Manning up isn't going that hot.
June 6, 2016 11:05 AM Subscribe
I'm a transmasculine transgender person, who was assigned female at birth. I got my first shot (50 ml?) 10 days ago in the Endocrinologist's office, on a Friday. I'm scheduled to take shots every two weeks. If I get no more shots, how long will the testosterone currently last in my body, and when will my hormones balance out again?
As I'm Trans, I completed the 3 months of counseling that my insurance requires, I found a very trans-friendly Endocrinologist that is on my insurance, and we agreed that we should give a low dose of Testosterone a try - which made me elated!
Technical details - I'm 46, and not perimenopausal. I haven't had a hysterectomy, I don't plan one as part of my transition, and that part of my body is all working as expected. I'm taking 5 mg Buspar 2x a day for Anxiety, which worked like a charm. Unfortunately, I can't up that dose, as it gives me muscle weakness.
The Testosterone is not going well. I also have a history of anxiety and depression, both of which were under complete control before I started Testosterone. Since I had the shot, both got completely upended, and became problematic again. Panic attacks, crying, depressive and self harm thoughts, the works. (my docs and therapist know of these, and I'm not at risk of doing anything). We all agreed that Testosterone in this form is not for me, and I'm not going to get another shot of it. If this is what it's going to do, I'll just forgo this part of my transition for now. I know there's a gel, but my insurance doesn't cover that, and I'm a full time student - so I can't afford it out of pocket. So, I basically get to wait it out. How long will that be?
Thank you!
As I'm Trans, I completed the 3 months of counseling that my insurance requires, I found a very trans-friendly Endocrinologist that is on my insurance, and we agreed that we should give a low dose of Testosterone a try - which made me elated!
Technical details - I'm 46, and not perimenopausal. I haven't had a hysterectomy, I don't plan one as part of my transition, and that part of my body is all working as expected. I'm taking 5 mg Buspar 2x a day for Anxiety, which worked like a charm. Unfortunately, I can't up that dose, as it gives me muscle weakness.
The Testosterone is not going well. I also have a history of anxiety and depression, both of which were under complete control before I started Testosterone. Since I had the shot, both got completely upended, and became problematic again. Panic attacks, crying, depressive and self harm thoughts, the works. (my docs and therapist know of these, and I'm not at risk of doing anything). We all agreed that Testosterone in this form is not for me, and I'm not going to get another shot of it. If this is what it's going to do, I'll just forgo this part of my transition for now. I know there's a gel, but my insurance doesn't cover that, and I'm a full time student - so I can't afford it out of pocket. So, I basically get to wait it out. How long will that be?
Thank you!
IANAD, and don't know this answer first hand. But what you need to know is the half-life of injected testosterone.
Oh! And Dashy got there before I did.
Half of the testosterone will be metabolized out of your system in eight days. It'll take longer to completely clear, but yeah, not weeks. Since you were scheduled to get shots every two weeks, I would wager that you'll feel back to normal before your next scheduled shot.
You said you got your first shot 10 days ago, though -- are you feeling any better now than you were immediately after? Do you have a followup appointment with the endo any time soon, and did they say how long it would be before they expected you to start feeling better? If the answer to those is no, you really should call the Endo and make an appointment. Even low dose hormones can sometimes throw you out of whack for a little while, and there might be something they can do to help.
I hope you feel better soon!
posted by Made of Star Stuff at 11:58 AM on June 6, 2016 [1 favorite]
Oh! And Dashy got there before I did.
Half of the testosterone will be metabolized out of your system in eight days. It'll take longer to completely clear, but yeah, not weeks. Since you were scheduled to get shots every two weeks, I would wager that you'll feel back to normal before your next scheduled shot.
You said you got your first shot 10 days ago, though -- are you feeling any better now than you were immediately after? Do you have a followup appointment with the endo any time soon, and did they say how long it would be before they expected you to start feeling better? If the answer to those is no, you really should call the Endo and make an appointment. Even low dose hormones can sometimes throw you out of whack for a little while, and there might be something they can do to help.
I hope you feel better soon!
posted by Made of Star Stuff at 11:58 AM on June 6, 2016 [1 favorite]
I'm ftm and I had bad anxiety and mood swings when I was on that exact dose, but every two weeks. We changed it to half that dose, but injected once a week (thus leveling out the half-life trough at 8 days), and that fixed it.
Also, you're new to testosterone and your body is not used to it yet. I found that a lot of emotions calmed down after the first couple months. If you've never used it before and you still have endogenous hormones, my understanding is that you can experience some difficulties while your body acclimates to your new hormone base. So if you feel that you're not in a crisis, stick with it and see if it levels out-- it could be partially psychological or a temporary adjustment. If you are in a crisis, stop now and talk to your doctor about what else you can try. There is no one dose or timing that works for everyone, and it's not a requirement to be a man, so do what works for you!
