I posted this on another forum that I frequent but thought that I would share my situation with this group as well.

I've been living as female full time since the start of this year.  So far things have been going really well for me, and I've just been waiting for the next stage of my transition to begin, which is HRT. I had made an appointment to see an endocrinologist many, many months ago, and finally the appointment date arrived last week.

Now I like to think that I'm fairly intelligent and have good common sense, so I prepared myself as best I could before going to see the endo. I had a pretty firm grasp on the possible results to expect as well as what the health risks and side effects of HRT would possibly be. While I hadn't memorized every single brand of hormone out there, I was familiar with the popular ones.  So, with a letter of recommendation for HRT from my therapist in hand, I arrived at my endo's office in good spirits.

To summarize the appointment, he explained that he had treated many trans patients and was one of the few doctors in the whole province who did prescribe HRT for trans women. He was pleased with how successful my transition has been to date and felt that I was ready to begin hormones.
Now the first thing that struck me as odd, was that he was comfortable with prescribing drugs to me without doing any kind of physical exam or seeing any blood test results. He assured me that I seemed perfectly healthy and that as long as I got blood work done soon, he would take a look to make sure everything was ok for me to continue taking my prescription.
The second thing that made me scratch my head, was that he prescribed an acne medication/birth control pill that I was not very familiar with as my HRT.  He said that it had a little ethinyl estradiol and a little cyproterone acetate, so it was a good place to start. He gave me a 6 month script and said I should come back in 5 months for a follow up.

So when I left the office I had mixed feelings. I was thrilled to finally have reached the point of having an actual prescription in my hand for HRT medication. But I was also concerned that I had never really heard of this "Diane-35" medication. My concern turned into major disappointment when I began researching the drug online and found that most trans websites that had information on it consider it ineffective at best and at worse an unnecessarily dangerous regimen.

So after less than a week of taking these pills, I have stopped and will try to schedule an appointment to see another endo. Since there is such a long wait time to get in to see these docs, I might also try to get back to the original doc and see if there is another regimen that might be better, but I'm very wary of his opinion at this point.

In any case, HRT is once again on hold. Disappointing, but for health reasons I think its best to get a second opinion.

Hello.

So, I am a med student.. my words don't have the same weight of a graduate doctor, but I have read a few things about health.

I can't flat out say what he did was wrong, because there COULD have been reasons I don't know about. But basically as far as I know,  before you pescribe drugs such as hormones, you should investigate for any endocrine diseases, ask a hemogram, ask for liver function tests (TGO, TGP), kidney function (creatinine) and various exams regarding your respiratory and circulatory system.

As far as I know, that drug he gave you ins't really good for HRT. Its possible he plans on changing in the future, I don't know. Of course, it's agains't forum policy to discuss that, and since I am new here I am unsure of where the line is draw.. but I think it's important to tell you that to my knowledge, the knowledge of someone who is still undergraduate at med school, it's not a good medication.

Anyway, I think there is something fishy.

That doctor....ugh...I almost started cussing. Please find another doctor and if they prescribe you hormones without blood work then find yet another doctor. And that other drug...my head is spinning that a reputable doctor could prescribe that.

Whenever you start a new drug regiment a blood test needs to be done as a baseline.  That way you can be monitored for changes.

Diane-35 is a weak, at best, drug.  At the worst it is a dangerous drug for Transwomen.  Get a second opinion.  He sounds like he is not really the best choice for you, or anyone.

I noticed you mentioned that he was one of the few endo's in your province, and I was wondering what province you were in. I am in Ontario, and I have just been referred to an Endo by my GP. In preparation I came across a list of bunches of LGBT friendly endo's, and could easily send it to you.

-G

Quote from: Laura91 on October 04, 2010, 09:32:43 AM
From everything I have read Diane-35 is an ineffective and dangerous drug so why they prescribed that to you is beyond me.

That's what I've heard as well.

Time to find a new doctor. You are worth quality health-care.

Thank you all for your comments and words of warning. I am scheduled to see my GP in November (he is on vacation) and will ask for a referral to another endo at that time.

Gwenhyvar - I am in New Brunswick and I so far have only found two endo's who will treat trans patients for HRT. The first one I went to does the "majority" of HRT cases but doesn't appear to be the right doc for me at this point. However there is a new doc who just finished his internship in a different province and just started up a practice here in NB. That's the guy I'm going to try and get an appointment with, as he might have more up-to-date training with HRT for transwomen.

thanks again ladies. I'm glad to know that someone has my back. 

Interesting... technically diane discussion in susans.org is prohibited, I know because when I politely objected to the rule because my doctor was prescribing it and thus it seems like a good idea to let people mention it, I was outright ignored and my only indication that I was not to bring up that unfortunate fact of reality was that my post in the thread simply 'disappeared'. Alas, susans.org is of the abstinence only model, believing denial of access to information and secrecy are more effective than harm reduction by open access to information.

