Recent Discovery

[Plix]

I recently discovered that Anne Lawrence no longer prescribes to people who do not have a therapist letter. I do not have one, so getting hormones from her will not be an option

Most likely I will have to continue on my current path of doing it myself. Not the best option, but sometimes the only option. I really am not in a position to afford 3 months of therapy, and it seems doctors no longer prescribe to people like me. As I said in my other post, my own doctor will have nothing to do with it.

Even if doctors would prescribe, I did some calculations and learned doing what I am doing now is much cheaper than going to a doctor because even if the pills are cheaper, there are costs such as visits and blood work that can be quite expensive.

[Terri-Gene]

Plix, I'm not going to go through all the retoric of proper protocols and the necessity of doing it properly by working with a therapyst.  You seem to have already made up your mind on this.  I can and will though ask you to reconsider your view on medical supervision and blood tests.

Though your present doctor will have nothing to do with it, you should not have a problem finding a doctor who will monitor your health and interpet the blood tests even if they have nothing to do with the perscribing or condoning of hormones.  They just need to be aware you are using them.

I know the dr. visits and blood tests are expensive, but at what expense your life?  Please be responsible, it is only for your own good and health.  Issues can arise that you would be unaware of.  You could be unaware of a potentual problem right up until the moment it whacks you with no warning.  You don't necessarily need to go in all that often if you are of normal good health with no diseases or problems with heart or liver and possibly other organs.  A blood test every few months or even bi-yearly might be sufficient, but I would leave that to a dr. to determine.

I can in a way understand the reservations about therapy, but I can not understand the reluctance toward medical supervision, nor can I condone it.  For the greater many, no major problems are experienced, as in a proper program, those with potentual problems are weeded out in the beginning, but hormones can be tricky stuff and very sneaky in the way they degenerate and attack your health.  The risk is very, very real, no matter how fit and healthy you may appear to be.

I myself have had two rather tramatic experiences, one with estrogen thought to be the culprit and the other spiro while under a completely insured top rate medically supervised program with the finest of medical care and am generally thought of as having a particularly tough physical constitution and for the most part in enviable fit physically condition.  The instance with Spiro was discovered discovered though a blood test which detected exceptionally high potassium levels which were serious enough to warrent an emergency EKG, but having been detected in time, steps were taken to lower potassium levels and in a matter of days my system was returned to safe levels.  Without the blood tests, it could have dropped me before I had any realistic concerns.  They tell me it could have happened at any time during that period if it hadn't been caught.  The estrogen experience left me with sever hemmoraging in the right brain and required months before I could function normally and I still have a "hole" or pocket in my brain as a result.

We don't need another statistic, please be smart and get yer A** to a doctor.  You haven't said if you are taking spiro or not or some other form of T blocker, but assuming you are, be sure you understand if the particular blocker retains or eliminates potassium from your system.  this is important as some do one and some do the other, and an inadiquate diet in referrence to which can affect potassium levels in the blood, to much or to little can cause highly sever cramps and even heart seizure, which could stop your clock in mid step without you even being aware of a major problem.  You are playing with fire doing this on your own without proper supervision.

In the meantime, take an asprin a day as a blood thinner to minimize the blood thickining properties of estrogen to minimize the risk of thrombosis, and if you smoke, please don't, for the same reason.

It's your life, but take some responsibility toward it, please, or don't make such posts here as it just encourages others to be irresponsible and negligent toward themselves and the community.

Terri

[Plix]

I don't have any T to block , well, not enough anyway, so there would not be much point to taking a T blocker. That makes me feel much safer.

I really wish I could get to a doctor. Believe me, I want that more than many things else right now. But there are no doctors in this suprisingly conservative for a decent-sized city I live in who will help. All they do is say it's beyond their expertise while offering to refer me to an endocrinologist on my poor people's insurance network who probably has no knowledge of T issues, let alone understanding. And since my doctor wants to write "wants to make himself more female" as the diagnosis, I don't see the insurance approving that referral.

I have to say that I'm sorry I don't have money. I learned long ago that money equals happiness. I would like to consider some other things more valuable than money, but since I live in a society that disagrees, I must accept and deal with the fact that money is king, and without it I'm not going anywhere.

We all have to make choices in life, and while I'm not thrilled about all of the ones I've made, I accept most of them as what was right for me at the time. Unless you've been there, it's difficult to understand why someone makes a certain choice. I know when I was seeing the therapist I thought taking hormones without a doctor was quite stupid, now since it's my only option I see it much differently. Even if many years from now I am condemning someone for taking hormones on her own, I will always understand why she is doing it because I have been there. I know that sometimes there is no other way.

[Leigh]

I don't have any T to block , well, not enough anyway, so there would not be much point to taking a T blocker. That makes me feel much safer.

I really wish I could get to a doctor. Believe me, I want that more than many things else right now. But there are no doctors in this suprisingly conservative for a decent-sized city I live in who will help. All they do is say it's beyond their expertise while offering to refer me to an endocrinologist on my poor people's insurance network who probably has no knowledge of T issues, let alone understanding. 

  You have not seen and endo ( who probably has no knowlege) yet you state you have no T levels, how is this possible that you know?

I will wager that if you post the city, I or someone here, can find a Dr. within 5 minutes of reading your post.

[Terri-Gene]

Plix, for the purpose of monitoring your health, you don't need any experts, a simple MD will do and if any problems arise, that MD can refer you to a specialist who is more familiar with the particular problem.

The MD monitoring you does not have to be deeply into T issues, just read chemical levels in the blood which are indicators of specific problems with specific organs and functions.  If the Doctor can not do this, their licences is fraudulent.

The statement about low T is interesting.  As stated, if not diagnosed, how would you know?  Behavior and such actually isn't always the best indicator of this, and even low levels above a particular point would prevent estrogens from having the desired effect, thus taking all the risk without achieving gain, thats what the blockers are for.  Once T levels have been reduced beyond a certain point, it actually takes very little estrogen to have the desired effect, though if T levels are to high, the amount of estrogen necessary to overcome it could be prohibitive for the body to stand.

As to the insurance issue. it would most likely cover mental therapy, for depression or other such related problem to begin with, and as you progress to what you believe the real problem to be, the therapyst can refer you to the endrocrinologist who can sort out your chemical levels, Yes they do very well understand estrogen and it's effects, though they may need to do a little review about it's use in males, but they can easily determine both Free T and Estrogen levels and obtain any information they need about proper values in a male body and proscribe the necessary dosages for you.  I hope you can understand how working with a therapyst actually simplifies the entire process, since most everything needed for a sucessful transition is based on their recommendation anyway?  If you wish to go on to SRS, are you aware of how important a psychological recommendation is?  You are already finding out what it means to HRT.

And, as mentioned, finding a Dr. who could monitor you, even without the theraputic recommendation isn't the problem you seem to think it is or are using as an excuse because you are afraid someone might disagree with your self diagnoses.  As to the insurance issue of this doctor, it would mostly just be a matter of seeing the doc for preventative medical checkups, which is exactly what you would be doing, just particular attention would be paid to consiquences of estrogen use which most any doctor should be somewhat familiar with since they have female Post Menapausal patients on HRT which is after all, the original and most targeted group for HRT in the first place, so they do in fact know what to watch for even if not in any way knowledgeable about proper dosage for male bodied individuals, which are extreamly higher then for females to the point of being somewhat rediculous in compairison, thus the risk, which in growing circles is being considered to high even for females with thier miniscule dosages.

That Doctor better become #1 priority real quick Plix,  I don't think you have the slightest clue about what you are doing and you are probably going to be talking total risk for zero gain.

Get Real and have a life.

Terri

[Plix]

And who is going to pay for this MD or this specialist should I need one? I have an HMO. All medical care must be provided by or arranged through my PCP, and the HMO must approve referrals requested by her. My PCP will have nothing to do with it, including a blood test. All she will do is refer me to an endo with the diagnosis of "wants to make himself more female." What are the odds that poor people's government run insurance is going to approve that?

Well, I don't know, but I just assumed not posessing the organs that produce almost all T makes just a teeny bit of difference when it comes to T levels.

Yes, my insurance will cover therapy at the county therapy clinic. Most likely there are one or two therapists to choose from. What are the odds she or they will have any understanding of T issues?