Good luck! I hope you feel better!
posted by blnkfrnk at 12:18 PM on June 6, 2016 [3 favorites]
Also, you're new to testosterone and your body is not used to it yet. I found that a lot of emotions calmed down after the first couple months. If you've never used it before and you still have endogenous hormones, my understanding is that you can experience some difficulties while your body acclimates to your new hormone base. So if you feel that you're not in a crisis, stick with it and see if it levels out-- it could be partially psychological or a temporary adjustment. If you are in a crisis, stop now and talk to your doctor about what else you can try. There is no one dose or timing that works for everyone, and it's not a requirement to be a man, so do what works for you!
Good luck! I hope you feel better!
posted by blnkfrnk at 12:18 PM on June 6, 2016 [3 favorites]
On the insurance side of things, sometimes insurance will cover different medications or methods of delivery if your medical provider can provide documentation that other, insurance-preferred methods did not work or had severe side effects, etc. That is called 'step therapy'.
What you want to do is get the formulary, or drug list for your plan (this should be available on your insurance web site, it's easiest if you create whatever member access portal thing they have). In the formulary (.pdf probably) ctrl+f for the drug (testosterone, in this case) and see if different methods are covered and at what level. It may be that you just needed to submit prior authorization request from your doctor, or as I mentioned above to submit proof that other options don't work.
You also have the right to appeal denials of medication with your insurer. It takes time and paperwork, but maybe it is worth the try to you.
Apologies if you have already explored this route, but I thought I would suggest it in case you haven't.
If your medical provider doesn't have a lot of experience working with trans folks, you may also want to seek out community resources in your area for some guidance. A lot of these things are still being worked out or fought for by advocacy groups and so often there's not a lot of institutional knowledge or awareness outside of specifically LGBTQ organizations.
posted by tivalasvegas at 2:25 PM on June 6, 2016
What you want to do is get the formulary, or drug list for your plan (this should be available on your insurance web site, it's easiest if you create whatever member access portal thing they have). In the formulary (.pdf probably) ctrl+f for the drug (testosterone, in this case) and see if different methods are covered and at what level. It may be that you just needed to submit prior authorization request from your doctor, or as I mentioned above to submit proof that other options don't work.
You also have the right to appeal denials of medication with your insurer. It takes time and paperwork, but maybe it is worth the try to you.
Apologies if you have already explored this route, but I thought I would suggest it in case you haven't.
If your medical provider doesn't have a lot of experience working with trans folks, you may also want to seek out community resources in your area for some guidance. A lot of these things are still being worked out or fought for by advocacy groups and so often there's not a lot of institutional knowledge or awareness outside of specifically LGBTQ organizations.
posted by tivalasvegas at 2:25 PM on June 6, 2016
I don't personally have experience with the injection (though my partner does), but I'm on the gel. Does your insurance not cover ANY gel or just not the name brands? There's a generic now, so that might be worth checking on.
posted by HermitDog at 2:34 PM on June 6, 2016 [1 favorite]
posted by HermitDog at 2:34 PM on June 6, 2016 [1 favorite]
Response by poster: I'll answer this in one go; I was in class until now.
1. I'm not in crisis or in immediate harm. However, I do feel pretty awful - but I can still function and go to classes, do my homework (most of the time), etc. However, I'm going to be in school for the next year, with all of its ups and downs, and I want to get on a stable emotional base before resuming HRT. I may not even resume HRT; I identify as 'genderqueer transmasculine', and so far my dysphoria is under check with a name/pronoun change (he/him), and dressing in a more masculine matter.
2. I see my endo in three months for a followup, as I also have pre-diabetes, and she's also handling that. She also has experience treating trans patients.
3. I haven't investigated the gel yet and if there's a chance my insurance will cover it as an exception. I figure that the next 3 months will be enough to get my balance emotionally, go through my Summer Quarter class (which will be an advanced programming one, so I expect it to take up all of my time), and then contact my insurance company. I'm not opposed to using the gel, and that may be the perfect way for me to go in the future - especially since I tried the shot, and I consider these to be kind of intolerable side effects.
4. I've been going to regular meetings of a local trans support group in my area, and there is a transmasculine breakoff group, where I've also asked them the same stuff about testosterone.
5. I am starting to feel better emotionally, though I'm still getting some of the side effects. But, they are lessening, both physically and emotionally. Thank you, all.
posted by spinifex23 at 3:36 PM on June 6, 2016
1. I'm not in crisis or in immediate harm. However, I do feel pretty awful - but I can still function and go to classes, do my homework (most of the time), etc. However, I'm going to be in school for the next year, with all of its ups and downs, and I want to get on a stable emotional base before resuming HRT. I may not even resume HRT; I identify as 'genderqueer transmasculine', and so far my dysphoria is under check with a name/pronoun change (he/him), and dressing in a more masculine matter.
