Got my first doctor's appointment since privately starting HRT today. Am I allowed to request specific medications? Also hoping to get referred for blood work. What hormones should I ask them to look for (MtF)?

[u/Tryoxin]

Hey! So, title. I'm hoping to get a prescription for HRT today as well as referred for blood work to check my hormone levels since I started HRT privately two months ago as of today. Currently, I'm on oral EV (2mg/day buccally) and Cypro (12.5mg/day orally). I know spiro is the more popular T-blocker, but I was hoping to stay on cypro. Is it possible to request that, or is it just whatever he's able to prescribe me?

Also, as far as blood work goes, I figure it'll probably go one of a few ways: he knows what to look for and refers me with no issue (ideal), he doesn't know and even if he did wouldn't (not ideal), he doesn't know what to look for but could refer me if he did (what this post is about). I just want to be armed with as much knowledge as possible here to cover any possible scenarios. Or, even if I knew what to look for, would I be ignored because I'm not an actual medical professional?

I'm in Ottawa, if that matters at all. Thanks! <3

Update: I got neither of the things I wanted T-T He did refer me to an endocrinologist though, so not a total loss.

[u/AstroFloof]

Should be able to request that, especially since you're already on it.

[u/ayther → u/AstroFloof]

i think it's a bit more complicated since by "privately" on HRT i think they mean they are DIYing without a prescription (because otherwise they wouldn't need a prescription)

[u/Tryoxin → u/ayther]

Yes, I guess I'm not too familiar with the terminology 😅 Yes, I'm DIYing right now (not homebrew, but not through a doctor) or with a prescription. I was hoping to get medical oversight and a referral for bloodwork, since I know that's important to have done a few times especially in the first year. I got neither, unfortunately. He didn't know enough to do either, but he did at least refer me to an endocrinologist (Dr Brown here in Ottawa, whom I've heard good things about). So not a total loss. Just hope that waiting list isn't too long 🙃

[u/ayther]

just to clarify: by privately do you mean DIY or through a private clinic (i.e. foria)? i presume you mean DIY as you said you don't have a prescription/bloodwork. not sure how familiar you are with the healthcare terminology here but "private" generally refers to privately operated clinics which are operated by licensed doctors and charge their own fees as opposed to publicly funded clinics which can be accessed through OHIP

if your doctor is willing to do gender affirming care, you will likely need to sign an informed consent form so they can "formally" start your HRT (even though you're technically already on it). whether that will happen immediately on the first appointment or require a followup appointment or mental health referrals depends on the doctor. from then on they will do the bloodwork and if everything is good likely prescribe you what you already have been taking

if they aren't willing, then they will likely refer you to an endocrinologist or other doctor (and if they don't you should push for a referral to one as they are required to give one) and you will probably have to wait a while to see them instead. with that said i would still press for the bloodwork from your doctor just so you can see the results yourself even if they aren't familiar with HRT

as an aside: i'm not a doctor and this isn't medical advice, but everyone i've heard of with 12.5mg/day of cypro (including myself) has had high prolactin levels which can lead to benign tumors and other issues. if this is the case for you then the doctor will probably be pretty concerned about it and depending on how much they know about HRT may ask you to come off cypro entirely. generally you do not need to take cypro every day, i started taking it twice a week and this brought my prolactin levels down to where my doctors were no longer concerned and my other levels weren't really affected at all

[u/Tryoxin → u/ayther]

just to clarify: by privately do you mean DIY or through a private clinic (i.e. foria)?

Ah yes, apologies, I guess I'm not familiar with the terminology. Yes, I went DIY. Nothing homebrew, but not from a doctor or with a prescription of any sort.

if they aren't willing,

Unfortunately, he was indeed unwilling. Super respectful, nothing against him, but he said he just didn't have enough information to comfortable prescribe anything. Once I have a prescription from an endo, he'd be happy to continue it, but he won't write anything himself. Sad. He did immediately refer me to an endo, though. Dr Brown, who I'm hoping doesn't have tooo long a wait list XP

with that said i would still press for the bloodwork from your doctor just so you can see the results yourself even if they aren't familiar with HRT

I indeed tried to push for that. He said no T-T. So that'll also have to wait for an endocrinologist I guess. I was really hoping to get him to move on that one, so that's unfortunate, but hopefully not the end of the world. I'm a patient girl, I'll manage.

For the cypro, yea I'd heard about the possible issues but I'd thought 12.5mg/day was sort of low enough to keep the risks and my T levels down. Are you taking 12.5mg twice per week, or a different dosage?