I have already obtained hormones and an orchiectomy without any help from a therapist. Yes, there is an American doctor who will castrate TSs and non TS men on demand as long as they can pay (that pretty much cleaned me out moneywise).

I have already been diagnosed with GID by a GID therapist, not that I need anyone to tell me how I feel.

If you can tell me how to pay for it, I'll gladly go and see a doctor. Until then, I have to do what is my only choice.

[Terri-Gene]

Ok, caught the reference to "castration" or Orchieotomy in the Stuggles thread, had missed it before, ok, no blockers needed, granted.

As to who is going to pay for it?  Seems to me you are so busy worrying about WHO that you arn't properly exploring the options you have.  You mentioned having been in therapy before and being diagnosed with sever depression.  You also mention about having an HMO.  The depression is a legitamate treatable condition under most any HMO, start with that.

As to a medical dr. to monitor you, that should also be covered by your HMO.  It may be difficult or even impossible under the HMO contract you have to directly address GID specific issues such as Hormones, but you can still see a doctor to check your vital organs and do blood work.

Now is not the time to crawl under a rock and cry about it, now is the time to actively explore options and be as creative as necessary.

I noticed in the Stuggles thread you mentioned thinking some of the depression issues might have to do with the Orchieotomy?  why would that be so?  Do you feel you have lost something that may have been important to you?  I would consider it a aid in a conflict with the HMO, as after Orchieotomy, you obviously need hormones not only to counter the effects of the body not having any hormones (possibly a large part of the depression issue) but to prevent bone thinning, which will likely happen and make your bones brittle and subject to easy breakage after some years.  There are many reasons why you would need hormones now, be it male or female.  You could use written documentation from the psychiatrist who treated you for gid to obtain the female variety, but in a way you have worked against yourself by going outside the system by haveing the Orchie done by a doctor who doesn't require documentation, as it can be declaired self inflicted and so not covered by insurance.  Another example of what going outside the system can bring on.

Anyway, forget the rest for now and work on seeing a therapyst for the depression issue and see where that leads as the therapyst begins to realize the root of the depression and it may surprise you where things can go from there.

Never give up a fight as long as you can draw breath as you never know what the next few seconds will bring or what may come to your aid if you can simply hang on one more heartbeat at a time.  I can tell you that giving in to what you think is inevetable will only make things worse when you do in fact survive the enevitable, and then you have that giving up, and giving in can have far reaching consiquences when in fact, things do begin to work out for you.  If you want something bad enough, you will find it in you somewhere to get there, though it may take longer then you would hope or think you can take, but you can get there and you can take it if only you have the will to do so.

Make an appointment through your PCP or HMO to see a therapyst for the depression and work on it from that angle, It just may go where you want, if not, take a deep breath and re-explore your options, Nothing is impossible until you give up trying.

Terri

[Susan]

Ok, caught the reference to "castration" or Orchieotomy in the Stuggles thread, had missed it before, ok, no blockers needed, granted.

In actuality they should be on a small dose of T as it's required for proper functioning of the male or female body.  Both sexes produce some of the other sexes hormones.

[Leigh]

One thing to consider.  After surgery medical requirements are not much different than a woman of the same age who has had a hysterectomy.  Of course going to a Dr. and asking for a prostate exam can certainly raise their eyebrows.


testosterone

The overlooked hormone

Testosterone is the strongest of the male sex hormones, or androgens. In addition to estrogen and progesterone (the female hormones), our ovaries are the primary -producers of testosterone during our reproductive years. Other androgens, as well as a small amount of testosterone, are produced by our adrenal glands and fat tissue, along with small amounts of estrogen.

At menopause, when our ovaries no longer release eggs, stop producing the potent forms of estrogen (estradiol and estrone) and stop producing progesterone, they also slightly decrease production of testosterone. The word slightly is important here because the lower amount of testosterone is less important than the fact that the ratio of testosterone to estrogen and progesterone changes.

Testosterone is particularly important because it activates the sexual circuits in the brain for both men and women, Dr. Vliet explains. It helps maintain normal energy levels, muscle tone, and a sense of well being. And it actually helps in the formation of new bone.

