Help me get hormones

January 13, 2010 9:11 AM

Should I try to convince a particular doctor to prescribe me (a transsexual man) testosterone? If so, how should I go about it?

I am a transsexual man (that's female-to-male) in the process of trying to hormonally transition. Many doctors are reluctant to prescribe testosterone without a letter from a therapist verifying that you've been psychologically evaluated, though some will do it using an informed consent model. I don't have the resources to track down a therapist after the one I was seeing refused to write the letter on invalid grounds.

A few months back I found a doctor who said she might be willing to prescribe testosterone for me once she'd done more research and was convinced it was safe. Well, she just got back to me, and she's refusing to prescribe on the grounds that some of the effects are irreversible. I sent her a reply telling her that that's what I want, and that I am informed about the entire process. It's been a week and she hasn't gotten back to me. There is one other doctor* I'm looking into and have an appointment with, but if he doesn't work out I'm sunk.

*The first is a GP, and the second is an endocrinologist who has never prescribed HRT before.

Should I keep pushing the first doctor, or let it go? I've considered talking to her in person, but that means confronting her in the health center, which means paying the bill for a visit. There are plenty of arguments I could use, but I don't know how to deliver them, or if they would just end up making me look stubborn.

How should I handle this?

posted by anonymous to human relations (13 answers total)

My guess is that this is an issue related to scope of practice and standards of care. The former implies that health care professionals should only practice in areas in which they have received training. The latter implies that practitioners should follow procedures and protocols that are widely adopted in their fields. To do otherwise exposes the practitioner to liability should things go wrong. It's not enough for a patient to offer to sign a waiver - the doc is the professional and has to make decisions consistent with his/her training and the standards in the field. In other words, I doubt that pushing would make any difference unless the doc is interested in expanding her practice to include these treatments.

You don't say where you are located, but your best bet might be to search out resources connected to a transexual community near you. Chances are you can connect with a doctor who has been trained and is familiar with the procedures.
posted by jasper411 at 9:31 AM on January 13, 2010

I don't have the resources to track down a therapist after the one I was seeing refused to write the letter on invalid grounds.

This sets off alarms in my head. The gender reassignment process (whatever you'd like to call it) is a complex thing and has many 'checks' in it to ensure that things are going well. This is not a fly-by-night type of work.

If your therapist has put up red flags, doctor shopping is not going to fix those problems.
posted by unixrat at 9:32 AM on January 13, 2010 [2 favorites]

Is there a GLBTQ advocacy center near where you live? Folks there should be able to help you. Failing that, the site TheTransitionalMale.com has information about therapists and health care providers.

If you're in the US, be aware that a lot of doctors in the US work for practices and HMOs that follow the Harry Benjamin Standards of Care when working with gender-transitioning patients, which specifically state that those patients need to have psychological evaluations before being prescribed hormones. If that's a practice-wide or HMO-wide guideline, pressuring the doctor isn't going to accomplish anything, and you'd be better off spending the time finding either a new therapist or a doctor who doesn't follow the Benjamin Standards (or both).
posted by Sidhedevil at 9:33 AM on January 13, 2010 [4 favorites]

If your therapist has put up red flags, doctor shopping is not going to fix those problems.

It's certainly possible that that particular therapist could be inexperienced in working with gender-transitioning patients, or just not particularly competent--I have some friends with absolute horror stories on this topic. Finding a therapist who is experienced in working with gender-transitioning folks is probably the best choice for the OP.
posted by Sidhedevil at 9:35 AM on January 13, 2010 [7 favorites]

When my partner transitioned, he had to educate his doctor. He had a good prior relationship with her, and he put together a packet of medical journal and other articles, with a cover letter I think, for her. One reason we like her as a doctor is that she was willing to educate herself about the issue, and she has become a local "good doctor" for trans people in the years since. Based the the information he gave her, and I think some of her own research, she was willing to go outside the standards of care.

That said, if you don't have a doctor you can do that with, finding a new doctor (or therapist, if you're more comfortable with that) is probably your best bet. I do not know on-line trans communities anymore, but that's where I'd start.
posted by not that girl at 10:30 AM on January 13, 2010

I would start by looking at online forums and resources for identifying physicians with experience in gender reassignment. This is not what I would consider to be part of the scope of routine primary care or something physicians are trained to know how to do. I certainly wasn't through medical school or internal medicine residency, and I wouldn't know the first thing about how to prescribe testerone for hormonal transitioning. I suspect your random doctor out of the yellow pages would be in the same boat, so you really need to do some research and find someone who actually know what they're doing, as opposed to doctor shopping or trying to convince someone who is uncomfortable with prescribing testosterone to do so. The latter are going to be an utter waste of time. It would be like trying to convince a radiologist to do brain surgery on you.
posted by drpynchon at 10:37 AM on January 13, 2010

If you are in any sort of large city, or near one, there are doctors and therapists who have worked with transitioning patients before. Definitely try to find one of those. The thought of having to teach a doctor about transitioning and deal with all of the stuff in your own life seems exhausting!

Check out Andrea James' Transexual Road Map for about a billion resources.

Best of luck to you!
posted by Sophie1 at 10:38 AM on January 13, 2010 [1 favorite]

I don't want to sound like a total dick, but I want to strongly encourage you to find a new therapist who can support you on your way to make the right decision for you.
The creator of the classic game M.U.L.E. - Dan/Daniell Bunten Berry- had her own thoughts about it.
Otherwise the last paragraph of jasper411's post gives you the best advice.
posted by mmkhd at 10:41 AM on January 13, 2010 [2 favorites]

If you're anywhere in MA or close enough to, MeMail me.
posted by zizzle at 11:13 AM on January 13, 2010

Check out Andrea James' Transexual Road Map for about a billion resources.

It's a great site, but unfortunately it's useful primarily to MTF transitioners. There's some information on there about choosing a therapist that might help the OP, but it doesn't really have any information for FTMs looking to transition.
posted by etoile at 11:25 AM on January 13, 2010

Many doctors are reluctant to prescribe testosterone without a letter from a therapist verifying that you've been psychologically evaluated

This is a good thing, though, no? Instead of spending all of this time and frustration looking for a doctor to get around what is a totally valid safeguard (IMO), why not either work to mend things with your previous therapist or find a new therapist that you can work with through your transition?

I sympathize that delaying things to "start over" seems maddening, but I think you owe it to yourself to do this the right way, with a doc who knows what they're doing regarding hormonal therapy.
posted by desuetude at 11:26 AM on January 13, 2010 [1 favorite]

The creator of the classic game M.U.L.E. - Dan/Daniell Bunten Berry

Thank you for posting this, I had never seen it and had no idea at all. MULE is an awesome, fantastic game.
posted by rr at 3:28 PM on January 13, 2010

It's so hard to know from these questions, so... IF you are in Canada, here are some directions to resources:

• Trans PULSE Resource Guide
• There's a collection of provincial resources at the end of this article from The Positive Side (Canadian magazine for people living with HIV), which also notes:

To find a trans-positive doctor, particularly if you live in a smaller town or city, Scanlon suggests looking for practitioners who have worked with people with HIV/AIDS and with those from the lesbian, gay and bisexual communities. “They may not have any experience working with trans people yet, but often they have proven themselves to be patient-centred, progressive and willing to research what they don’t already know.”

Off topic, but if you're into dudes, you might be interested in queertransmen.org, which publishes a lovely guide called Primed: The Back Pocket Guide for Trans Men and the Men Who Dig Them along with some other resources.
posted by heatherann at 6:38 PM on January 13, 2010