My GP gets upset about my HRT

[sandra-leigh]

I started Spiro at the beginning of January. I had an appointment with my GP (General Practitioner) just a week or two afterwards, but the GP went off on such an odd tangent that I just wanted to get out of there, so I didn't tell him about the spiro then. I had an appointment with him in February that I missed going to. Having missed, I dragged my feet but eventually made the appointment and went today.

As usual when I got in, I laid my medications out on the counter. All of them, including the spiro and E patches. He didn't react visibly to the spiro, but he was obviously unhappy about the E patches. He asked me about them; I said how long I'd been on the spiro and the E and briefly explained my goals.

Well, he was somewhat less than happy :sad: He twice said that he could just could just call up the governing body and get the other clinic's doctor's license yanked. (I imagine he'd find it more difficult than that, as he is not popular with the governing body, and the clinic is being funded by the province as a safe haven for transgendered people.)

He again (see my past postings) asserted that the regime I was taking was the route to breast cancer and heart attacks, and made reference to an unnamed UK study -- but I remember that the time last year that he made reference to the same study, it involved cases where anti-androgens were not used. I had already mentioned Spiro as an anti-androgen; he said it is not one, which is contrary to any information I have been able to find at home tonight.

I indicated that the regime is standard practice and is part of the Standards of Care for British Columbia and many States; he sneered at it as being "pseudo-science".

I referenced the studies I had found, such as the Dutch study with only one case of breast cancer in 23000 patients (the correct figure might be 2300). He said, not kindly, "I'm sorry that your research has misled you". I asked, "Okay, so I've been finding the wrong research; what papers should I be looking at? Where can I find the better research?" He told me I needed to go back to the clinic and demand the research from them.

He specifically said during the conversation that I was "looking at the expert in Hormone Replacement" and that he'd recently given a talk on it in Miami and also in the city I'm in. I've been looking around the 'net since I got home and I have not yet found any hint or evidence of his having anything to do with Hormone Replacement.

I was instructed to go back to the other clinic and talk with them, and that I was required to decide whether they were going to take on my primary care or if I was going to stop going to them and stay with him.

:beatup:

I asked specifically whether I will still be able to proceed with hormone therapy if I stayed with him; he said Yes, and that he would refer me to specialists. He also mentioned in passing issues such as FFS and breast implants, which he was fine with as they had no lasting health impact.

Early in the discussion he asked me why I didn't get my testicles removed. I did, later in the conversation, manage to get one specific drug name out of him (Taxol) which I gather would shut down the production of testosterone. It is hard to tell due to the thickness of non-information that he gave me, but it appears to me that he advocates drastic measures -- measures that might in fact be quite suitable for someone who was certain and determined to go through SRS, but not (as best I could tell) measures that were suitable for transgendered people exploring their place in life.

:brolleyes:

I have been online tonight looking for papers. I have not yet been able to find any hint that the standard regime is seriously flawed: the most severe of the papers basically say "We don't have enough information, but there have been two proven deaths, and there might have been some others." (Yes, just two, world-wide, at least due to the sorts of issues that my GP was talking about.)

I don't know for sure yet what I am going to do. I will talk to my gender therapist; I can pretty much predict her reaction. I will also talk to my regular therapist (who thinks my trying HRT is the right thing for me to do.)

:sh:

At this point, I essentially need to evaluate: is my GP [-]lying[/-] overstating his knowledge of the topic, or is he indeed so extremely versed in the topic that he is contemptuous of the common (published) understanding of it as being dangerously inept? Or does he happen to know something that hasn't really made the rounds yet and has a complex about having his knowledge challenged?

:Pullhair:

[AllieSF]

Wow, a complicated set of circumstances that does need to be sorted out. First, there must be some reason you still go to this doctor after the rather rough way that he handled you. What is it? Does he normally have good bed side manners, give you all the time it takes to ask questions and give thorough answers, does he have a great reputation? Since he is your general care provider and I assume refers you to specialists when needed, I would think that he could easily be replaced if that was necessary.

Second, you mentioned that you are "trying" HRT to see if that helps you. I now remember reading that in one of your previous posts. That time and this time, I am wondering why would a doctor give you body altering drugs that can also play with your mind? Drugs that are given for those that qualify for HRT and the concept of transitioning from male to female. I think from what I remember from that previous post of yours, is that you and your other doctor think that it may help you emotionally and that you can stop taking those drugs before any permanent changes take place. Is that a normal accepted approach to deal with these types of emotional issues? That has me confused, because you are the first person I have read about on this site that has a doctor supporting that approach.