Preventing osteoporosis, a disease in which the bones lose mass at an excessive rate and break easily, is one of the primary reasons for adding testosterone to hormone replacement therapy after menopause, Dr. Vliet states.

[Terri-Gene]

Yes, hopefully, enough T is produced by the other glands of the body for proper maintainance, though this information has not been voluntiered to me by my own doctors and I have failed to ask.  Thanks for the reminder Susan, I'll ask my doctor specifically about this during the week as I pass her office every day at work.

As a side issue on this, I know some surgeons used to retain the testicles in MtF's relocated in the abdomin for just this reason.

Terri

[Plix]

Ok, caught the reference to "castration" or Orchieotomy in the Stuggles thread, had missed it before, ok, no blockers needed, granted.

As to who is going to pay for it?  Seems to me you are so busy worrying about WHO that you arn't properly exploring the options you have.  You mentioned having been in therapy before and being diagnosed with sever depression.  You also mention about having an HMO.  The depression is a legitamate treatable condition under most any HMO, start with that.

As to a medical dr. to monitor you, that should also be covered by your HMO.  It may be difficult or even impossible under the HMO contract you have to directly address GID specific issues such as Hormones, but you can still see a doctor to check your vital organs and do blood work.

Now is not the time to crawl under a rock and cry about it, now is the time to actively explore options and be as creative as necessary.

I noticed in the Stuggles thread you mentioned thinking some of the depression issues might have to do with the Orchieotomy?  why would that be so?  Do you feel you have lost something that may have been important to you?  I would consider it a aid in a conflict with the HMO, as after Orchieotomy, you obviously need hormones not only to counter the effects of the body not having any hormones (possibly a large part of the depression issue) but to prevent bone thinning, which will likely happen and make your bones brittle and subject to easy breakage after some years.  There are many reasons why you would need hormones now, be it male or female.  You could use written documentation from the psychiatrist who treated you for gid to obtain the female variety, but in a way you have worked against yourself by going outside the system by haveing the Orchie done by a doctor who doesn't require documentation, as it can be declaired self inflicted and so not covered by insurance.  Another example of what going outside the system can bring on.

Anyway, forget the rest for now and work on seeing a therapyst for the depression issue and see where that leads as the therapyst begins to realize the root of the depression and it may surprise you where things can go from there.

Never give up a fight as long as you can draw breath as you never know what the next few seconds will bring or what may come to your aid if you can simply hang on one more heartbeat at a time.  I can tell you that giving in to what you think is inevetable will only make things worse when you do in fact survive the enevitable, and then you have that giving up, and giving in can have far reaching consiquences when in fact, things do begin to work out for you.  If you want something bad enough, you will find it in you somewhere to get there, though it may take longer then you would hope or think you can take, but you can get there and you can take it if only you have the will to do so.

Make an appointment through your PCP or HMO to see a therapyst for the depression and work on it from that angle, It just may go where you want, if not, take a deep breath and re-explore your options, Nothing is impossible until you give up trying.

Terri

I will look into seeing a therapist, but seeing a doctor is not going to work as long as my doctor is unwilling to write anything different on the referral request. Is there anything she could write on there (though she probably wouldn't be willing) that would allow for possible approval and still be honest?

It is possible for orchiectomy to cause depression even if the person is happy about it, which is certainly true in my case. It can sometimes be just the biological result of falling hormone levels and chemical changes in the brain.

I could probably get male hormones easily, but I'm not so sure about female hormones. I guess I can try the therapist and see what she has to say, though I really don't consider it likely she will have any knowledge of T issues.

I could always decide to fork out the cash and go see one of the big name TS doctors in LA. I'm sure I could get a prescription without a letter. But I'm afraid of what the blood work would cost. I'm also concerned about how the doctor would feel about progesterone. I've already made up my mind that I want to take it.

If I were to find a doctor who would do some tests, what tests should I do? I would guess E/T levels as well as liver function. Are there any others?

[Leigh]

A reputable Dr. will or should do a complete physical.

My Dr. did a blood workup when I started.  Two more at 3 month intervals and another 6 months later.  I have no idea if this is the norm or not but with her patient load I am sure she has one of the highest % of transitioners in the country.

If your family has any history of med problems you have to tell the Dr.  What they don't know could cripple or kill you.