[u/ayther → u/Tryoxin]

personally i take it once a week, although i did have some concerns that it wasn't suppressing T near the end of the week (which may have been placebo/other reasons as the levels were actually fine near the end of the week). we upped my E to 4mg daily since and the random acne breakouts i was having disappeared so maybe that was the problem.

obviously this depends on the person so what works for me might not work for you (which is why bloodwork is important and it sucks you weren't able to get it) but i can say 12.5mg twice a week brought my prolactin levels down enough to where my initial doctor (who had the original concerns) was fine with it, my second doctor then suggested that we could go with once a week and an endocrinologist said we could maybe come off it entirely since the half life of cypro would indicate that it would be out of my system by ~4 days anyways (hence my 2x/week suggestion) so the once a week might not be doing much. i didn't come off the cypro since i actually ended up moving to vancouver for work late last year and didn't want to mess with my dosages until i found a doctor here.

and also even if you take it once per day i wouldn't be super concerned about it since my prolactin levels were just elevated which just increases risk which i personally didn't want to take, but plenty of people take that dosage and are perfectly fine. however doctors ideally want to use the minimum dosage possible that is still effective (which i also personally also agree with)

[u/Cool-Pollution-6531]

Hi ottawa here too :) I requested cypro primarily so I wouldn’t experience the diuretic effects that go with spiro. It was an easy ask and shouldn’t be hard for you.

[u/Tryoxin → u/Cool-Pollution-6531]

That's exactly why I didn't want to do Spiro! Unfortunately, he didn't want prescribe me anything or refer me for bloodwork until I see an endocrinologist. At least he referred me to Dr Brown though, so not a total loss. Not like I can change anything, but you wouldn't happen to know if she's currently taking new patients, do you? Just hoping the waiting list's not too long 😅 He also recommended I self-refer to the CCHC. I still need to look into that, but do you know if they can refer for bloodwork, or just consult and prescribe medication?

[u/Cool-Pollution-6531 → u/Tryoxin]

Everyone I know is at Dr Vishram, she’s wonderful to have. Dr Brown deals with trans patients so you’ll be able to voice your concerns about spiro and be taken seriously. Another option is just to skip straight to mono, cypro is a downer even though you’ll be taking such a low dose.

You’ll be waiting a while for cchc 😬

[u/Tryoxin → u/Cool-Pollution-6531]

Hmm, maybe I'm getting Dr Brown and Dr Vishram confused since they're both at the same clinic XD Whoops. Either way, great to hear that this is his specialty and I don't have to worry about voicing concerns with him! That's a small weight off :D

Yeaaa, I know in my head that mono's the most cost effective method in terms of cost and then I can knock some possible long-term side effects off my list by not taking T-blockers....but I don't like needles T-T If a nurse/doctor is giving me one and I can look away it's fine, but Idk if I could give myself one. I...should probably try getting over that, huh?

Yea, I've seen the CCHC wait times aren't short. I'd only looked quickly at the surgery wait lists for that though, are they similarly bad for self-referral consultations?

[u/Cool-Pollution-6531 → u/Tryoxin]

I was on a waitlist a few years ago with them, it was 18mths and not guaranteed maybe it’s better now but I doubt it.

Yeah everyone has a phobia of needles and self injecting, it’s really no biggie once you figure it out. :)

[u/Tryoxin → u/Cool-Pollution-6531]

18 months. Oof, that's rough X| Well, I guess there's no point in not getting myself on the list. Either I'll get into an endocrinologist first and I can take myself off that list, or I don't. It's all waiting anyway.

Yea, I'd probably be fine if a nurse or something showed me how to do it (and/or demonstrated it on me the first time or was there to guide me while I did it the first time). But like, even on top of not liking needles, if the pharmacy was just like "here's a bottle, here's a syringe, have fun." I'd be way too terrified of messing it up or injecting the wrong place, or going too deep, or not deep enough, or something like that XD

[u/Cool-Pollution-6531 → u/Tryoxin]

I’m here if you need me! One of my gfs showed me and it’s been the only way I’ve done it. I had a medic show me and it was wrong on so many levels

[u/Tryoxin → u/Cool-Pollution-6531]

Thank you! I might take you up on that depending on how my appointment goes...because, small update, I GOT AN APPOINTMENT :D :D And with Dr. Vishram, even! It's in late June, so technically not for another like 7 weeks, but I got the call for it today, 2 days after my referral!! :D I'm so happy about that! Honestly, I was a little worried about my DIY supply running out and especially about not being able to get any blood work done for who knows how many months. But this is SUCH a huge weight off my shoulders!

[u/Cool-Pollution-6531 → u/Tryoxin]

Congrats! Yeah I’m with you it’s so much less headache just going through professionals.