Third, your general care provider may or may not have a valid point about the approach you are taking. But it appears that his personality and bed side manner is not answering your questions clearly and nicely enough to gain your trust in those opinions of his. I would not dismiss his opinions, just verify them from maybe a second or third opinion. He clearly thinks a lot about himself, maybe rightfully so, but you need to believe in him too. From all that I have read here, HRT drugs, hormones and blockers and all the rest, are not to be taken lightly at all. It is clear to me from what you have written that you also are not taking them lightly either. So, I recommend that you continue your research into your primary care doctor's comments and stated expertise, asking him, in a diplomatic way, for proof of his statements. I would also get another opinion from a brand new and HRT qualified doctor. In the end the decision is yours and that is exactly where it should be. But that decision needs to be based on some solid research on your part, which is not always easy. I do wish you the best of luck in sorting out all these differing opinions and approaches.

[Aprilrain]

TAXOL!?!?!?!? are you f@#$ing kidding me? this guy doesn't have the first clue what he is talking about. This is a cancer drug i.e. chemo therapy. After A two minute google search I found out that this drug is only to be prescribed while the patient is in a hospital because it has serious life threatening side effects like lowering your white blood cell count.
Why go back to this person? Who wants to argue with their doctor? He sounds like an arrogant jackass to me. All of the very limited information available on the subject is right there on the internet in black and white for anyone to read. The fact is virtually no real research has been done on the subject. Most of the information available on HRT involves natal women who are or have taken it for menopause. Is the risk of developing breast cancer higher on HRT? yes, blood clots, stroke, heart attack, yes, yes, yes. have people taken M 2 F hormones at pre SRS levels for many years without incident? yes. but heres the REAL question is taking estrogen and an anti androgen worth the risk to YOU. If not don't bother if yes then its probably best to stick with proven drugs and doctors comfortable prescribing them.

[sandra-leigh]

First, there must be some reason you still go to this doctor after the rather rough way that he handled you. What is it?

I went to him when I was severely depressed and literally couldn't get 2 minutes attention from another doctor; my GP took my condition entirely seriously, held all his other patients to deal with me that first day, and has worked with me on my depression for years. I owe him a great deal for that. Still, sometimes a child needs to leave home, as what worked or was acceptable in one set of conditions may not work or be acceptable when the child reaches (or regains) The Age Of Reason.


Does he normally have good bed side manners, give you all the time it takes to ask questions and give thorough answers, does he have a great reputation?

Is there a icon for snorting? His "bed side manner" is much disliked by a number of (ex) patients, with definite hints of "I know what's good for you" and sometimes elements of "you couldn't understand". Asking questions that hint that there might be factors he has not taken in to account usually leads to dismissive comments at the very least. Today with respect to the effects of Spiro his implicit message was that if I wasn't prepared to take him at his word, then he would expect me to pay for his time to lecture me about it. Note that in our medical system, GP visits are no charge for residents, and there are billboards around town specifically emphasizing the right of patients to ask questions, so this is a decidedly not-approved attitude to express to a patient.


Since he is your general care provider and I assume refers you to specialists when needed, I would think that he could easily be replaced if that was necessary.

No so easy. There is a shortage of family doctors accepting new patients.


Second, you mentioned that you are "trying" HRT to see if that helps you. I now remember reading that in one of your previous posts. That time and this time, I am wondering why would a doctor give you body altering drugs that can also play with your mind? Drugs that are given for those that qualify for HRT and the concept of transitioning from male to female. I think from what I remember from that previous post of yours, is that you and your other doctor think that it may help you emotionally and that you can stop taking those drugs before any permanent changes take place. Is that a normal accepted approach to deal with these types of emotional issues? That has me confused, because you are the first person I have read about on this site that has a doctor supporting that approach.

The original Benjamin standards of care state specifically that trying HRT is a differential diagnosis tool to confirm (some degree of) transsexualism. I have not yet found hard information on that, but if I understand correctly the basic finding at the time was that those who did not have an innate TS nature would likely find HRT to be a source of depression and mental and emotional confusion, but those who did have an innate TS nature would
likely find HRT to be peaceful and relaxing.

The original Benjamin standards do not expect everyone to go to SRS, and found that a fair number of people were comfortable living their life with HRT without SRS. I posted recently a reference to Gender Outlaw that said studies showed that most MTF do not dislike their male genitals; I haven't tracked that back to a specific citation as yet.

