Tomorrow I'm seeing my primary care physician. He used to be my doctor way back before I went to grad school, but I haven't seen him in ten years. Back then, he didn't know that I was trans. So tomorrow I guess I'll tell him that I'm trans and that I'll be starting my transition very soon.

I'm nervous. I really don't want to come out to him yet. But I guess if he's going to be my doc again, I will have to tell him at some point. But I don't know whether I should tell him now or later.

Here's the thing. I'm going to him for a pre-T blood panel. My endo apparently doesn't require bloodwork before T, so this is all my idea. But a couple of months ago at a support group, I heard one of the guys talking about getting a testosterone level test BEFORE going on T, and I don't know if I should ask for one. I mean, I sure can't have much T in my system now, right? And I'll have my levels checked in a few months anyway.

If I ask for a blood panel only, then I don't have to come out to my GP yet. I have a lot of stress in my life right now, and I might want to come out later, when things have calmed down a little. But if I also ask to have my T level checked, then I really have no choice but to come out to him.

I did a little poking around on the Internet and mostly found advice about checking T levels after T, not before. So I'm not sure how important this test is at this time.

Or maybe I should just come out tomorrow no matter what.

Sigh. Any advice?

i don't think having your T level checked will signal anything or force you to come out to him. they checked my levels repeatedly when trying to find out what was wrong with me (what illness).
all you would have to say is that you're concerned about your hormone levels for {fill-in-the-blank} female reason.

Baseline labs are important.  Not necessarily for T level, but to monitor your cholesterol, liver function, etc.   A general list of pre-T labs are as follows;

Lipid profile - cholesterol and triglyceride
CBC
Testosterone level (preferably trough, once you're on T)
Liver Function (ALT, AST, ALP, GGT, albumin, bilirubin, PT)
Clotting factors

Mister is right. The baseline test is a docs way of deciding how much T you should get and still maintain a normal, healthy body. Testosterone can make your cholesterol and tryglicorides shoot through the roof, which isn't good. It can also cause some problems with your liver, so the baseline test is very important in knowing how the T affects your insides. Right now my doc won't up my levels because I have high cholesterol, tryglicorides and a high red blood cell count.

Docs tend to check your T levels prior to initial T prescription just in case they're higher or lower than usual... if so, then they will modify the dosage so you're getting into the right level range. The other tests are incredibly important, though, because things like lipid levels, cholesterol, etc might need to be modified before you can safely start testosterone. You have to make sure you're healthy... don't want to start T and then have to stop because it's compromising your health.

SD

its important to get a baseline, but you don't have to "come out" to do so.

for example, my bilirubin has been elevated since i started T.  There was no way to know that without the baseline.  sucks though 'cause i'm on a pretty low dosage still but i'd rather be alive now that i enjoy living.

about four/five years ago i was able to get my T level tested by simply asking for it.  "Hey i think my T level is pretty high or something, can we check?"  Sadly it was within normal female range to my disappointment.

One of the friends I have come out to is a nurse. She was a nurse at the one DR. who did FTM care in the small town I moved from. Two things she told me to make sure I do are 1) get your baseline levels 2) make sure I take something for Osteoporoisis (because of my age). She said a bone densisty test would be great if I could afford it or bone scan or whatever she called it. Sort of like having my own nurse.
Myles

Thanks for the feedback, guys. I wound up coming out anyway...it wasn't a perfectly comfortable situation. He kept asking me why I wanted labs and particularly why I wanted a testosterone test, and he saw that I was being evasive. I'm not very good at that when it really counts--only when it doesn't! So I finally told him. I'm not sure whether it was the right thing to do, but he did tell me that he doesn't judge people's decisions and lifestyles and the like. That response is not ideal, and he could have been a bit warmer; but it could have been worse. And, of course, I was nervous and probably read more ambivalence into it than was really there.

After I told him, he remained professional and talked to me about my general health. He promised to have the labs back in the next day or so for me to pick up (what a relief--I had such a hard time scheduling an appointment that I was afraid I wouldn't get them in time). And he recommended that I take some calcium supplements for my bones but noted that testosterone should help. He seemed genuinely concerned about me, so that's good. So I'll keep seeing him, at least for now.

Here's a funny. Since I had seen him before many years ago, they had scrounged up my old records. I was in the waiting room filling out forms when they called a strange name--the name of a famous movie actress of yesteryear who has the same last name as mine. So I'm sitting there, thinking, "Imagine growing up with THAT name!" And then they called my name. When I went up, the nurse asked me which one I prefer. I blanked out and said most articulately, "Huh?" She flashed me the folder, which had two names on it--the actress name and my name. I stared at them stupidly for a moment or two before I got it. (Hey, I'm running waaay short of sleep this week.)

Apparently, I started seeing this doctor right before I changed my name many years ago. On the chart, though, they didn't just write down my original birth name and my current legal name. Someone had written an incorrect perversion of my given birth name and combined it with my current last name. I'm not sure how they arrived at that particular combination or how they managed to so badly torture my original given name, but there it is. I suppose they simply mistook the given name and then assumed that I had gotten married or something. Weird.

So I'm out to my GP now, whether I like it or not. I just hope the insurance still covers the visit and the labs. He said it would, but I'm skeptical because he noted in the paperwork that I was thinking about seeing an endo for HRT for my trans situation. We'll see what happens.

At least I got through it, huh? I was pretty nervous. I always blow these things out of proportion. That's me, Arch the drama queen.

->-bleeped-<-, insurance probably won't cover it.  most don't.  to get around that i asked my doc to not indicate anything related to gender identity disorder in his coding.  he told me he puts down "endocrine disorder" or something like that.

tell your doc that insurance won't cover and you need him to be creative with the coding.

Quote from: J.T. on February 06, 2009, 04:42:59 PM
tell your doc that insurance won't cover and you need him to be creative with the coding.

He said that he was going to order the labs because of "fatigue" (which is perfectly true, I am tired and strung out), but he still insisted on making some kind of trans note in my file. I told him I wasn't comfortable with that, and we went round in circles for a couple of minutes on it. There was no way I could stop him. But I don't know what the HMO will see and what they won't. I could still be all right.

I expect that it will probably be a couple of months before I know whether the visit was covered. That's how long it took for my partner to find out that treatment he had wasn't covered. We thought it was, and then months later we received a bill. The wheels of the HMO grind slowly.

Apparently, my testosterone level is quite low. It won't be for long...

259.8 is the magic ICD9 code-  'other unspecified endocrine disorder.'