HRT Question

[Veronica Nicole]

Well here we go again about every 3 or so months I get this urge to research HRT. I've been seriously thinking about starting HRT I'm just over 50 and not getting any younger so just have a few questions for those of you who have been down this road. I'm sure these have been asked many times and also can be researched but I'm going to ask. Also not sure if this the place to ask.

1. am I to old to start, I am 52 and I don't want to offend anyone who has started at an older age.
2. Where and how do I start, I know you have to start therapy but for how long.
3. Do they just start you on HRT

Those a just a few questions and I have many more. I have no plans to transition as that is not an option. I would just like to start on a low dose so maybe I can think clearly. It's really hard to explain, there are many nights I don' sleep cause I can't stop thinking about it.

[Heidi Stevens]

Hi Veronica. Even though your from Texas, I’ll answer your questions! LOL!
I had just turned 59 when I started HRT, so no you’re not too old. The process for me was one of finding myself first. I had concluded that I was transgender in the fall of 2014. To confirm my feelings, I sought professional help from a psychologist trained in these matters. After a few visits with her, she approached me with the possibility of HRT treatment. This was stunning to me as this was not my motive for therapy. I asked her “am I that obvious”? She said yes and then started sessions that would she how I would approach HRT mentally and socially. One month later I started.

This is just my path, as they say, your path will vary since you are looking to get on HRT. You’ll have to be yourself with your counselor and they will decide if you truly are ready for this big step. What ever happens, do not self medicate! Use professional help and stay safe. Good luck!

[Pat]

1. No, you're not too old.
2. The classic way is you start with a therapist who confirms that this is an appropriate treatment for you, there's no telling how long it will take - it could be a very short time, it could be months. It depends on you. The therapist writes a letter which you take to an endocrinologist who will probably start you on hormones the same day you see them. There's an alternate path in some states called "informed consent" where you go directly to an endocrinologist, affirm you know what you're getting into and demand hormones. I have no experience with that and I don't know if Texas offers it. It strikes me as the worst possible path to hormone therapy.
3. see 2.

A discussion with a therapist would help you unpack the meaning of wanting to take hormones but "have no plans to transition." It's kind of like saying you want to paint yourself green but you don't want to be green. Or get paint on you. Hormone therapy is part of a "medical transition." Maybe you're just saying that you don't want surgery?

[Rachael Leigh]

Hey Veronica I'm like you here I am 56 and never expected to be in this position to begin hormones but now I'm sure it's
what I believe is best so I can be more comfortable as I transition.
I've got concerns as well but I am going to a counselor who's helping me just confirm what I think I already knew
Good luck hon
Rachael

[Charla]

No, you’re not too old. The effects may not be as drastic as with someone much younger.
Finding a therapist who is knowledgeable on gender issues is the first step, and the hardest. The therapist will need to evaluate you and write a letter to justify HRT. There is very specific wording that has to be in the letter.
Then finding an endocrinologist who will work with you is the next step.
Once all this is done, you get a prescription, go to your local pharmacy, get it filled, and go back to your doctor periodical for blood work.

[Melissa Rose]

Veronica, you are not too old providing your health status is compatible with starting HRT.

Based on what you have shared, going to a gender therapist should be your next step. Starting at a low dose to help taming gender dysphoria is an option for some and works well in some cases, but be very aware others who had no intention of transitioning changed their mind after being on a low dose for a while. Do not assume your thoughts and feelings about transitioning will not change after starting HRT. Is that a risk you are willing to take and can you deal with none of the available options being good ones if that occurs? This is something a good gender therapist can help you navigate.

Self-medication is not a good option and risky. Informed content works for some, but not for most. It still requires proper medical care, but by-passes some of the psychological gate-keeping up front which carries some risk.

[Dorit]

I have yet to post on this forum, was planning on doing so at a later date, however your question has motivated me to post with an answer. I have been in therapy for two months and the recommendation from her just last week is to start HRT. I am 70 years old, albeit a "young and healthy" 70! My therapist said my age was no problem, so I cannot imagine how yours would be. In my country you need a letter from a licensed psychologist that you take to an endocrinologist. I am waiting for my appointment.