The expectation that HRT is only for those "transitioning" is strongly associated with the Gatekeeper approach, which is based upon the implicate premise that the Gender Binary is real, and very high barrier, and that there must be extraordinary proof of membership on the other side in order to be permitted access to treatment. This lead to "The Script", to TS learning that they had to tell the right story about "always having known" and "played with dolls" and so on, in order to get access to treatment.

The city I live in has a strong gender study program at one of the universities, and is one of the (multiple) places world-wide that is developing the idea that gender is not at all well defined or black and white, and that no substantive barriers beyond informed knowledge of the medical risks should be put in place towards finding one's gender identity, including basic HRT. SRS still has higher requirements and the surgery is not done locally and is not funded by the medical system (but sometimes associated surgeries can be funded.)

So, Yes, trying HRT is accepted here. And the idea isn't to stop before there are permanent changes, but rather that the individual only continues HRT to the point they are comfortable with.

So far at least, HRT has been good for me, except for the tiredness I get from regular doses of Spiro.


Third, your general care provider may or may not have a valid point about the approach you are taking. But it appears that his personality and bed side manner is not answering your questions clearly and nicely enough to gain your trust in those opinions of his.

Yes. I owe him a lot for getting me to the point of being well enough to have the clarity of thought and the drive and inner resources that I can now question his professional opinion. But I'm there now and I am no longer satisfied with "Because I say so!". Distrust and rejection of "Because I say so!" is a reoccurring theme in my life.

[donnalee]

It sounds to me like he's slipped a cog. It's also proof that a doctorate does not necessarily indicate an intelligent person. Please find someone else; you're endangering your health and maybe your life if you don't.

[AKAMichelle]

I would definitely go back to the other clininc for your primary care. That jerk is just going to belittle you at every turn. You will not get the help that you need there so move on.

[KarenCDFL]

Hi,

The answer is simple.

It is time to find a new GP that has an open mind, is a lot more educated and is not such a bigot against LGBT folk.

[CharleneT]

What a complex problem ! Two things make me give the advice that you should seek out a new doc: the idea of giving you Taxol and what seems to be a very bad attitude about treatment for TS issues. You need a doc who is at least sympathetic to your needs, if not supportive. As for Taxol, as said earlier, that is so far out there, it is simply ridiculous. I work in a Pharmacy attached to the ICU's and Cancer wards here and work with this (and other similar) cyto-toxic agents every day. That is just plain nuts to recommend use of that agent unless you were dying of a cancer (specifically either breast or ovarian). It would be malpractice for certain to use it in this situation. That stuff is literally lethal. Find a new doc.

[Melody Moore]

Hi,

The answer is simple.

It is time to find a new GP that has an open mind, is a lot more educated and is not such a bigot against LGBT folk.

:yt:

Sandra,

Up until now I wondered why you were so mixed up about what you wanted, but after reading this
& realising how mixed up & crazy your doctor really is, it's no wonder you have been stuck in such
a quandary. Your doctor is only interested in helping himself more so than his patients. He is a bigot
that doesn't agree with transgendered people, so he hasn't offered any advice or support to help you.

It sounds to me that this quack has a bad case of 'little big man syndrome' for a start to be making claims that he can have another Doctor's license revoked. He only THINKS he knows better than thousands of other doctors around the world that are still prescribing hormone therapy without any of the issues he claims it has. I also don't know a single person who has started HRT without knowing the risks.

So it's really not in this jerk's job to try & play gatekeeper to you or anyone else who is already well aware of those risks and this is where the medical profession needs to be brought more into line & stick to a uniform code when it comes to dealing with transgender issues. Because I believe rogue doctors like this one are the quacks that need to have their licenses pulled, because their actions can cause even greater problems for those who are affected with GID.

If every doctor around the world was like him in how they respected & treated their patients, the suicide rate amongst
transgendered people will most likely hit the 95-100% mark. This quack is dangerous & should be avoided at all costs.

[AllieSF]

Thanks for the detailed reply to my queries. I again wish you the best of luck.

[sandra-leigh]

The GP has spent notable portions of our appointments in the past praising how bright I am and how courageous I am for exploring my gender. Which I usually shunt aside mentally into the "Blah, blah blah" bin. He hasn't seen me at work / hobby, so he doesn't have a basis for assessing how bright I actually am... that part just becomes noise, like my massage therapist saying that I must really know a lot about music just because I knew something about the background history to CSNY's "My House", which she'd never heard before.

