What to expect from an informed consent appointment?

[katiebee]

I've finally decided to take the leap, start hormones, see how I feel for a month or two, and go from there. I worked up the courage and emailed a doctor who was flagged as doing both informed consent and telehealth in my state on a resource I found online. But that was last night, on the start of a long weekend, and my head is racing and heart is pounding about this. What questions can I expect to get in an informed consent telehealth appointment? What's the flow of that conversation? Am I going to have to give my life story and "prove" I need HRT, or is it more like those telehealth appointments for hair growth or weight loss drugs where they ask if I'm allergic to anything before sending me on my way?

Also, how does picking up a prescription work if one wants to minimize the awkwardness of picking up estradiol and spiro/bica? Every time I get so much as antibiotics, I feel uncomfortable with how...invasive, I suppose, the interaction feels. I get that at some point if I start HRT and never stop, I'll just have to get over it at a certain point. But I'm not there yet. From the outside, I am profoundly male and the idea of showing up, beard and all as they take 10 minutes talking about my HRT prescription touches on the same nerves that you'd get before having to hop on stage in front of hundreds of people. Might just be part of it, but figured I'd ask.

Not to play 20 questions but I have two more.

First, if I get injections, which from my research seems to be the ideal route, do they provide needles with the prescription or do I get that separately (and if separate, where do I go for that? Never seen needles in the store before)?

And lastly, while I know this is not sustainable or healthy, I will be starting this in secret. I said it at the start but I'm hoping to see how I feel after a month or two and make a final decision based on how my body/mind reacts. I know it's kind of cowardly in a way to half-commit, but I just really have to be absolutely sure this is right for me and what my body and mind needs to finally feel "at home," or if I'm barking up the wrong tree after all these years. Has anyone else here done this (or heard from people who did) and have any advice? I know the ideal would be to come out and be open from day 1, but I just can't do that in my situation unless I know for absolute certain that I NEED this. I think I do, but I don't think I'll know until I finally take the leap and try it.

[Lori Dee ✅]

First of all, CONGRATULATIONS!

The first step is always the biggest and the hardest.

I didn't go the Informed Consent route, so I can't advise you there. But an educated guess tells me that you don't have to prove anything. You say that you want to start hormone therapy, and that is your consent. The informed part is where they will warn you about the side effects, warning signs that your body is not handling it well, and what to do about it. Pay attention to that part closely. Once they are certain that you understand the risks, they will accept your consent.

All of my prescriptions, including supplies (alcohol swabs, syringes, and needles), come to me from the VA Mail Order Pharmacy. Perhaps having your meds and supplies delivered by mail or from the local pharmacy is an option.

Providers prefer to start slow, so they might not want to jump right to injectables right away, especially if you are just starting and seeing how your body will react. Pills are normal starting doses, as are patches if you can't take pills.

Don't be afraid to start slow. Taking too much too soon can have the opposite result of what you want. They will want to check your hormone levels usually at 30 days after starting, then may jump to 90 days, the six months to a year. These tests are important to make sure you are getting the right dose. As your lab results come in, they will adjust your dose up or down as needed.

Good luck! I am so happy for you.

[Rochelle]

Amazon Pharmacy, very fast and aggressive for refills.  They reach out about 3-4 weeks prior and are ready to send the refills.  They do accept most insurances also.

I get refills for other things through my primary care and it's on me to remember and get the refills.

I went private pay as my insurance touches care I get through my military retirement and due to the current political environment, I prefer to keep them separate for now.

Cost through Amazon is pretty cheap as well.  I had my first telehealth visit on a Tuesday morning and had the meds Wednesday afternoon.

My provider said we will do labs every 4 months for a year and if it looks good, change to every 6 months.  The labs are in person at a clinic and they know what labs they are drawing.  They are medical personnel and not there to judge you.

