emergency estradiol refill needed in Houston TX
July 12, 2018 8:27 PM Subscribe
My trans daughter needs estradiol pills today. Her prescription estrogen refill was automatically denied by her doctor until after her next appointment--which isn't until August 6, twenty-five days in the future. Unfortunately, we did not realize it had been denied after we requested the refill last week, as the pharmacy didn't notify us, and we had a disconnect in which prescriptions needed to be picked up when. She is out of pills as of last night. What can we do?
Last month we called for a refill; the doctor's office said we needed to make an appointment before we could get it. Somehow she had forgotten to arrange the next appointment when she left her previous appointment six months before. So, we made an appointment and got one month's refill approved.
That prescription ran out yesterday. I called the pharmacy to find out what the hold-up was, and they told me it had been denied. I called the doctor's office, and after waiting on hold for fifteen minutes learned that they will NOT approve another refill without seeing her. "What if she needs to change the dosage?"
They said that maybe (though maybe not) we could get a same-day appointment tomorrow if we call at 7:00 am. I remember trying this when we wanted to get her in for her initial appointment several years ago, but it never worked then. Phone on speed-dial, trying to call late enough not to get the "we're closed" message and early enough not to be beaten by all the other people desperate to be seen right away. So frustrating and it didn't work for me. Maybe it will work this time?
This doctor's always been more difficult to reach than any of our other doctor's, but that's the deal when you need a gender care doctor. They are in short supply, I understand, even in the big city.
I called the pharmacy back and asked if we could "borrow" a few pills, like we did the time she forgot to refill her antidepressant. Nope. They can not lend us any pills when the doctor has denied a prescription. "What if she needs to change the dosage?", they asked (like the pharmacist).
Complicating matters is that all reasonably possible appointments are unavailable until at least Monday. We're leaving for a long-anticipated vacation with relatives for two weeks starting on Saturday morning. I guess my daughter will just have to stay home if she can't get her refill. But she's suffering from depression. I can't just leave her home alone without her meds, given the depression. (She's twenty-six years old and has legally changed her name and gender.) At least she does have enough spiro to get her through until then. Just no estrogen.
Is there anything else we can do?
Last month we called for a refill; the doctor's office said we needed to make an appointment before we could get it. Somehow she had forgotten to arrange the next appointment when she left her previous appointment six months before. So, we made an appointment and got one month's refill approved.
That prescription ran out yesterday. I called the pharmacy to find out what the hold-up was, and they told me it had been denied. I called the doctor's office, and after waiting on hold for fifteen minutes learned that they will NOT approve another refill without seeing her. "What if she needs to change the dosage?"
They said that maybe (though maybe not) we could get a same-day appointment tomorrow if we call at 7:00 am. I remember trying this when we wanted to get her in for her initial appointment several years ago, but it never worked then. Phone on speed-dial, trying to call late enough not to get the "we're closed" message and early enough not to be beaten by all the other people desperate to be seen right away. So frustrating and it didn't work for me. Maybe it will work this time?
This doctor's always been more difficult to reach than any of our other doctor's, but that's the deal when you need a gender care doctor. They are in short supply, I understand, even in the big city.
I called the pharmacy back and asked if we could "borrow" a few pills, like we did the time she forgot to refill her antidepressant. Nope. They can not lend us any pills when the doctor has denied a prescription. "What if she needs to change the dosage?", they asked (like the pharmacist).
Complicating matters is that all reasonably possible appointments are unavailable until at least Monday. We're leaving for a long-anticipated vacation with relatives for two weeks starting on Saturday morning. I guess my daughter will just have to stay home if she can't get her refill. But she's suffering from depression. I can't just leave her home alone without her meds, given the depression. (She's twenty-six years old and has legally changed her name and gender.) At least she does have enough spiro to get her through until then. Just no estrogen.
Is there anything else we can do?