The courage part... he has expressed the idea that gender explorations are a matter of choice. I just "hmmm"'d in response to that and didn't press the point; there didn't seem to be any benefit at the time to raising topics like the neurological studies such as I posted about yesterday in Media.

To me it isn't bravery: it's just what I need to do. Unless the bravery is in being willing to risk public censure by being different. I do agree that I had to "work myself up" to being willing to wear dresses in public without wearing a female disguise: I can agree that some bravery was involved there in my being afraid but going ahead and trying it anyhow. But that was then; now wearing a dress in public is "just what I do", not a renewed act of bravery.

With the GP lacking an understanding of TG/TS as being at least partly biological, real inner needs, he also seems to lack an understanding of TG/TS as an evolving exploration of one's self, an exploration that will take different paths and stop at different places for different people.

It's like he'd be fine if I "chose" to take the big plunge to hard TS with radical methods, but that the soft "this is where I am now" approach is not on his radar. If it's choice then I should just go ahead and choose FFS and SRS and what-ever else I need to live as a woman, but that if I don't choose that, then I must be choosing to continue to live as a male and that should be cool with me since it's just a choice


Melody, I'll give an analogy: when I hop on my bicycle (I don't drive a car), I don't focus on going from Point A to Point B by the most efficient route. Instead I turn down side streets and wonder through neighbourhoods; I ride across fields and beside railway tracks. I stop and dangle my feet in the brook, and sit on the rock in the sun. I take home some of the bittersweet (Solanum_dulcamara). This activity doesn't have a "goal", or if it does, then the "goal" is to have an experience. These days I am on to the path of experiencing HRT, and if the path happens to run in to a marsh with nettles, then I'll get out of the marsh and pull off the nettles, and probably say "I wonder what I'll find if I go around?", rather than cursing Life that put the marsh in my path. I don't just take The Road Less Traveled: I get scratched a bit pushing the underbrush aside, I slap a mosquitoe, and I say, "Oh, look at the lovely birds; I'm glad I went this way."

[Jessinthesprings]

Dear if you can get a new doctor get one. He is not doing you any favors. It's one thing to challange your assertions but his attitude is arrogant, belittling, and a touch of biggotness... We are not transitioning for the fun of it. For many of us its transition or death. Simple as that. My understanding is transr on HRT have no more incidences of breast cancer than natal women. So we just need to be educated. Know what to look for and get mamograms. The rest, as long are you are getting your blood tests and BP checed (make sure the sprio is not dropping it too much) on a regular baisis the pros out number the cons.

[Eryn]

I had an appointment with my GP (General Practitioner)...

He specifically said during the conversation that I was "looking at the expert in Hormone Replacement" and that he'd recently given a talk on it in Miami and also in the city I'm in.

Umm, a GP who's "the expert in hormone replacement"?

He has delusions of grandeur. Talk to the doctors that understand you and ask them to recommend another GP.

[Stephenie S]

Taxol?

No, no, and no. Not a drug for you, dear. Unless you want some pretty serious side effects.

I wonder where this gentleman gets his info?

Stephie

[sandra-leigh]

Allie: further on the point of trying HRT:

http://www.avitale.com/TNote15Testosterone.htm


It is also known that the administration of cross sex hormones MUST be maintained to sustain the anxiolytic effect. It is not unusual for some patients, feeling better after starting hormones, to believe they are cured and no longer need to continue the medication. Unfortunately what they experience is a quick return of their gender dysphoria. If there is any physical test to determine who should seriously consider partial or full transition, taking cross sex hormones is it.

I can already tell that I probably fit in the category she describes. I was out clothes shopping with my wife yesterday and the women's clothes were mostly just "clothes for someone else", not things that were yelling at me, "Take me, Take me!" Didn't stop me from buying a flowery skirt and blouse combo at a good discount, but I could tell that I could have walked away from it without difficulty.

So... so far at least, hormones are good for me in the sense of making me feel better and more peaceful, quicker of thought and better able to handle abstract information, and better able to concentrate on what I'm supposed to be doing. They have not (yet?) intensified feelings that I need to live as a woman, but they are allowing me to get on with my life, just living as me, what-ever that "me" is. Though Yes, I am checking a couple of times a day hoping to feel those breast-buds come in. :battingeyelashes:

[darla_g]

i have a GF who lives in Canada so she has explained some of the idiosyncrasies of the Canadian Health Care System. Finding another GP is not a simple matter. I suppose there are tradeoffs to the inexpensive and readily availability of health care.