2. I see my endo in three months for a followup, as I also have pre-diabetes, and she's also handling that. She also has experience treating trans patients.
3. I haven't investigated the gel yet and if there's a chance my insurance will cover it as an exception. I figure that the next 3 months will be enough to get my balance emotionally, go through my Summer Quarter class (which will be an advanced programming one, so I expect it to take up all of my time), and then contact my insurance company. I'm not opposed to using the gel, and that may be the perfect way for me to go in the future - especially since I tried the shot, and I consider these to be kind of intolerable side effects.
4. I've been going to regular meetings of a local trans support group in my area, and there is a transmasculine breakoff group, where I've also asked them the same stuff about testosterone.
5. I am starting to feel better emotionally, though I'm still getting some of the side effects. But, they are lessening, both physically and emotionally. Thank you, all.
posted by spinifex23 at 3:36 PM on June 6, 2016
A form of medicaid( IL) I work with doesn't cover the gel but covers a patch instead.
posted by AlexiaSky at 4:21 PM on June 6, 2016 [1 favorite]
posted by AlexiaSky at 4:21 PM on June 6, 2016 [1 favorite]
Response by poster: If it helps, I'm on WA State Medicaid, which is AppleHealth. My plan is through Community Health Plan of WA State.
posted by spinifex23 at 5:49 PM on June 6, 2016
posted by spinifex23 at 5:49 PM on June 6, 2016
One of my partners had a similar experience. Lowering the dose to 25mg helped, but ultimately it just took time. Your estrogen/progesterone levels may fluctuate wildly trying to "get the upper hand," so to speak, until the testosterone overrides them and a new balance is established. This process can take months.
My doctor friend says intramuscular injections actually have slower release than patch or gel, keep that in mind if you're worried about seesawing.
(DM me if you want to chat. My partner stopped T after a few months. His body changed very, very rapidly and when he started to pass as male, he regretted losing certain feminine features, especially the sharp angles of his face. He ultimately realized he identified more closely as genderqueer, transmasculine and androgynous. He decided to work out to increase his musculature and may or may not get top surgery.)
posted by fritillary at 6:46 PM on June 6, 2016
My doctor friend says intramuscular injections actually have slower release than patch or gel, keep that in mind if you're worried about seesawing.
(DM me if you want to chat. My partner stopped T after a few months. His body changed very, very rapidly and when he started to pass as male, he regretted losing certain feminine features, especially the sharp angles of his face. He ultimately realized he identified more closely as genderqueer, transmasculine and androgynous. He decided to work out to increase his musculature and may or may not get top surgery.)
posted by fritillary at 6:46 PM on June 6, 2016
If this is the right drug coverage list for your plan, you're in luck. The 1% Androgel (which recently went generic, at long last, though it's not much cheaper) is covered. That's really the thing to try next.
A form of medicaid( IL) I work with doesn't cover the gel but covers a patch instead.
FWIW, the patch has a pretty dreadful reputation. It seems that if you don't start out reacting to the adhesive, you will eventually. It pretty much ranks at the bottom of the options.
My doctor friend says intramuscular injections actually have slower release than patch or gel, keep that in mind if you're worried about seesawing.
This goes against all the received wisdom and seems like it can't possibly be right. You'll get a spike on injection, which will then decay. The trick with injections is getting the combination of dose and injection cycle right so that the fluctuation from that spike and decay work for your body (assuming that's possible). Obviously, that same cycle happens with topicals too, but daily, meaning that your hormone level is much more consistent.
posted by hoyland at 4:42 AM on June 7, 2016 [1 favorite]
A form of medicaid( IL) I work with doesn't cover the gel but covers a patch instead.
FWIW, the patch has a pretty dreadful reputation. It seems that if you don't start out reacting to the adhesive, you will eventually. It pretty much ranks at the bottom of the options.
My doctor friend says intramuscular injections actually have slower release than patch or gel, keep that in mind if you're worried about seesawing.
This goes against all the received wisdom and seems like it can't possibly be right. You'll get a spike on injection, which will then decay. The trick with injections is getting the combination of dose and injection cycle right so that the fluctuation from that spike and decay work for your body (assuming that's possible). Obviously, that same cycle happens with topicals too, but daily, meaning that your hormone level is much more consistent.
posted by hoyland at 4:42 AM on June 7, 2016 [1 favorite]
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posted by Dashy at 11:51 AM on June 6, 2016