To start, I've been on hormones since May of last year; which consisted of Estrogen, Progestin and anti-androgens.

My original Endocrinologist started me on a really low dose, but by the end of the third month I was taking dosages typical of HRT regimens for pre-orchi (typical as exampled by Dr Anne Lawrence).

I was very happy with my treatment at the time and was really worried when my local Endo switched to a private practice which my insurance doesn't cover.  So I was all but forced to find a new Endo.  Which I did, and made a trip out to see the new Endocrinologist - who was recommended by a new therapist I've been seeing (who specializes in gender therapy).

Anyway, my new Endo took Progestin completely out of my regimen.  He asked "why are you taking this"?  To which I wasn't prepared for a researched medical response and just replied that my previous Endo had recommended it.

So out it went.  I was like, OK... so he must know what he's talking about and it can't be a bad thing for me if he's taking me off it.  He's the Doc.

But then he went on to state that he wanted to lower my anti-androgen as well as my estrogen dosages.  I was like...    Really?

He said that if I lower your doses but have you take them more frequently, you will still get near the same results but not have to take such high dosages.

I wish I would have confirmed the exact dosages before I left his office, because if I had I would have spoken up at the time most likely.  Now, 2 weeks later and second guessing my prescribed regimen - I know full well it is well below the average dosages prescribed.

I'm leery of self medication, especially myself.  I have refused to take meds all of life, even aspirins or anything, with only a handful of exceptions.  HRT kinda changed that - I had to open my mind up to benefits toward my body using advanced medicine and chemistry.

Right, so... if I wasn't moving to the West coast in 3 weeks, I'd be looking to self medicate because I know from the labs and evaluations that I have taken regularly that I am healthy as... a clam?  And fit and all that jazzy stuffs.

But since I AM moving, which is where I'm asking for any advice or response, is if my new Endo on the West coast wants to start me off by continuing this 'low' dose newly prescribed for me; how should I go about persuading them that I feel it is in my best interest and benefit to take the higher dosages which were originally prescribed by the first Endo I had seen - which I had been on for 6 months and had no reason to change other than because of the opinion of my most recent Endo?  If that makes sense.

I've been researching HRT a bit more so I can actually speak and understand the lingo when I go see my new endocrinologist - I just don't want to seem like a demanding b*tch if I stand firmly by my opinions concerning my doses... but I don't want to just bend over and take the new prescriptions if I am once again not happy with the doses.

And seeking out new Endocrinologists until I find one that will prescribe the doses that I want, does not seem like a logical approach to me.

So... to end my babbling - I guess I'm asking how I should (and perhaps how I should not?) communicate this to my new Endo (which will be my 3rd one) once I move?

I know what you mean, I had a *lot* of trouble being comfortable enough to say anything to doctors that might even hint at suggesting an idea other than what they initially suggest.

What I do and did was I went through a lot of doctors before finding one's that I liked enough to stick with, and felt comfortable speaking openly with. And before that I tried to suggest things as unconfrontationally as possible to see how they react. You just need to get a sense for if they're the kind of person who will go crazy at any hint of disobedience or if they're the kind of person who's perfectly willing to at least consider your opinions and why you have them.

It took me about half a year but eventually I found doctors I could talk too. My advice would be to be persistent, know what you want, be educated. You could also be sexist like me and only choose female doctors if you're like me and think you'd be more comfortable with that. 

Really though, all you can do is use your instincts to gauge if a doctor seems open to persuasion or not. If they're not, find a different one.

I would try something like: the high (er) dosages are to both provide for foundation for secondary characteristic development (read: breasts) as well as reduce symptoms of gender incongruence. (my new pet phrase for "GID") while too high estrogen blood levels are a waste of meds and increased side effect risk, sub 10 total testosterone isn't a bad thing by any means. 

and as Ashley said, you have to be comfy with them, if their first contact is "you're being bad!, I'm taking away ur meds" it might be better to talk with your feet. (find another provider, maybe an OB/GYN?)

Was your endo sending you for blood tests? If your levels are where they should be and they should be after six months then the lower dose could be an acceptable option, but only if they are enough to keep your levels where they should be.
I half agree with taking out the progestin as that stuff is evil but he should of replaced it with Prometrium. When on a progesterone you don't need as much estrogen, so just adding a progesterone to what you are on now could make you feel more at ease and improve your overall mood if it is in question.
But blood tests are a must, especially when you're going through a patch of dose changing. I'm sure you have a general idea of what is best for you after researching and if any GP/endo goes against your instinctual gut feeling then change. IMO. It's where I'm currently at. ^_^

Thanks for the insight!

Yes, for some reason I am a little squeamish to see male doctors, always have been.  Never have insisted on a female Doc, but I probably will when I move.  I'm going to end up with my new Doc for quite a while I'm guessing.

I forgot to mention in my original post that my estrogen/testosterone count is at the desired levels, or at least was up until my new prescriptions... but the 2nd Endo made the changes to my dosages before I even had my lab - so he wasn't going off of any changes to my counts or anything.  And of course I realize that could make a difference in his recommending doses.

I'm just so extremely happy to be moving, to a bigger/better city, and to have access to so much more than I do.

If anyone else has additional advice or cautions, they are certainly welcome.

I intentionally avoided the bit about progesterone because it's mostly for (breast) ductal formation and maintenance of pregnancy. While it has it's uses, in transition, it's really low priority and should, in my not licensed to practice medicine opinion, be administered at low doses, with no regard to if it's a bioidentical, or a progestin.

Quote from: Muffin on February 17, 2010, 05:59:44 PM
Was your endo sending you for blood tests? If your levels are where they should be and they should be after six months then the lower dose could be an acceptable option, but only if they are enough to keep your levels where they should be.
I half agree with taking out the progestin as that stuff is evil but he should of replaced it with Prometrium. When on a progesterone you don't need as much estrogen, so just adding a progesterone to what you are on now could make you feel more at ease and improve your overall mood if it is in question.
But blood tests are a must, especially when you're going through a patch of dose changing. I'm sure you have a general idea of what is best for you after researching and if any GP/endo goes against your instinctual gut feeling then change. IMO. It's where I'm currently at. ^_^

Sorry I didn't include that in my original post (blood test/counts), I did respond to that topic though.   

And my mood is fine thus far, just starting the new doses this week so we'll see how things go.  I'll read up on Prometrium, haven't got that far yet.  Just being on anti-androgen and estrogen now, considering the lower doses, makes me feel like I'm not on the most optimal HRT regimen for myself.

It seems to me that prescribed HRT regimens are arbitrary.
I don't think that there are any established goals for hormone blood levels used by endos.
Then there is the whole progestin controversy.

Since there is no scientific basis for dosage it boils down to subjective effect.
That means that you take what your endo gives you.
If you don't find it fits your needs, you complain for them to lower or raise the dosage.
If they won't do it, you find another endo.