[NancyDrew1930]

Ontario has informed consent, so when I went through it 4 years ago, at first I had to get some blood work done and then the first appointment was a more "get to know" you" appointment where the doctor basically asks your health history so that, before they put you on hormones they get an idea of you have any heart issues or prostate or other issues that being on hormones could cause to get worse.  Then they also just went through all the usual stuff to explain what happens with hormones like the possibility of losing the ability to have biological children, and if you want to bank any sperm for the future.  As I recall the doctor also talked a little bit about future options like SRS and breast augmentation surgery and to just remind me that I'm not going to become Barbie because of hormones and there may be things that estrogen can not change because of my age.  Then they gave me another bloodwork requisition, because with the two requisitions they were establishing a pre-hormone baseline.  Them at the end of the first appointment they gave me an appointment for a few weeks later and it was that appointment where I actually got my first dose of estrogen and Cyproterone.  Then at that appointment they scheduled me for an appointment 3 months later, and throughout my first year I was getting blood done every three months and seeing the doctor to ensure that my body was ok with the hormone changes, and upping my prescription (I was started on the pills at their lowest dose and over the first year I was able to increase my estrogen.)

[NancyDrew1930]

@katiebee This is the clinic that I go to for my informed consent.  I'm just going to link to them because they do answer on their website some questions regarding that first appointment of what they cover for transpeople in Ontario and Alberta, which might be different from other provinces and states/countries and specific doctors.  (Apparently in Alberta, they need you to get blood pressure done before they put you on hormones, whereas they don't require that in Ontario.)

https://www.foriaclinic.com/ontario/services-hormones/ 🔗

[katiebee]

First of all, CONGRATULATIONS!

The first step is always the biggest and the hardest.

You aren't kidding...it's bizarre. For as long as my memory goes back, I wanted to be a girl. I'd fall asleep praying every night that I'd wake up a girl. I've spent over a decade of lurking on forums, seeing people's timelines, reading about clothes for inverted triangle body shapes, voice training, spent hours pouring over HRT dosing (including some DIY guides that are VERY different from the DIY guides most men read), read all about FFS, SRS, VFS...but still, even after sending an email to an actual doctor, after two decades of pining and wishing and praying, I'm still feeling like I'm at that bit at a top of a rollercoaster, wondering if getting on the ride was really a good idea.

I highly doubt this is a unique experience but it's still terrifying. In a weird way, part of me hopes I try it and it just makes me feel terrible, letting me finally close the book on it all with the knowledge that my issue isn't biological/hormonal in nature. Just some kind of "yep, you can go back to being 'normal' and figure out what the actual problem is." But obviously, a part of me is nervously hopeful that two months in, I look back and realize I feel incredible and that my brain really was wired for something else all along. With the huge problem being that if it is the latter, it means my personal life is about to get completely upturned. But one problem at a time, I guess.

[Lori Dee ✅]

obviously, a part of me is nervously hopeful that two months in, I look back and realize I feel incredible and that my brain really was wired for something else all along. With the huge problem being that if it is the latter, it means my personal life is about to get completely upturned. But one problem at a time, I guess.

This is the right way to go about it. I had my doubts that I would feel anything at all. But after a week on the pills, I knew THIS IS IT! After 30 days, I went in for a checkup, and my doctor wanted to go for another 90-day "trial" period. By the end of that, I knew there was no going back. And that is when I faced forward and started figuring out what that meant for my personal life. Fortunately, I had a great therapist who helped me figure it out.

I think you will do just fine.

[Alana Ashleigh]

I did informed consent through PP in May. I did everything over a video call. I talked with a woman before I talked to the nurse practitioner. The NP asked me a bunch of questions, and then went through the risks of being on hrt. I had to sign electronically that I understood the risks. The NP sent my prescriptions electronically to the pharmacy. I did all this on a friday, and I had my prescriptions Monday afternoon before I went to work. I was sent for bloodwork at a lab the same days. The whole process was completely affirming, and I didn't have to prove anything to her.



I pickup my my prescription in the drive thru, and the people pharmacy don't bat an eye when I pickup my hrt. I'm still presenting as male, and haven't had a negative experiences at my pharmacy.

[Simplycause]

I'm going through the informed consent PP route. Have my appointment scheduled the 31st. Unsure on the pharmacy front but probably going to go with Amazon.

The PP I'm going to is about only about 40 minutes away but it's in a different state. Ideally I'd want to get my HRT that day and not wait but I'm also going to be gone all day depending on how the appointment goes.

[katiebee]

I'm going through the informed consent PP route. Have my appointment scheduled the 31st. Unsure on the pharmacy front but probably going to go with Amazon.