Excuse my bitter and sarcastic minirant, I plan to make up for it with somewhat useful opinion now. 


I'm going to break with the crowd here and repeat some of my own doctors information and what I have gathered. (and I assure you that despite susans assertions, she most certainly is sane and competent).

On the subject of you not getting any initial blood work, yes that's perhaps ill advised. If only because it would provide a base line of your hormone levels.

But, keep in mind, doctors don't go to the length of testing your liver function before they prescribe MOST drugs. And for all we worry about it, none of the HRT drugs (except perhaps cyprotone, which is present albeit in extremely low amounts in most birth control pills) are unusually liver toxic.

Apart from that, all they can test for is full blood counts and other measurements of very general health that again, they wouldn't worry about with most any other drugs apart from ones specifically indicated for it.

As for being prescribed the birth control pill. It is not in and of itself the worst decision made by medicine since the ECT. It most certainly does have effective feminisation, however it needs to be combined with an antiandrogen, the tiny amount of cyprotone in it isn't enough by itself. But with a correct dosage of antiandrogen, here's the only reasons you shouldn't take the birth control pill.

1. It can have more noticeable side effects like headaches, mood swings, etc. But the same is true of anybody taking birth control.
2. It is 'more' liver toxic than bioidentical HRT, and if you are over about 40, a serious smoker, then yes you really should avoid it. However if you are young and healthy, there's no more danger in taking it than any other female on birth control.
3. I'm not sure if ethylestradiol shows up on an estradiol blood test, I'm fairly sure it doesn't. But that's not a serious problem because it the estradiol levels, after a certain point, don't make a tremendous amount of difference to your results apart from speed of the results, PROVIDED you are on an effective antiandrogen like spironolactone.

My doctor offers the pill to any younger patient because in her opinion, and my observation, far from being ineffective, ethylestradiol has faster acting feminisation effects.

So yeah, in conclusion, I don't think there's a huge problem with using birth control pill in HRT, provided it's combined with an effective antiandrogen. Provided there's no reason to be concerned for your liver health.

I do think there's a problem with you being told to take ONLY the birth control pill and come back in 6 months, don't mistake anything in my post to be supporting that. You're right to look elsewhere.

Drop that endo like a hot potato... Find a real endo and get the real stuff... Just my opinion

{{{HUGS}}}

Just to echo what others have said, run, don't walk away from that "doc". Don't even go back.

  I am sooo sorry that you have had a bad experience. But you ARE doing the right thing by going to a dr. I would not go back to that dr. Find another one, and find a transwoman currently on HRT to refer you. And please, whatever you do please do NOT try to self medicate. IF it is results you desire, a Dr is the ONLY way to go. I am now just beginning my 10th month....keep your head up, you WILL get there

Huggs
Nicole

Quote from: superkitty036 on October 05, 2010, 12:02:56 AM
I am sooo sorry that you have had a bad experience. But you ARE doing the right thing by going to a dr. I would not go back to that dr. Find another one, and find a transwoman currently on HRT to refer you. And please, whatever you do please do NOT try to self medicate. IF it is results you desire, a Dr is the ONLY way to go. I am now just beginning my 10th month....keep your head up, you WILL get there

Huggs
Nicole

There are GOOD reasons not to self medicate, pretending that it's impossible to accomplish without a potentially incompetent doctors supervision, isn't one of them.

I'm sorry, I just really dislike this pretense that self medication is almost akin to shooting heroin into your carotid artery. It is dangerous, it is *usually* unwise. But pretending that it's not an option doesn't change the fact that it IS an option. 

Being on birth control without blood tests or an antiandrogen... IS an inferior option to being on birth control/HRT without blood tests and with an antiandrogen. In terms of accomplishing results.

I keep noticing more and more just how MUCH this selfmedication phobia here is similar to "the only safe sex is abstinence" in mentality, and just like that mentality, it's unrealistic and ultimately unhelpful.

Quote from: Ashley4214 on October 05, 2010, 04:32:37 AM
I keep noticing more and more just how MUCH this selfmedication phobia here is similar to "the only safe sex is abstinence" in mentality, and just like that mentality, it's unrealistic and ultimately unhelpful.

Look let's cut to the nub here. The reason for the rule is quite simple, and not difficult to understand.

The website operates from webservers based in the USA and is therefore subject to American law, one of the most litigious societies in the world. If people stumble on your lawn and break their toenail in America they can and sometimes do sue for damages, and websites are NOT immune from such attempts.

Now imagine what happens if someone gets information from here on dosages and where to get HRT for self med... then some time later they decide that transition isn't for them. I would not put it past someone to try and sue the forum for having "encouraged" them to do something which caused them social embarrassment and/or medical harm. Even the doctor who back in the mid 80's saved my life by arranging my SRS had an ex patient who had regrets and then tried to sue him in the UK.

