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not yet on hrt. how do i proceed?

Discussion in 'Gender Identity and Expression' started by Miss Emma, Jan 9, 2014.

  1. Miss Emma

    Miss Emma Guest

    Hi all.

    Anyone (preferably Trans feminine but guys feel free to chime in(*hug*)) tell me what I need to do to get a Dr recommend for beginning hrt? I've seen a psych Dr for bipolar but he's been in the loop on my dysphoria for a while. Insurance issues have not allowed me to continue seeing him SOOOOO I went to another therapist today for the first time since Nov 11. (happy vets day all you vets!)

    I told her where I was at, plus new developments since Nov. And that I determined I DO need medical therapy and to begin feminization. And that I needed that support so I can get this party started!

    I'm not sure what I'll need or how much this can cost. Anyone have any advice? Any will be appreciated. Thanks!
     
  2. Just Jess

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    Really glad you asked this question :slight_smile:

    So anyone else reading this, really sorry, but it only applies to the U.S. Although if the OP wouldn't mind someone from the UK sharing stuff (code of conduct in mind, some SAS surgeon's websites have 18+ sections), I think that would be great. The primary focus of this site is of course helping people come out of the closet, and there are great resources out there that are going to be better than here - tsroadmap.com is a favorite - but I know how frustrating it can be once you are "all dressed up and no place to go" and so I'll share some of my own experience.

    So there are two kinds of doctors that can prescribe hormones: GP (general practitioner, your regular doctor in other words) and Endo (short for endocrinologist). And there's two types of these: informed consent, and therapist's letter.

    Informed consent means that you don't need to see a therapist first. The upside is that you save money going to a therapist. The downside is that there is a waiting list, and there's fewer of them. You'll find informed consent people at LGBT clinics like Chicago's Howard Brown. They still screen people psychologically the same way a therapist does, it's just that you don't have to pay for it separately.

    I went the therapist's letter route. Both paths now are in accord with something called the WPATH Standards of Care. The modern idea is to not hold trans people up to a higher standard of mental health than other people. They will still turn you down if you have a medical or mental health condition that would interfere with your taking hormones, or if you are trying to get hormones under some kind of duress. There was a news story about a trans man that unfortunately took his own life because he transitioned to make his mother happy a while back; that is the kind of thing they are trying to avoid.

    The advantage to the approach I took is that I have more doctors I can see for hormones. You also need a therapist's letter (sometimes two) for any more serious operations. A lot of urologists, for instance, won't perform orchiectomy (castration) without a letter. You often do not need a long term relationship with a therapist, although there are advantages. Your therapist has helped a lot of trans people before, and they are experts on transitioning. They can also help with all the mental health heartache that comes with being trans. I personally had a lot of relationship stress because of my being trans, and that bled into my life in other ways. Therapy has helped me TONS where that is concerned.

    So cost, my therapist was about $100/session give or take. Actually $200 over 1 and a half sessions. Hormones are pretty cheap, you are looking at roughly $70/month for both prescribed anti-androgens and estrogens total. A lot of local pharmacies like the one at your grocery store can give them to you once you have a prescription. And you will have a couple office visits and a blood test, so they can figure out the right dosage to give you.

    So finding doctors and therapists. I found my therapist through this site,

    Therapists

    (Dr Becky Allison is an amazing trans woman by the way)

    And the best place to find a doctor is at an LGBT center if your city has one. They can usually help you get trans friendly health insurance too. That's where I was this afternoon :slight_smile:

    If you can't find a doctor that knows how to help with being trans, you can go to the World Professional Association for Transgender Health (WPATH) website, WPATH , and click "Find a Provider" on the far right.

    One other thing to consider. Anti-androgens are healthy and safe, but shouldn't be taken for a very long time. Otherwise there are risks to your liver, and the really scary risk of something called deep vein thrombosis (DVT). Even long term, there are ways to minimize both those risks that your doctor can tell you more about, including a different way to take the medicine. So it would be a good idea, when you make this decision, to ask yourself if you are going to want to get the t-factories removed eventually to make things safer. You can get them removed by themselves, which is what I'm doing, or you can do it as part of a sex affirmation surgery. The difference is cost; my operation runs about $2k, the whole shebang is usually about $20k including hospital stay etc. If you want to know more, a surgeon named Dr Bowers has an excellent explanation on her website. I won't link directly to it because it has an 18+ section. But she does a great job explaining everything.

    And good luck! (*hug*)
     
  3. Miss Emma

    Miss Emma Guest

    Cassie you have a knack for detailed explanations. I thank you. (*hug*)Btw .... I'd need a psychologist? Other therapist ok? There is no gender therapist on my area.:***:
     
  4. Just Jess

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    I always think I write too much :stuck_out_tongue_closed_eyes:

    I'm not 100% on the difference or what letters people will accept, that is a good question. Sorry there was no one on that list, there are other lists online.

    There's a link to the WPATH standards of care in the resources section here. I'd read through that. I'm kinda going through a stack of job apps right now (I got laid off recently but it's turning out to be kind of a blessing in disguise with the timing) or else I'd do it.

    Worst case, you can print out some pages from the standards of care, and bring them to a therapist. I think that a therapist and a psychologist are going to be equally ok. Or just give them the link.
     
  5. Miss Emma

    Miss Emma Guest

    I looked up the therapists there @ Dr Becky. The ones listed are 300 milesaway but they are not docs so mine should be able to help. Plus she was super empathetic when I spilled it all out! Yay!!
     
  6. Miiaaaaa

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    Glad it went well. :slight_smile:
     
  7. Miss Emma

    Miss Emma Guest

    Thank you! I'm going to follow Cassie's advice and get a copy of the standards of care and bring to her (therapist) so she can see what she's dealing with. First consultation, scooped out the office and saw books on the psych of gender! SCORE!! That's why I could spill to her. She said I sound like I've got figured out where I'm going with this and asked what i needed from her. I said support. Sheer agreed and set me back up!
     
  8. Daydreamer1

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    If you find a good therapist, they can be of service. I was told by the people where I go to go to my primary doctor, so I'll see if he can help.

    If you know of places like the Mazzoni center in Philadelphia, they do informed consent I think and getting assistance is easier. I've heard if you're unemployed or you have insurance issues that they can help you cover things.
     
  9. Miss Emma

    Miss Emma Guest

    Thanks daydreamer. I'm in NE so can't do that though. :slight_smile: