Convincing doctors that hormones are not that complicatedPosted: May 13, 2014
I just got back from my first appointment with a new doctor at a women’s health group (unintentional!) This has been an ongoing saga, and although it’s not a perfect fit, it’s good enough, at least for now. Looking for more backstory?
Back in January, I decided I was fed up with my doctor, and that I could do better.
By the end of February, I’d found a promising candidate, only to realize she’s part of a women’s health group.
My last appointment with my doctor, at the end of March, was an absurdist performance piece.
It has been challenging to find appropriate health care where I live, but I’ve plowed ahead anyway because: 1)I know what I am trying to get, and 2)I don’t see any reason why I should not get it. This new doctor has no expertise in trans* identities, and I knew that going in. But I did find her through the local gay alliance’s resource page, so that was a start. When I told her that this is how I came to be here, she replied, “Well… yes, I am LGBT friendly, but I don’t know how I got on that list.” What does that mean???
When I told her the reason I’m here is to get more Androgel, she replied that she does not feel qualified to prescribe hormones. That was the start of the discussion, but by the end, she was giving me a prescription for exactly what I said I’ve been on for over a year already, and she was changing her tune to, “I suppose I could for the time being, but the long-term health risks are too great, and it’s not my area of expertise.”
I told her I’ve been going to the one trans* specific doctor in the area who treats adults (that I know about), and I want to switch because I do not like him. She used her laptop to confirm she knew of no local doctors, aside from the clinic that treats adolescents and young adults. She suggested I could use her as my PCP and still go to my other doctor for the hormones. I told her I was not going to do this. She then suggested she might be able to get me in at the adolescent clinic for a one-time visit, so that she can then be advised by them about my care. I told her that would be amazing. She will be following up with me on this, and I would be happy to go.
I told her how I perceive my gender identity, why I’m taking testosterone, and that it does not involve much health risk for me personally. She said, even so, she did not know enough about it. I asked her, “What if a woman wanted to take testosterone to address issues with a low sex-drive?” (Women do this.) She said that she would not use testosterone as a treatment. It’s not been proven to be effective. She continued on to say that she does have some male patients (husbands, sons, etc. of patients, who want to come here), and some have low testosterone levels, and she’s not the one to prescribe them testosterone. I found this difficult to believe.
I showed her a copy of my latest blood tests, and this is when the tables started to turn. I saw her open up. I illustrated what I knew by telling her what “normal” female and male ranges were, and where I fall within that. I told her that risks such as increased blood pressure, red-blood cell count, cholesterol, etc., are real concerns that can be monitored through blood work, but I believe I counteract those risks anyway with my lifestyle (vegetarian diet, active profession, don’t smoke, drink only moderately.)
I told her, bluntly, “It’s not that complicated.”
And, in the end, she seemed OK with it. She was asking me what diagnosis I would like her to put for insurance purposes. I told her that Gender Identity Disorder is in the DSM – “I don’t like it, but it’s there.” She responded with, “What about ‘hormone treatment for transgender patients?’ Well, you don’t identify as transgender…” I told her that I do, that “transgender” is an umbrella term, and that diagnosis works OK.
I went by this new name I’m trying out, at the doctor’s office. I figured this is a compartmentalized atmosphere, and a good place to see what it feels like. I gotta say, it didn’t feel great. I’m not sure what that’s about yet. If that means this just isn’t the name for me, or if I’d actually feel this way about any new name, because any and all would feel foreign at first. I’m sure my gut will tell me. And time. Time will tell me. I also told her I’d like to go by male pronouns. She said, “We can do our best with this. You’ll probably have to remind us, but we’ll try.” Her body language while she said this conveyed, “I don’t get it. I’m not really going to try, but feel free to try to get us to try.”
And this is where things are.