Can you both show up at the doctors office tomorrow morning? Since phoning is an issue, just be the first patient to walk in the door and explain the situation. If you can’t get appointments with any of her health care providers immediately, another option may be to take the medication history from the pharmacy to a walk-in clinic to ask for a 25 day prescription, or failing that, two weeks to hopefully allow time to see a member of her health team. Third choice, can it be ordered from Mexico or Canada via online pharmacies?
posted by saucysault at 8:46 PM on July 12, 2018 [2 favorites]
posted by saucysault at 8:46 PM on July 12, 2018 [2 favorites]
An Emergency Department might also be an option, but I would run through PCP/Urgent Care/Sit-In at the specialist's first.
posted by lazuli at 8:49 PM on July 12, 2018
posted by lazuli at 8:49 PM on July 12, 2018
You might try Planned Parenthood. They see trans people in some areas, but I don't know about Houston off-hand. (KIND clinic in Austin sees trans people, but I have a vague idea they're only open Saturdays. I could be totally wrong.)
Unfortunately, refusing refills until someone comes in is a fairly common tactic (although kind of absurd when you've been on the same dose for years). It's terrifying when you think you're going to run out of hormones, never mind it actually happening, but it's something that happens to a lot of people sooner or later and she can make it until August if she has to. (If it's a protracted situation you want to think about stopping spiro because you need some sex hormone for bone health, but afaik that's not a factor on this sort of timeline.)
posted by hoyland at 9:07 PM on July 12, 2018 [3 favorites]
Unfortunately, refusing refills until someone comes in is a fairly common tactic (although kind of absurd when you've been on the same dose for years). It's terrifying when you think you're going to run out of hormones, never mind it actually happening, but it's something that happens to a lot of people sooner or later and she can make it until August if she has to. (If it's a protracted situation you want to think about stopping spiro because you need some sex hormone for bone health, but afaik that's not a factor on this sort of timeline.)
posted by hoyland at 9:07 PM on July 12, 2018 [3 favorites]
Memail me.
posted by fritillary at 10:16 PM on July 12, 2018 [7 favorites]
posted by fritillary at 10:16 PM on July 12, 2018 [7 favorites]
Show up at the doctor's office first thing in the morning.
If that doesn't work (or, have someone do this over the phone out of the hearing of the staff of the first doctor's office while you are waiting), call PCP and ask them to prescribe.
Urgent care might be willing to help.
If you have a transgender resource center where you live, see if they have any suggestions.
posted by yohko at 10:48 PM on July 12, 2018
If that doesn't work (or, have someone do this over the phone out of the hearing of the staff of the first doctor's office while you are waiting), call PCP and ask them to prescribe.
Urgent care might be willing to help.
If you have a transgender resource center where you live, see if they have any suggestions.
posted by yohko at 10:48 PM on July 12, 2018
I second physically going to the doctor's office first thing in the morning. Also if you ever run into the "what if she needs to change her dosage?" question again, the answer is "You've just changed her dosage without seeing her. To zero." Them being highly conscientious about meds is fine, but the other side of the coin is that they have to make a similarly conscientious effort to actually see her in a timely manner.
posted by trig at 11:27 PM on July 12, 2018 [55 favorites]
posted by trig at 11:27 PM on July 12, 2018 [55 favorites]
All the medical advices are sound.
So on a different note - you could reach out to the trans community, many of whom will be on the same medication and be able to help with a short term cover.
posted by intergalacticvelvet at 2:19 AM on July 13, 2018 [1 favorite]
So on a different note - you could reach out to the trans community, many of whom will be on the same medication and be able to help with a short term cover.
posted by intergalacticvelvet at 2:19 AM on July 13, 2018 [1 favorite]
As a former medical office employee, I agree that denying someone their medication in a case like this is bullshit. The office should be doing a WAY better job managing their followup appointments and what we call recall scheduling. This type of medication crap isn’t limited to gender care and it sucks.
For today, go to the office in person first thing and quell your justified anger. Be nice, apologize for the oversight (it’s falling, I know. But if the person you get at the desk is on a power trip, this is not the time to explain that the office failed. You’d be right, but it won’t get you the help you need today and it will leave a bad taste in the mouth kdnthat person for the future). Explain that you are willing to wait all day for a spot, a cancellation, anything. You’ve brought a book, coffee for yourselves, donuts for the staff and you’re here to get this done today. Schedule the next appointment for six months out before you’re even seen.
