Thanks, ladies.
Today's appointment was almost a 180-degree difference. They were on-time and engaged. The first doctor introduced himself, confirmed my name, and my pronouns. He scored points for that.
We discussed some medical history, and I could see he was often referring to my chart. Then he got to the "we need to change your dose due to risks" part. He explained that they follow WPATH Guidelines (which shocked me since Trump bashed them), and that the guidelines aim to minimize risk. I corrected him and stated that the purpose of the guidelines, as stated are:
"The overall goal of the guidelines from WPATH, called 'Standards of Care, is to provide clinical guidance for health professionals to assist transgender and gender diverse people with safe and effective pathways to achieve lasting personal comfort with their gendered selves, and to maximize their overall health, psychological well-being, and self-fulfillment." (I didn't quote this; I paraphrased, but he got the message.)
I told him that I understand they are overworked and understaffed and do not have time to research or read the studies. I am retired. I have time, and I do research and read the studies. He said he would go get Dr. Iwamoto, their head Endocrinologist.
He was a very nice man, and it didn't take long for him to realize I wasn't a dumb patient. We sparred for a few quick moments, just to establish that we had common ground and could speak the same language, I think. So he tried to tell me that he wanted to reduce my dose of estradiol to reduce the risk of blood clots. I disagreed. I am not on oral estradiol, and injectables have the same risk as patches, and patches have not worked for me.
He wanted to reduce my progesterone dose for the same reason. I agreed that, as an oral medication, it passes through the liver but does not increase the risk of clots. The danger lies in the metabolites' side effects, which cause dizziness and drowsiness. I told him that I have been on this dose for two years and I am not bothered by the side effects any longer.
He then tried to tell me that the pharmacy may push back because the maximum recommended dose is 200mg per day, and I take 300mg per day. I told him the VA pharmacy has been filling that prescription for two years without any "push-back".
Finally, we reached an agreement. He said he will document our conversation in which he explained the risks (i.e., Informed Consent), and that no changes will be made to my prescription. At the end of May, we will do labs to check my hormone levels, and we will talk again. If the labs show my levels are elevated, then we will discuss decreasing my dose. I agreed. However, what he calls "elevated" is my normal. I told him that if he drops my levels and I start to experience symptoms (hot flushes, night sweats), I will call him in the middle of the night to complain. He smiled and said most people don't feel any symptoms. I said if that were true, he would not ever prescribe hormones for women in menopause.
He smiled at that and left the video call.
Overall, I think it was a good appointment. I achieved my goal of not changing anything until they understand who they are dealing with, and made it clear who they are dealing with. If they continue to listen and have intelligent discussions with me, I will be more willing to accept their recommendations. They now know that I will call them out if they try to BS me.
They are sending out new prescriptions with no changes, and I will talk to them in six months.
Life is good.
