Convincing doctors that hormones are not that complicated
Posted: May 13, 2014 Filed under: Testosterone | Tags: androgyny, coming out, doctors, gender identity, genderqueer, hormone replacement therapy, lgbt, lgbtq, medical treatment, non-binary, queer, testosterone, trans, transgender 14 CommentsI 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.
janitorqueer 
Oh, this is not the good news I expected…. Sorry to hear this 😦
“I don’t know anything about this, so I’m not going to treat you” isn’t the best attitude. How about getting educated? “I don’t know about this, so let me read up and get back to you.”
I’m glad you knew enough to explain the details to her, but the onus to be informed should be on the doctor, not the patient. I always suggest people bombard their doctors with resources. Recommend she attend Philly Trans Health to get educated (that was what the original PTHC was for, for health providers!). Point her to websites, semi-local networks, semi-local trans clinics, give her phone numbers.
Of course, does she care enough to learn? Maybe not. And that’s where the problem lies. Not in lack of information, but lack of desire to take the extra step to help.
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Yeah, kind of a bummer. I have a feeling she was taking an extreme stance from the outset largely because she didn’t know where I was going with my explanation / she didn’t know anything about it. I did sense her softening her position, and she did have an attitude of, “Well, if there is no one else more qualified, I will certainly not be denying you treatment.” Simultaneously, the underlying vibe seemed to be, “We need to find you someone more qualified / why are you here?” We’ll see…
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Maybe I can offer her a ride to the Philly Trans Health Conference!
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I’m thinking she’s proof that there’s always someone who graduated at the bottom of the class. With her “I don’t know/I don’t care” attitude, how did she make it into medical school in the first place?
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Good on you for educating your doctor! I only realised very recently that I could do this and it has helped me so much! Also going to the doctors and not leaving till you get what you want. I didn’t realise that medicine ia not an “exact science” and some doctors won’t treat you because of their beleifs. This is bullshit but useful to know so you can get what you need.
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Yeah definitely. It’s important to advocate for yourself! And also to keep searching for a doctor that is aligned with your needs. And ideally, find a doctor who will advocate on your behalf when other stuff comes up, for example, insurance hassles or other issues that might be unpredictable.
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Bah! You deserve better than all of these bad/meh-attitude providers….!
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Thanks! I’ll settle for her for now, and keep my eyes open for other options. She’s definitely an improvement over my last doctor. At least she was listening to me and telling me her thoughts, which could not be said about my last doctor whatsoever!
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I am taking a more positive attitude to this. Lots of people, doctors included, are still way in the dark about trans stuff. The real test will be if she has taken any action to educate herself before your next visit.
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I agree. I’m certainly not giving up on her yet. I appreciated her willingness to work with the trans* youth clinic as opposed to just telling me she won’t treat me.
At least so far she heard me out, told me what she was thinking, and admitted to what she didn’t know. My last doctor never did any of these things.
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Ahhh – yes, we have to educate our doctors, don’t we!? I just switched, too…. I shall be writing about it. Each of the 3 I’ve seen on this have told me very different things. So frustrating, But I love how you handled her and educated her. That’s great!
Oh by the way, I nominated you for that Liebster Award thingy, since I enjoy your posts so much. Here’s my blog about the award and how to pass it along: http://tsoihawk.wordpress.com/2014/05/15/liebsteraward/
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I’m convinced!
I’m really sorry you had to deal with this 😦 I think you handled it really well though 🙂
I find that a lot of older physicians have a tough time adding new tools to their practice. Most doctors only really know and are comfortable with a handful of medications and using anything outside of that is scary and unknown. It’s not a good excuse of course. Those of us who are brand new are used to changing and learning new things everyday and the resources are definitely available to her and it is definitely appropriate for her to extend her practice in that regard.
The pronouns issue is really crappy. I’m sorry. I wish she were more understanding. She might not be able to instantaneously change how the practice manages pronouns but she should at least show that she’s going to educate herself. It would be totally appropriate for her to write a reminder to use masculine pronouns at the top of her note I think.
I hope she does surprise you the next time you visit her. Hopefully she takes this opportunity to educate herself and her staff. Who knows, you might have just sparked a revolution in that clinic!
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Hi! Just wanted to let you know I nominated you for a Liebster Award.
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Ouch!!! I hope she evolves over time. Or you find someone better.
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