[Frances]

i have a GF who lives in Canada so she has explained some of the idiosyncrasies of the Canadian Health Care System. Finding another GP is not a simple matter. I suppose there are tradeoffs to the inexpensive and readily availability of health care.

It is almost Kafkaesque! The biggest worry is having a GP retire or die on you. Most GP's will not take on new patients. Patients then have to go to public clinics and ER's, and wait forever.

[Tina B.]

I life in a small town and we have that same problem, the few doctors we have are filled with all the Patience they need, and won't take on anyone new. But I think I would take a clinic over a doctor that won't talk to me. I go to a GP, an interest and a Heart specialist, none have an ego so big they won't take the time to answer what ever it is you need to know. And when I get an answer I have faith that I can believe it, because they all tell you right up front whats going on, no games. I've got too many reason to want to know whats happening to me, to put with bulls**t answers. Dump him!
Tina B.

[Hope]

Hi,

The answer is simple.

It is time to find a new GP that has an open mind, is a lot more educated and is not such a bigot against LGBT folk.

Yup.

Even if your GP doesn't like what you are doing, there is no excuse for the belittling from any professional, for any reason, at any time.

Simple solution - find a new GP.

[sandra-leigh]

Following up on this:

At the time that my family doctor got so upset at me in mid April, I already had an appointment scheduled at the transgender clinic; that appointment was today. I had that appointment and discussed the situation with them.

I am pleased to say that even though they are busy, they agreed to take me on for "primary care". I didn't even have to prompt them for that; it was their suggestion once they heard about the situation. My expectation was that they would refer me to a GP in my area who would be willing to work with them.

I am also fortunate with respect to location, in that the transgender clinic is only a few minutes by bus away from my workplace.

I didn't expect this personally encounter this kind of treatment from my GP (though I had heard of such things happening), but at least the outcome is favourable.

[Melody Moore]

Personally I think your original GP is pushing the boundaries & almost to the point that he should be de-registered for
malpractice hereafter what I have read here - I most certainly would be dropping him as my regular GP in the very least
after his claims to be the 'the expert in Hormone Replacement'. Luckily not all doctors are as obnoxius as your GP is.

[Sally24]

You don't "owe him" anything. He's doing his job. I avoid doctors that are sure they know it all. They are almost certainly wrong!

[Aprilrain]

It is almost Kafkaesque! The biggest worry is having a GP retire or die on you. Most GP's will not take on new patients. Patients then have to go to public clinics and ER's, and wait forever.

AHHH, socialism, boy i can't wait for the US to "catch up" to the rest of the western world. Nothing is perfect but at least in a capitalistic society you have an incentive to earn an income.

[Jay Cee]

I am very happy for you, Sandra. It must be a huge relief to not have to deal with that yahoo anymore.


AHHH, socialism, boy i can't wait for the US to "catch up" to the rest of the western world. Nothing is perfect but at least in a capitalistic society you have an incentive to earn an income.

<said with cheesy Russian accent>

Watch out, capitalistic American pigs! You are next.

With love and hugs

Comrade Jay Cee :D

Seriously, Canada is not socialistic. True, we do have health care paid for by our tax dollars. However, almost everyone I have talked to here has to wait (on average) two hours to get in to see their doctor (with an appointment). So it's not like they are slacking off, or not seeing patients. We simply don't have enough doctors.

[boardpuppy]

April, you comment about socialist medican is so cute but I do tend to agree.

Sandra, I'm so glad you got a new GP (the way I read it) and hope you have intelligent discussions to help you.

Alice

[Hope]

AHHH, socialism, boy i can't wait for the US to "catch up" to the rest of the western world. Nothing is perfect but at least in a capitalistic society you have an incentive to earn an income.

A financial incentive. Which when we are talking about healthcare - is unethical. In the extreme.

What you don't understand is that MOST people are not significantly motivated by financial rewards. Most people will do a job they find rewarding and enjoy for whatever amount of money they need to live comfortably. Most folks cannot be enticed to do jobs they hate for more money.

AND it is cute to think that you can get a new GP in the US without twisting an arm, a leg, and or knowing someone. I moved about a 9 months ago and I am still looking for a new GP who is accepting new clients. Forget about trying to find one who takes my "insurance." I just want someone to take care of my general medical issues. I am willing to pay out of pocket - which is good, because I will have to.

"Socialized" medicine isn't a perfect system. There is no perfect system. But what we have in the US is just about the worst possible system conceivable - and socialized medicine would be a HUGE improvement.