[LeaP]

You are definitely not too old for HRT. You don’t HAVE to start therapy first these days, assuming you can find a doctor willing to prescribe, but I strongly suggest you do. Whether or not you need to see an endocrinologist for HRT itself depends on both you and your primary care doctor. I started with a therapist, asked for the letter 5-6 months in, and my primary care doctor prescribed the HRT (with which she has considerable experience). YMMV.

[Chrissi]

Hi Veronica,

As others have already said: You are not too old, but starting HRT has another dimension that depends on your health and family history. I started recently at 54. I am very health conscious, but I had reached a point where the risks were outweighed by the benefits.

There are several paths:
A) First Check Insurance Coverage. primarily you would want to start with checking your health insurance to see if there are any “gate-keeper” requirements for them to pay for HRT. HRT, depending on delivery method, is not super expensive, but it’s not pocket change either. Most all insurances cover HRT with a diagnosis from a therapist or MD. (I am really concerned however for “Hobby-Lobby” exclusions because of an employers or insurance companies religious beliefs)
B) Informed-Consent a direct path to HRT: More and more doctors, indeed, I believe the WPATH recommends, an “informed consent” path to starting HRT. endocrinologists can prescribe HRT without a therapist’s letter provided you have asked for and have given an informed consent. Endo’s who specialize with trans patients, will advertise this, and it’s starting to become widespread. However! And
C) see A above. Your insurance still may require a therapist letter, although I believe an Rndo’s letter works too, but it’s always best (and easiest) to check. Plus if GCS is in your future you may need to see a therapist anyway!
D) Gender Therapist: see one! They are going to discuss things with you, that perhaps you have not yet thought of. They really help. Let them know you want to start HRT. I see my therapist now on an as needed basis. Which thankfully has been less frequent of late. Your therapist can also issue your “letter” recommending HRT on an informed consent method, or after several to many visits.

Only you, truly know when the time is right to start. Get informed! Understand the risks. Understand the benefits, know the realistic expectations. I trust my medical providers. All expectations are different and highly personal. Discuss them with your doctor. What works for a friend, is not necessarily right for you. I see a lot of internet MDs, some are rather knowledgeable and some are experts in their own right...so again, educate yourself and don’t be afraid to discuss with your doc your concerns.

Best of luck, Cristine

[JohnH]

I started M2F HRT with the informed consent model and I am so glad I did. I have been on the regimen for over 6 years and have acquired a feminine shape including DD cup breasts. I feel so much better about myself and will continue. I was thinking about transitioning socially to being a woman but have decided to continue socially as a man whose name is John, preferring masculine pronouns. For church and business I wear lipstick, mascara, and eyeshadow and have hair past my shoulders, but I have a deep bass voice. So there are exceptions to rules.

And by the way, I was 59 years of age when I started.

[LeaP]

The WPATH SOC (V7) endorses the traditional use of informed consent - that is, ensuring patient understanding of therapies, options, consequences, etc. before proceeding with treatments including HRT and surgery. WPATH distinguished between this use of the term versus the “Informed Consent MODEL” (my emphasis), explaining the difference in the SOC itself (see following excerpt). While WPATH does not exclude the use of this model - stressing that the SOC itself is flexible - it clearly does not endorse it either. The flexibility expressed is toward the knowledgeable practitioner, not the patient per se.

The following is taken directly from version 7 of the WPATH Standards of Care, starting at page 35:


Relationship between the standards of Care and informed Consent Model Protocols

A number of community health centers in the United States have developed protocols for providing hormone therapy based on an approach that has become known as the Informed Consent Model (Callen Lorde Community Health Center, 2000, 2011; Fenway Community Health Transgender Health Program, 2007; Tom Waddell Health Center, 2006). These protocols are consistent with the guidelines presented in the WPATH Standards of Care, Version 7. The SOC are flexible clinical guidelines; they allow for tailoring of interventions to the needs of the individual receiving services and for tailoring of protocols to the approach and setting in which these services are provided (Ehrbar & Gorton, 2010).