The PP I'm going to is about only about 40 minutes away but it's in a different state. Ideally I'd want to get my HRT that day and not wait but I'm also going to be gone all day depending on how the appointment goes.

Yeah, the PP near me was in-person only and booked through March. Zero chance I follow through if I have to physically go into an office. I'm just too chicken when it comes to social awkwardness. Which is obviously something I'll have to get over real quick but still.

[Simplycause]

Yeah, the PP near me was in-person only and booked through March. Zero chance I follow through if I have to physically go into an office. I'm just too chicken when it comes to social awkwardness. Which is obviously something I'll have to get over real quick but still.

If I had to do this any part of where I live I wouldn't be able to do it. I almost went the DIY route but about 5 years ago I had a bad reaction to finasteride. I took the first one and in about half an hour I had the blurred vision, the ball aches and started getting migraines. And everything said those would stop in a couple of weeks and in a couple of weeks they just kept getting worse. Part of the reason I asked about Microdosing in an earlier comment.

I've had a concussion or two playing hockey and Lacrosse through school, but outside of getting wacked in the head I've never gotten a migraine until I took the finistaride. I had a low dose opioid pain killer I had gotten for dental work and I had to take one of those to even sit up.

And from what I've read it's not uncommon for estrogen to cause migraines as a side effect.

[katiebee]

I do get really bad migraines already. Hopefully that doesn't get any worse...didn't realize that was a possible side effect.

[Simplycause]

I do get really bad migraines already. Hopefully that doesn't get any worse...didn't realize that was a possible side effect.

Finasteride is an anti-androgen and chemically identical Estrogen isn't. So for me it might be different.

Hormone imbalance also causes Migraines. Everyone has testosterone and estrogen. Men have more testosterone. Women have more estrogen but we need both. And if the levels are out of wack for anyone really that causes problems.

Going through some stuff on ->-bleeped-<- so I can educate myself on questions to ask or things to watch out for I've read people who didn't have migraines get them as a side effect, and people who were getting migraines when they started HRT they went away.

And those who started getting migraines as their levels evened out or their doses got adjusted, for the ones who posted anyways, their migraines eventually stopped.

[Lori Dee ✅]

Finasteride and spironolactone work by affecting the 5a-reductase, which affects all hormones. On my own journey with a team of endocrinologists, it took years for them to figure out what was wrong. I seriously do not understand why providers still use those two. They are using their side effects to achieve a purpose. There are other medications available that do the job directly and do not interfere with other hormone levels.

The spiro and finasteride were affecting my T and my E levels. So adjusting one only complicated something else. We ditched those two. I went on Eligard (leuprolide) injections every 90 days. That blocks T production at the source. Then added Casodex (bicalutamide) daily tabs, which are androgen receptor blockers. It has no hormonal activity, so it doesn't affect hormone levels. But by blocking the receptors, any T that was converted for other use will have no effect.

I don't get migraines, so I do not know how this might affect a migraine sufferer. If the trigger is fluctuating hormone levels, this might be a solution. The problem is that the Eligard injections are expensive. I was told $400 each (every 90 days). That might rule out that option for some people if insurance won't cover it.

[katiebee]

I got a response from the doctor, and she seems incredibly supportive! She laid out that she'd want to talk about my gender history, dysporia, expectations and then the usual side effect stuff. She did say I needed to give my phone number for her assistant to schedule the session. I've just been staring at the email all week. Every time I look at it, my heart pounds out of my chest. I know I want this, but I freeze every time I go to send the draft with my phone number. I don't think I've ever been this nervous before...but I've said it a few times, at some point in this process I'll have to just get over it.

I am worried that the practice will mail a bill to my house. It seems anything I do medically makes a paper trail of doctors drowning my mailbox. It's the last rationalization/excuse stopping me, so I've responded to ask about if it's possible to do e-billing only. Now we wait...

[Lori Dee ✅]

That is exciting!

The first step is indeed terrifying, but also necessary.

As the saying goes:

"If you keep doing what you're doing, you'll keep getting what you're getting."

If that is not what you want, then change is necessary.

Hopefully, they will agree to e-billing. Just let them know that it is a privacy/discretion issue. They will understand.

If not, you may need to rent a post office box to have those bills sent to, if that is practical.

Good luck!