Most such frivolous attempts at damages do fail, but the cost of defending them can be huge, and meanwhile potentially the site could cease to function.

So the rule is there to protect Susan and her staff from any possible legal comeback... and yes we know that people do it! Heck I've even admitted to having done it myself, but we just can't take the risk of allowing a free for all on this subject.

So please lets try and understand that sometimes it is better to live with a few restrictions than allow the whole forum to be threatened by someone who is looking for people to blame for their own actions.

In an ideal world such restrictions would not be needed. Sadly in this one they are because there are always people looking for an excuse to make trouble.

Quote from: rejennyrated on October 05, 2010, 05:25:31 AM
Look let's cut to the nub here. The reason for the rule is quite simple, and not difficult to understand.

The website operates from webservers based in the USA and is therefore subject to American law, one of the most litigious societies in the world. If people stumble on your lawn and break their toenail in America they can and sometimes do sue for damages, and websites are NOT immune from such attempts.

Now imagine what happens if someone gets information from here on dosages and where to get HRT for self med... then some time later they decide that transition isn't for them. I would not put it past someone to try and sue the forum for having "encouraged" them to do something which caused them social embarrassment and/or medical harm. Even the doctor who back in the mid 80's saved my life by arranging my SRS had an ex patient who had regrets and then tried to sue him in the UK.

Most such frivolous attempts at damages do fail, but the cost of defending them can be huge, and meanwhile potentially the site could cease to function.

So the rule is there to protect Susan and her staff from any possible legal comeback... and yes we know that people do it! Heck I've even admitted to having done it myself, but we just can't take the risk of allowing a free for all on this subject.

So please lets try and understand that sometimes it is better to live with a few restrictions than allow the whole forum to be threatened by someone who is looking for people to blame for their own actions.

In an ideal world such restrictions would not be needed. Sadly in this one they are because there are always people looking for an excuse to make trouble.

Except that they would have no case. I could sue susans.org for disallowing conversation that could have prevented me doing something stupid by being informed. I would most definitely loose, but I could still do it, and likewise I would loose if I attempted to do it on the grounds that it provided access to that information.

Allowing discussions for the purposes of harm reduction would not put susans.org at an increased legal liability. I don't see how anyone can argue that it would. Such websites already exist for other topics like drugs, without complications.

I have yet to see any example of a civil suit against a website hosted in the united states for providing information that was later involved in a harmful manner, certainly not for one susans size and that got anywhere past initial hearing. And as I said, you can sue anyone for any reason anyway.

There's millions of websites hosted in the US that allow significantly more dangerous information to be shared, wikipedia for one.

I think this whole lawsuit phobia is in everyone's heads. I don't think it's a real problem.

But, lets say for arguments sake it was. That's not the reason susans.org is giving, the reason susans.org is giving is that they are protecting people from themselves, not protecting themselves from other people. If the real reason is a fear of lawsuits, then they should just say, it's a fear of lawsuits.

But saying it's for everyones own good, is nothing more than an example of an abstinence only mindset applied to HRT. And if it's not even believed by the people espousing it, then it's simply self serving cowardice.

Sorry to the original poster, rejennyrated i don't want to derail this topic anymore than I already have done, if you wanna talk about this in PM you're welcome to do so, but despite my frustration at this, I honestly don't wanna mess up a thread. I'm just really frustrated about this, in large part because of the utter and complete disrespect I was met with when I tried to discuss it civilly in an appropriate place (I was ignored, given no reply apart from the deletion of my posts.)

Well the ONLY correct way to do HRT is to bring testosterone level down to that of a GG a d to raise estrogen lervel to GG level, and since there is NO way for someone to know what those levels are without getting bloodwork done. there are other levels to be watched as well, prolactin being one of them. And beieve me I practice what I preach..... This is my opinion. That is all im going to say

Quote from: superkitty036 on October 05, 2010, 12:06:56 PM
Well the ONLY correct way to do HRT is to bring testosterone level down to that of a GG a d to raise estrogen lervel to GG level, and since there is NO way for someone to know what those levels are without getting bloodwork done. there are other levels to be watched as well, prolactin being one of them. And beieve me I practice what I preach..... This is my opinion. That is all im going to say

I agree, however it would seem that the doctor in this case isn't doing those tests anyway.

Quote from: Ashley4214 on October 05, 2010, 05:40:15 PM
I agree, however it would seem that the doctor in this case isn't doing those tests anyway.

I also totally agree with you there Ashley. Care of a competent dr!! 

Wow, I certainly didn't mean to spark such a lively debate. I do appreciate everyone's opinion though.  All I can say is that for my own comfort level and also for the comfort level of my wife, I just feel that I should get a second opinion regarding HRT.  I know everyone's process is a little different, but I'm settled on seeing an experienced endo, who is more likely to prescribe a more sensible regimen.

Thanks again to everyone for their comments.