HRT and needing a letter

[Billiejosehine]

At the beginning of this year I decided that I wanted to transition and begin the process. Everything was new, I was not well informed, and I was not seeing a gender therapist. Yet I tried to get on HRT, but was turned down for having no letter. Since then I have been going to a gender therapist and about a month I was told about the gender health center in Sacramento. When I called to set up an appointment, they gathered intake info over the phone and was told I had to wait till July/August since there was a long waiting list. Which I was fine with now that I'm in process of transition and taking things slowly (as I said I was in a rush to start at the beginning of this year). Well yesterday I got a call from the program director of the gender health center. During the conversation it was recommended to go through health insurance if I have it, especially if I don't want to wait. They also said that I no longer need a letter to get HRT; as the guidelines have changed and most insurances will cover things. They also said my primary doctor should help me and provide a prescription without a problem, if there is they will advocate for me. The lady did send me a PDF document stating these new guidelines if there was a problem. I don't know if things should be the same across all states, but is a letter still required to go on HRT? I'm planning on going back to my primary doctor with this new info in the next couple of weeks to see what happens. I have also set up an appointment for the hormone clinic at the gender health center in Aug and can wait till then if I need to.

[stefan37]

My general practitioner was very uncomfortable prescribing estrogen. I had to wait 12 weeks for an endo appt. I already had my therapist willing to provide documentation. My endocrinologist required the letter

[whowhatwhen]

IIRC Some endos will prescribe hrt with informed consent, your best bet is finding one that does.

[Billiejosehine]

Originally my primary doctor was uncomfortable to prescribe HRT, so they referred me to an endo. As I said, When I told this to the program director of the gender health center on the phone, they sent we documents to give to the doctor and they would advocate for me as well. But if they are uncomfortable, I'll probably won't get the best service if I were to convince them to help me. The endo I got referred to is the best were I live, but they don't have much experience working with TG individuals. The endo was willing to help me when I first went, but since they never worked with any TG individuals and were not familiar with the guidelines ( which they went over during my first appt); required a letter based on the guidelines, which I didn't have. At this point (almost 2 months since my first appt), I might have better luck with endo and HRT, if I give them the documentation instead of the letter.

[I Am Paula]

The standards of care are interpreted by your Dr. No, you do not legally need a letter, but a lot of Doctors still want one for the sake of liability. Many gender clinics advertise informed consent, try them first. Your Doctor may refuse outright, ask for a letter, or just prescribe. His call.

[arbon]

I am confused - what guidelines are they referencing? I think the SOC indicate a letter is still generally needed?

[JohnH]

I have to confess I cheated in initially self-medicating. I admitted to my new general practictioner of my self-medication and asked her for prescriptions. She did not feel comfortable prescribing the medication so she referred me to an endocrinologist. He saw that there would be no major problems so he did prescribe the medication. The same endocrinologist is also my wife's endo and he had a talk with my wife about my medication. She reassured him that I was not up to any funny business (e.g., going out dressed as a woman to have a wild time) and that set the endo's mind at ease.

To make a long story short, no, I did not need a letter from a gender counselor.

Johanna Anna

[Barbara Ella]

I also have been self medicating for the past 18 months, and using my GP blood work to monitor everything but the hormone levels. I felt i could no longer do this and also advise younger girls in our support group not to do it. I knew I could not wait for a letter, and fortunately there are forward thinking medical practitioners. The Howard Brown Health Center in Chicago is one of the leaders in treating transgender issues as strictly a medical situation, with no therapy needed whatsoever.

So Monday I walked into the clinic with my dear friend who has been going there for 8 months. I was seen by the Dr. and we filled out all the health forms, and discusses what hormone treatment I had been on, and where I got them. He was worried that i was getting them secondhand etc. I met with a hormone advocate and answered questions regarding my understanding of feminizing hormones, expectations, side effects, medical dangers, etc. Only purpose being to illustrate that I could make an informed consent about the use of hormones for feminization. I signed the forms, had blood drawn, got my prescriptions, and got my hormones from the pharmacy, and left feeling much more complete about myself, and how I represent to the support group.

No letter required, just an honest discussion about the medical condition.

Barbara

[whowhatwhen]

I am confused - what guidelines are they referencing? I think the SOC indicate a letter is still generally needed?

I think that in some cases where there is sparse availability of therapists or financial restrictions you'll find endos that won't need a letter.
It's probably a good idea to get one if you have the means though.

My endo did a light dose of spiro at first without one but I guess what it comes down to is that they want someone to say that "yes, this person is mentally stable and capable of making this decision".