Sadly, donuts are the magical currency of medical office favors. They may not be able to get you seen right at 7, but they’ll smooth the way for this and future ‘fabots.’
posted by bilabial at 4:06 AM on July 13, 2018 [6 favorites]
For today, go to the office in person first thing and quell your justified anger. Be nice, apologize for the oversight (it’s falling, I know. But if the person you get at the desk is on a power trip, this is not the time to explain that the office failed. You’d be right, but it won’t get you the help you need today and it will leave a bad taste in the mouth kdnthat person for the future). Explain that you are willing to wait all day for a spot, a cancellation, anything. You’ve brought a book, coffee for yourselves, donuts for the staff and you’re here to get this done today. Schedule the next appointment for six months out before you’re even seen.
Sadly, donuts are the magical currency of medical office favors. They may not be able to get you seen right at 7, but they’ll smooth the way for this and future ‘fabots.’
posted by bilabial at 4:06 AM on July 13, 2018 [6 favorites]
Are you or she on any local queer or trans Facebook groups? In my local group, folks help each out with this kind of thing. Also, have you contacted the Montrose Center to see if they have any resources?
Also if you ever run into the "what if she needs to change her dosage?" question again, the answer is "You've just changed her dosage without seeing her. To zero."
This line is golden. And absofuckinglutely correct.
Also seconding the advice to try her PCP. My PCP now prescribes my ADD meds because the psychiatrist I was seeing was unreliable and...uh...not great (long story, not terribly relevant here.) But what I wanted to share with you was her rationale: she wouldn't have been comfortable issuing the initial prescription, but since I was diagnosed by a specialist and she was just authorizing the refill, she is okay with that.
posted by desuetude at 7:47 AM on July 13, 2018 [1 favorite]
Also if you ever run into the "what if she needs to change her dosage?" question again, the answer is "You've just changed her dosage without seeing her. To zero."
This line is golden. And absofuckinglutely correct.
Also seconding the advice to try her PCP. My PCP now prescribes my ADD meds because the psychiatrist I was seeing was unreliable and...uh...not great (long story, not terribly relevant here.) But what I wanted to share with you was her rationale: she wouldn't have been comfortable issuing the initial prescription, but since I was diagnosed by a specialist and she was just authorizing the refill, she is okay with that.
posted by desuetude at 7:47 AM on July 13, 2018 [1 favorite]
Yeah, short term the way everyone I know deals with this is to call friends and ask if they can spot you some.
Long term the way everyone I know deals with this is to occasionally skip a dose, and so build up a buffer of extra pills (which is also why we're sometimes able to spot our friends some). Oral estrogen and spiro are both harmless to skip occasional doses on. I'm not saying she should do this, but TBH she should probably do this.
posted by nebulawindphone at 8:10 AM on July 13, 2018 [4 favorites]
Long term the way everyone I know deals with this is to occasionally skip a dose, and so build up a buffer of extra pills (which is also why we're sometimes able to spot our friends some). Oral estrogen and spiro are both harmless to skip occasional doses on. I'm not saying she should do this, but TBH she should probably do this.
posted by nebulawindphone at 8:10 AM on July 13, 2018 [4 favorites]
Mod note: From the OP:
Thank you so much. I love you all! Something wonderful happened. We have the prescription in hand.posted by restless_nomad (staff) at 8:24 AM on July 13, 2018 [31 favorites]
It turned out that my daughter had to switch pharmacies a few months back when her new insurance would not cover the old pharmacy, and there was still one refill remaining there. It's enough to get us through to the next appointment. I wish we'd thought of this sooner.
i will be taking her to my primary care physician next month in order to line up another doctor who is more available for emergencies. She saw her before, before she transitioned, and she is often quickly available for an appointment. I don't know if that doctor will be willing, but, if not, we will go to another, and so on. Just the way I had to go to a new endocrinologist to treat my thyroid problem until I found one who would do it right. I'd rather not go to an Urgent Care if we can manage another way, because well, this is Texas, and I fear running into someone there who would be unkind.
With my own prescriptions, I can renew them a few days before I run out. I always refill as soon as possible, and have built up over a month's backlog on my most important meds. (Essential hurricane preparedness activity.) I have strongly urged her (again) to do the same.
I am so grateful to have had your responses. This community is so incredibly valuable.
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posted by AlexiaSky at 8:40 PM on July 12, 2018 [5 favorites]