After reading the rules about HRT posts i find i cant ask the questions i spent this morning carefully constructing so ill post the little bit i can.
I fully understand the issues of liability regarding such things. Oh well..

snipsnipsnipsnipsnip.....


Ok...I know... I should get the endo/ blood work/ TG therapist ect before I make such a life changing decision but, because I'm on SSDI, No extra money, no extra insurance and the nearest LGBT endo is a 300 mile round trip.

I do this with careful consideration. I do have some medical knowledge.
Blood clotting should not be a issue as I take Crestor and low does aspirin.
I will be observant for breast cancer (I can get that checked with normal screenings as well as check myself)
High BP is being monitored and treated successfully.
Weight is coming down (have 25lbs to go) Lowing fat, sugar, carbs. Increasing protein, fiber, Soy, multi vitamins.
I don't smoke or use nicotine but, is it smoking or the nicotine that's the problem with HRT?
Coffee, that's going to be tough, but again is it really that big of a deal?
Alcohol cut from 7 to 3/day.
I do yoga, thi chi, resistance training and as much cardio as my MS will allow.
I will have my T and E levels tested every 6 mo's (can fudge it in with other blood work).
I am seeing a therapist and we are addressing TG issues but she is not a TG specialist. ( but its free of charge).
What am I missing other than $1400 out of my pocket for the best health care in the world?

Any competent MD can prescribe medications, order tests, interpret results, etc.  Some trans-friendly GPs might be more versed in transition issues than inexperienced endocrinologists.

The value of a endo is particularly important, though, when you have multiple health issues going on at the same time.

BTW - Crestor is a powerful statin (anti-cholesterol medication) that has known effects on the liver.

Look at this recent topic:
https://www.susans.org/forums/index.php/topic,102303.0.html

It is understood that some people have limited access to proper transition healthcare, due to geographic, financial, and other causes.  There are non-medical methods of transition, like those transgendered people used 80 or more years ago, before the advent of hormone therapies.

SSDI if you've been on it for two years offers Medicare so you have a PCP.  As others said any MD can do your endo work.  Mine did it for quite a while and even when we found an endo she said she didn't mind to continue if he wasn't a good fit for me.

I'm new here & to HRT. But I know from my 13 months on HRT that there are many body functions that can be disrupted by the drugs used in HRT. For example, after my first blood work was done, they found my potassium levels were too high(Slightly over the HIGH end of normal). This was apperentally caused by a drug interaction(Sprio & an Anti depressant). This caused my doctors to not increase my Spiro dose due to making my potassium levels higher. After switching antidepressants, My potassium went down to normal and I was able to up my Sprio dose.

Bottom line is that our bodies, down to the individual "workings" of cells(electro-chemical balance), are dependent on a rather "fine" line! Mess with that line and bad things will happen. Think of it like this In a GREATER sense: BLOOD goes round & round. AIR goes in and out. Any deviation from that and you are in trouble! OK, That sounds reasonable. Think of the micro workings of you body just as important in the long run!

To be honest, I'm not sure if the medical "powers to be" really know all the effects of this treatment. To us its like: HIT ME with the anti-boy drugs and Estrogen! But in reality, there are fine lines that bust be observed or you will have serous problems on the scale of: .... Blood goes round and round, and Air goes in and out!

I in no way intended to be "mean" w/that..... Just letting you know what I've learned thus far.

Best...

Dani

Since each body's so different, even gender expert doctors have to experiment to find the hormone balance that works for each of us. There's no magic formula. So many things are affected.

For the first two years of my transition my GP handled my HRT needs. It wasn't until I had an orchiectomy that I was refered to an endo to handle it.

Any MD can prescribe your HRT. Monitoring for the various issues that can arise from HRT use is not rocket science. By the time you are a couple years into transition chances are you will be able to look at the blood panels and understand them yourself.

Get a baseline before you do anything.

(I am on SSDI and my blood work is paid for by insurance. Same for the HRT. It is all in how the doctors code things as to wheather you or the insurance pays for this stuff.)

Don't self med, you need to be monitored.

I'm on a low dose of Spiro, but my endo mentioned to me last time that I was borderline HYPOTENSIVE.  (Blood pressure too low).
I've had to keep a close eye on myself to watch out for fainting fits or feeling lightheaded.  If it gets too low, I'll have to go off the spiro.

Life is full of risks.  If you sent everybody to an Endo, everybody would be on some drug to fix some problem that isn't really a problem.  Letting the medics control your life is a safe way to go.

But there are many studies that show that feeling in control of one's own care is the number one factor that correlates with healthy outcomes, across all conditions and factors.

At the very least, even those who are under medical care need to be able to negotiate medicines and dosages with their doctor, and more information and more knowledge is more empowering than less knowledge.  Thus, I strongly disagree with the censorship of such information; and I encourage everyone to become as educated, as involved, and as in control of their situation as possible.  In my case, that translates to my abject refusal to pay medical bills for the privilege of educating doctors about science, medicine and ->-bleeped-<-.

On a specific note, there are two studies that show no significant difference between smokers and non-smokers on HRT with regards to blot-clotting, amongst transwomen.

Quote from: GinaDouglas on August 23, 2012, 04:52:44 PM

But there are many studies that show that feeling in control of one's own care is the number one factor that correlates with healthy outcomes, across all conditions and factors.

At the very least, even those who are under medical care need to be able to negotiate medicines and dosages with their doctor, and more information and more knowledge is more empowering than less knowledge.  Thus, I strongly disagree with the censorship of such information; and I encourage everyone to become as educated, as involved, and as in control of their situation as possible.  In my case, that translates to my abject refusal to pay medical bills for the privilege of educating doctors about science, medicine and ->-bleeped-<-.

On a specific note, there are two studies that show no significant difference between smokers and non-smokers on HRT with regards to blot-clotting, amongst transwomen.

Quite often i tell the docs what i need and they usually say "sure" But the office staff's around here are numbskulls. I asked  for the results of my T test and they said "It's normal".
When i asked for the numbers they said they would have to look it up call back tomorrow. Another office "lost" my T and turns out somebody stole  two boxes and they still  haven't fixed it.
Yes indeed, you have to be proactive with health  care   these days
                                                           
It's easier to change your sex and gender in Iran, than it is in the United States.  Way easier.

I remember Ahmadinejad addressing the UN and said
"We do not have homosexuals in our country. We just don't have this probolema..." The audience laughed.