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.