the ball forward it will never get moved forward. She would be fine ignoring the elephant in the room for as long a I allow it to be ignored. Which will only hurt our relationship just as bad as she thinks transition will or worse.

I am tired of living life to please everyone else, to live my life and be as everyone else expects me to do based on how I look. I want to take the mask off.

That being said I'm willing to move slowly and hopefully slow enough for my wife to adjust and cope. I hope with this she takes a more serious and active role in educating herself and not just go on what society and her up bringing has taught her about trans individuals.

We wish you all the best.

You are making progress, and as you stated, the ball is moving forward.

Quote from: Robbyv213 on October 16, 2024, 06:35:04 PMWhich lead to a conversation that I know she struggles with. Which only confirms my suspicion that she's ok with anything as long as it doesn't involve actual change or transition. I know she is torn, for a lot of reasons. I know she doesn't want me to transition for those same reasons. I know she loves me and wants me to be happy, and do what ever I feel I need to do for my health as well.

If your partner knows you're going ahead with hormones, laser and voice therapy and she's not putting up any barriers to those three, then it sounds like she is okay with some actual changes? In other words, she might be further along with consenting to this than you suspect.

Got a call from the VA scheduler asking if I want to continue and get laser hair removal and voice training, to which I said yes. She then proceeded to say ok someone else will contact you for each to set up an appointment... Lol. Way to many middlemen in the process.

Quote from: Robbyv213 on October 18, 2024, 11:39:55 AMGot a call from the VA scheduler asking if I want to continue and get laser hair removal and voice training, to which I said yes. She then proceeded to say ok someone else will contact you for each to set up an appointment... Lol. Way to many middlemen in the process.

The VA doesn't have anyone to do laser, so that will be through Care in the Community. The call will come from the provider that will do the procedure.

The Voice Training is done through a national program called GAPS (or something like that). Your provider could be anywhere in the US. Some of the gals here had their training through the VA in California. Mine was through the VA in Iowa City, IA. If you get her, she is very good. Maggie Deezuw is her name. I meet with her again next month. Those are through TeleHealth via secure video conference. I don't have a camera and microphone on my computer, so the VA sent me an iPad to use for those sessions (no charge).

Sounds like things are moving forward for you. Even slow progress is still progress!

Thanks @Lori Dee

Things seem to be moving along slowly. That's awesome you got a free o pad out of getting your voice therapy done. I figured they would be in person so they can hook me up to a sound machine to scale my voice and see where it's at (pitch, resonance etc) but im all fornas many virtual appointments they are willing to do. Lol.

This is where they're sending me out for Lazer/electrolysis

https://senzapelo.com/

Quote from: Robbyv213 on October 22, 2024, 01:56:27 PMThanks @Lori Dee

Things seem to be moving along slowly. That's awesome you got a free o pad out of getting your voice therapy done. I figured they would be in person so they can hook me up to a sound machine to scale my voice and see where it's at (pitch, resonance etc) but im all fornas many virtual appointments they are willing to do. Lol.

She has excellent hearing and listens to the way that you speak. She had me download an app to my phone called Voice Tools to do the measurements you refer to. She had me read a short paragraph and then read back the analysis numbers to see where I was. Then after several sessions, we did it again. It is a great tool to practice with.

Quote from: Robbyv213 on October 22, 2024, 01:58:31 PMThis is where they're sending me out for Lazer/electrolysis

https://senzapelo.com/

Let me know how it goes! I might start kicking over trash cans here to get them to fly me to Phoenix.