[Terraforming]

I just looked up informed consent clinics and went to the nearest one. No letter, no misunderstandings, and no wait. I was happy with how smooth the process was, since I was almost certain I'd be held up somewhere.

[Marleena]

I think that in some cases where there is sparse availability of therapists or financial restrictions you'll find endos that won't need a letter.


It's all about choices. When I was looking for a TS support group one could hook you up with informed consent while the other followed SOC guidelines and getting a "letter". They knew I was suffering with GD and one route was faster, I chose the SOC based endo just for safety concerns. A lot can go wrong without a doctor's supervision, heart attack, stroke, etc. I'm not being self righteous because I understand GD and getting help can be a long process so some will turn to self medicating. Of course I advocate supervision and doing it the safe way though.

[mikiSJ]

...the gender health center in Sacramento....

I thought you would have sought out help in San Francisco rather than Sacramento. The City has many more resources than SAC and it's much closer (as the crow flies).

[PretzelGirl]

It is a mixed bag as no one is officially held to any standards. I choose to find a therapist that held to WPATH. Once I had the letter, my GP answered an email and said he had no experience and wanted to go to an endo. I ended up with a OB/GYN who didn't require the letter, but took it and added it to my file. So go with what you find, but just make sure you are taking care of yourself since the "standards" are loosely held.

[Billiejosehine]

It's funny that there are standards, but it seems medical doctors will do there own thing when it comes to standards. For me it's is vital to get the best care I can with those that are at least knowledgable, because transitioning will affect the rest of my life and I want to start the next chapter of my life on the right foot. I do have a few options my GP, Endo, and gender Health Clinic, so I have see what's the best route.
MikiSJ: Where I live Sacs an hour and SF is 50 min, so I'm not far from either location. So I never really thought of going to SF, I dislike the traffic sometimes and I have to pay $10 in toll for crossing the bridges. But going to SF is another option to consider and I will see resources are available there. Also I choose the Gender Health Clinic in Sac only because it was recommended by my therapist.

[samantha rogers]

Add me to the self medicating group. I finally asked a TG counselor for the name of a doctor who was friendly. I wanted my bloodwork done to be able to judge progress. The doctor I went to took blood, spoke to me for awhile about what I had been doing, and then wrote me a prescription. No letter.
Later, when I began seeing a therapist, she sent him a letter anyway.

[Cheryl123]

Hmmm … I’ve discovered that SOC is only one set of standards which doctors may use to provide trans-gender care. Other doctors use other methods to treat GID. The American Psychological Association, which created the GID diagnosis, recently concluded that there is no evidence one way or the other that SOC is the best form of treatment. Other approaches – such as Informed Consent –may be equally effective if not more so.

SOC was developed during a time when the trans-gendered were considered to be mentally ill. As recently as 5 years ago, this idea was still held by many. And being mentally ill, the transgendered needed therapy.

It is now known that people are born trans-gendered. And while it is recognized that some trans-gendered suffer psychological problems, the symptoms of GID – anger, depression, self-hatred, etc -- are caused at least in part by a hormone deficiency. The Informed Consent protocol is based on this knowledge

Because hormones can often relieve the worst symptoms of GID, Informed Consent doctors will provide hormones immediately if the individual is physically healthy and knows of the risks. Therapy is made available, but is not a requirement to begin HRT.

Any doctor can prescribe hormones as long as he or she concludes there is a medically valid reason. Some doctors want the approval of a therapist but the approval letter is always optional.

Also in the US, it’s not illegal for a person to purchase estrogen and related HRT products from pharmacies outside the country, as long as the products are for personal use and are properly declared through customs. (This is not the case of testosterone, however).

Many gender clinics have found that a lot of their TG clients were already self-medicating. So it made sense to give prescriptions to these women for hormones they were already taking. This saved her money and also brought her under medical supervision. At the same time therapy services were made available. The Informed Consent protocol emerged from these conditions.

In my own case, thearpy proved to be absolutely useless in combating depression because I was so withdrawn I couldn’t participate in the therapeutic process. My replies to the therapist were often just a mumbled yes or no or shrugs of the shoulder. I wasn’t intentionally being uncooperative, this is just the nature of depression.

My depression, anger, self-hatred at all the rest lifted soon after I began HRT. During this period of transition, I know there will be times when I will want to seek the opinion of a therapist who specializes in TG issues. I’m OK by myself now, but it’s good to know the service is available. (All of the comments above apply only to the US. )