Obtaining informed consent for hormone therapy is an important task of providers to ensure that patients understand the psychological and physical benefits and risks of hormone therapy, as well as its psychosocial implications. Providers prescribing the hormones or health professionals recommending the hormones should have the knowledge and experience to assess gender dysphoria. They should inform individuals of the particular benefits, limitations, and risks of hormones, given the patient’s age, previous experience with hormones, and concurrent physical or mental health concerns.

Screening for and addressing acute or current mental health concerns is an important part of the informed consent process. This may be done by a mental health professional or by an appropriately trained prescribing provider (see section VII of the SOC). The same provider or another appropriately trained member of the health care team (e.g., a nurse) can address the psychosocial implications of taking hormones when necessary (e.g., the impact of masculinization/feminization on how one is perceived and its potential impact on relationships with family, friends, and coworkers). If indicated, these providers will make referrals for psychotherapy and for the assessment and treatment of co-existing mental health concerns such as anxiety or depression.

The difference between the Informed Consent Model and SOC, Version 7 is that the SOC puts greater emphasis on the important role that mental health professionals can play in alleviating gender dysphoria and facilitating changes in gender role and psychosocial adjustment. This may include a comprehensive mental health assessment and psychotherapy, when indicated. In the Informed Consent Model, the focus is on obtaining informed consent as the threshold for the initiation of hormone therapy in a multidisciplinary, harm-reduction environment. Less emphasis is placed on the provision of mental health care until the patient requests it, unless significant mental health concerns are identified that would need to be addressed before hormone prescription.

[Stephaniew]

I turn 51 this year, I too couple have thought about HRT over and over again each pasting year... please keep us informed

[maryjanedee]

I'm 54 and I just started HRT so your not to old to start...

[Sarah Doepner]

I sure hope you're not too old. I'm still considering it as I complete 68 years on the planet. I read another post here not long ago about a 70 year old who started, so it sounds like it's never to late to start. The major concerns should be how it effects your overall health, relationships and finances. Those are all very big and legitimate concerns, age not so much, on it's own.

[Ceera]

In 2015, when I was just shy of 59 years old, and widowed/single, I moved to a new town and got a new doctor. I had already been going out socially as a woman for two years, and have a fairly good female voice and could pass as female. I specifically selected a doctor who had a reputation in the transgender community for dealing well with trans patients. did my initial visit as a male, but I told him I was transgender, and showed him photos of some of my social excursions over the past two years, going out socially as a woman in all sorts of situations, including a boat trip with me in a bikini! He agreed that I was transgender, and he asked if I had started HRT yet, or if I was considering SRS. I told him I hadn't started HRT, but that I was seriously considering HRT, and that my mind was still unsure about SRS. He said he would have no problem with giving me a referral to an endocrinologist as soon as I felt I was ready to start HRT.

Unfortunately, before I could start HRT or get gender counseling (the counseling at my own choice, to be certain I understood my options and the impact of the choices), I lost my job and therefore my insurance. The temporary insurance I paid for over the next year covered little more than emergency hospitalization. Late this year I finally got on with Medicaid and with VA Health Services. Both would cover HRT, and Medicaid gives me renewed access to that doctor. I'm 60 now, and retired, having given up on getting a new job at my age. I'm essentially just waiting for the start of the new year, and re certification for medicaid and VA services, before I try to see a gender counselor and then start on HRT.

[Lindaa]

Hello Ladies, I'm 63 and about to start HRT just after Christmass. I've struggle with this over many years and I finally have just decided to go ahead with it. Not sure and dont expect to many body changes at my age. But emotionaly and mentally hope to finally be at peace with myself.

[JaytoJillian]

We are the same age, and I have been on HRT for nearly 3 months. Whether I am in girl mode or guy mode, no one believes I am 50-something. That said, as long as you are healthy, age is irrelevant.