Leigh

[Terri-Gene]

Good for you Plix, you seem to be at least starting to think.  after the last few posts, I hope you realise the long term effects of the orchie and how necessary it is that this issue be addressed.

Yes Plix,  The drop in testosterone can definately affect your thinking and bring on depression like effects.  I experienced this myself, though not to a dehibilitating degree, as a result of having an orchie myself which was considered a medical necessity to restart HRT on post menapause dose after a thromboses incident made it unsound for me to continue on conventional high doses of estrogen and I had to be pulled from the HRT program for a number of months.  After the orchie I was allowed to restart on the low dose.  We have been working with that to achieve exact levels of what I need without exceeding that amount thus increasing the risk, though I am told that any amount at all is a prohibitive risk in my case.  It is only because of my relationship with my doctors and their concern for my quality of life that allows them to wiegh and try to balance the risk vs. life issue as in most cases, HRT would not be allowed at all in such cases.

the referral request is not an easy issue depending on if Transsexual HRT is specifically prohibited by your HMO, which if it is a smaller one, probably is. I wouldn't know, but could you show her some documentation from the previous therapyst?  Perhaps with some work, things can be worked out with the HMO itself, thats what it took to get my HMO to pay for my own Orchie, though they never had any problem with the specific therapy, HRT or related medical concerns at all.  It was my psychiatrist who stood up to them and pushed it through for me, or I would have had to pay for it myself, but at half price since I work for the HMO that insures me.  You need to work with your people and it is sometimes surprising what they will do for you if you cooperate with them and they have confidence in your commitment and need.  It's just something you have to work with, but I'm sure there is a solution, the problem is finding it.

It is possible that she can refer you to the endo on the orchie issues and documentation from the other therapyst might work for the endo, though from what you said, she never recommended HRT, which complicates that issue.  You are in a bit of a mess and it would seem at square one, diagnoses and recommendation. My best guess is that your best hope is therapy, beginning with the depression, not GID and let the therapyst work toward GID as the underlying cause.  If the therapyst can see things in this direction, she or he can referr you to a more specialized person who can work with you.

This is going to be a long drawn out process over many months and you are going to just have to realize that and make the patience if you haven't got it.  As to the  progesterone issue, Stop right now with any conceptions of what you have already decided, you start talking that crap and given the fact that you have already "taken matters into your own hands" and you will be considered irresponsible to participate in any HRT program at all and they will not let you do it on that grounds alone.  YOU do not make the rules here, THEY do and you better get used to that right now or you are D.O.A. on this issue.  BELIEVE IT.

This is a problem you are going to have to address right from the beginning.  Despite what you think you want, you don't tell the mechanic how to fix the car unless you want to find another mechanic, and your options are a little limited for that arn't they?  And if you plan on taking estrogens before they tell you to, remember what I have just told you.  You have already gotten yourself into a real mess and if you want out, Play it straight or don't expect to play at all.  You've already had your strike and now you are playing on thier mercy unless you want to come up with the $$$ to hire your own people.

and please, STOP already with the perscriptions without a letter, havn't you figured out allready thats a dead end street unless you got more cash then brains?  Thats exactly why you are where you are now, trying to do it the "easy" way.  there is no free lunch, get that straight right now if you want to actually get anywhere.

As to the medical exam for HRT, depending on the doctor, it could be as simple as a blood test checking for any irregularities of various body functions.  Any doctor familiar with Female Post Menapause HRT will know what to look for.  Some doctors may want to go further, such as EKG tests, and medical history not only of yourself but of your family will enter into it because of genetic dispositions.  I have no idea what blood tests in your area will cost, I know here, depending on the test, can run $100 to $200 or more, depending on the depth of the report requested.  depending on the initial report, more tests may be necessary.  My initial report for HRT some years ago indicated exceptionally high liver functions which are an indicator of Hepititus, so Hepititus C had to be specifically checked for and came back positive which ment I was inelligible for HRT.  It took me two years to work that one out with the doctors before I was allowed to initially even start.  Like I said, you have to be patient and you have to work through the issues.

Just a lot of things to think about I guess Plix, but for starters, simply see about a complete medical checkup to make sure you are in good shape at this time.  It isn't about qualifiying for HRT right now, it's about making sure you have not already done yourself any damage and are in good health.  Also see that therapyst about Depression, and while that issue is being addressed, the GiD issue will come up, but remember, it was the depression that stopped the process in the first place, so don't pull that to impatient to work with it routine again.  You are going to have to take this by the numbers or you are just going to be right back at sqare one again.  Capish?

Terri

[Plix]

I've set up an appointment with my PCP. They can't get me in until the 25th. I'm mostly going to her for SSRIs. If I can talk her into a blood test, that'll be a bonus.

I also go to a urologist this Friday for a follow up visit. I had an infection as a result of my castration, and he's the one who's been taking care of me, if you want to call it that. He isn't supportive either and I expect even less from him.

I called the therapy place and learned all I have to do to get started is walk in for an evaluation. If my reasons for being depressed come up during the evaluation, most likely I'll be told they can't help me and they have to refer me to some expensive therapist way out in LA. But it's worth a try

[Plix]

Saw a therapist today. Just as I expected, she has little to no knowledge of T issues. She didn't even understand how dangerous it was for me to be taking estrogen without supervision. It was a surprise to her when I mentioned the problems that could occur, unlikely though they are at my age and dosage.

There isn't much they can do for me there, so we didn't schedule another appointment. But I did talk with an FtM who is getting hormones and monitoring from a local doctor. He gave me her number.

The bad news is he says she's not accepting any new patients. I will try calling her and see what happens.

[Sarah Louise]

Hi,

I have been self prescribing my hormones (but not without a LOT of research into normal doseages).  I would not advise it without having a doctor who monitors your health.

My health insurance specifically, Excludes Anything, to do with Transsexuals so I hve to be careful.  I do see my doctor quarterly for blood tests, so I do know how my liver and other things are doing.

I live about a 2 to 3 hour drive from where I could see an endo (the only local one will not deal with TS girls).  I don't do this lightly, I am very careful in what I take and what doseages.

Sarah

[stephanie_craxford]

I do see my doctor quarterly for blood tests, so I do know how my liver and other things are doing.

Sorry Sarah, no matter how much research you've done, self medicating, is dangerous, and fool hardy.  Why doesn't/can't  the doctor who monitors your blood test results prescribe the hormones.  Also how do you know what parts of the blood test to order.  You could be paying for something you don't need.

Steph

[ginaroxx79]

Have you thought about looking into Kaiser coverage? I know they cover hrt for TS individuals. As for the cost, maybe you could take the money that you are spending on hormones and put that towards the premiums. im not sure if they have a Kaiser hospital near you but it might be worth looking into at least. I know they have a few in the SoCal area.

As for the hormones being cheaper where you are getting them, which I presume is the internet, this may not be true. I live in Nevada otherwise I would go to Kaiser as the prescription co-pay is only 10 or 20 dollars depending on your coverage. Couple that with 20 dollar office visits and I am sure it would be cheaper than what you are paying now. I have to pay cash for my prescriptions so I buy generic. At the doses I am taking, which are higher than yours since I have not been castrated, my estradiol is only $49 and my progestin (medroxyprogesterone) is only $15. The highest cost is my T blocker which you do not need.

I lived in the San Gabriel Valley for a time and can relate with you on the attitudes some people have towards us. But even where I live, which is pretty red-neck, I have found a doctor that will work with me. I hope, for your sake, that are able to work something out.

Dont understimate what HRT can do to your health even at very low doses. Please don't put money above your physical well-being. What good is it to save a few dollars if you die in the process? What good is taking a short-cut if you never reach your destination?

Good Luck,
Gina

[Terri-Gene]

Ack!  I've said enough about self medicating, even when you think you know all about it......

But yes Gina, Kaizer does cover TS issues, everything but electro and ffs, surgery etc. but all hormones, therapy, medical etc. are covered in total, and if you happen to be an employee, heheeheheh, no copays at all and a $5 perscription fee, but they write the perscriptions for 3 months at a time.  Not sure of the cost of a private plan, but whatever it is, will pay for itself very quickly and save thousands.

Terri

[Leigh]

  I live in Nevada   

That wouldn't be Elko by any chance?