I have had two attempts at HRT. During the first try, my therapist penned a letter for me after about six months of sessions. I made an appointment with an endocrinologist at the VA through my GP there--who by the way is awesome. I wish I could say the same for the endocrinology department. It was totally amateur hour. I wound up in a room with three doctors who wrongly dismissed my letter because it was from a psychologist versus a psychiatrist. These people insisted that I must spend a year in therapy with a VA psychiatrist, and present daily as a woman for a year BEFORE getting hormones. I kept asking them how forcing me to essentially spend a year "in drag" to "earn" the feminizing meds that I needed to feel comfortable presenting as a woman made sense--I even showed them the current standards of care--when I did this, they "compromised and prescribed me Spironolactone on the condition that I would enter therapy with one of their shrinks. I had one session with the VA shrink they assigned. All I can say is that she was unprofessional, unduly familiar and made sexually suggestive comments about my appearance. I never went back to the shrink or their endo department, but I did try taking the Spiro they prescribed--It wreaked havoc on my body so I eventually ceased taking it and my body quickly recovered.

However, my state of mind became filled with panic and a sense that time was passing me by. In the spirit of the Marine Corps, I could almost hear a voice yelling for me to "get off this beach or die." For non-military types, think of the opening scenes of Saving Private Ryan. It took two years after the horrible VA experience, but I eventually found an awesome therapist who teams up with an awesome endocrinology nurse who can write scripts. The therapist assured me that the nurse would get me the meds I needed. The "classic" method described by Pat mirrored my second experience to a T (no pun intended). New therapist penned another letter--emailed it to his nurse partner--with my written consent--I made an appointment with her, we had nothing short of an awesome conversation that ended with her asking me in what form would I like my estradiol(that she was prescribing that day)--pill, patch or injection? I opted for the pill--my "happy pills" I like to call them. The emotional effects were seemingly immediate, but I think just having the script in hand did something powerful even before I swallowed the first tablet.

At our age, the physical effects are TYPICALLY slower and more subtle--but at a month and a half in--at least three women in the office made comments about "something" being different about me--very positive they said, but different, LoL. That said, you probably have time to figure out how far you want to go. I told my nurse that I really am concerned about sudden physical changes. She says that we'll monitor progress and adjust as needed--I can call, text or email with any concerns. I am very fortunate. This part II experience has been like having a great team in my corner--makes everything a lot less scary and worrisome.

Wishing you all the best with whatever you choose to do!

Cheers,


Jill

[grace7777]

I started HRT at 52, so you are not to old.

As far as getting started, check with your health plan to see if it will be covered. In California, health plans are required to cover it, but I have a feeling in Texas there probably is no requirement. If it is covered, you will have to follow the rules of the plan. At a minimum you will have to go thru therapy. Some plans will not cover it if you do not plan to transition.

If not covered by your health plan you will be more or less on your own. You should search for a clinic or physician who will prescribe it. You will probably be required to get a letter from a therapist. You could get the letter on the first visit or it could take several months.

Take Care,
Grace

[veola]

no one will understand our feelings and desires,and it's never too late

We must try , so as not to regret about the past!

[Pat]

I made an appointment with an endocrinologist at the VA through my GP there--who by the way is awesome. I wish I could say the same for the endocrinology department. It was totally amateur hour. I wound up in a room with three doctors who wrongly dismissed my letter because it was from a psychologist versus a psychiatrist. These people insisted that I must spend a year in therapy with a VA psychiatrist, and present daily as a woman for a year BEFORE getting hormones.

I'm so sorry to read about your experience. When I registered with the VA here in the Boston area, one of the first questions I asked the VA primary care doctor was about them honoring the diagnoses I had through civilian doctors and they said they would totally accept them. Maybe it was slightly different because I'm already on hormones and I would just be transferring established care? You could try them again now that you have a scrip because they are cheaper.

[JaytoJillian]

You could try them again now that you have a scrip because they are cheaper.

Thanks, Pat! Always nice to meet another veteran.

I pay my endo nurse $100 out of pocket per visit. My awesome primary care guy at the VA has been a huge help--other than my therapists, he was the first medical professional I had ever discussed being trans with. The guy never batted an eye. When my nurse needs to check my levels, I send the required tests to my primary care doc via secure messaging on "My Healthy Vet." He orders the labs, I Uber over to the VA from work for the blood draw and I am in and out in under an hour. The results are available in 3 biz days, and I just email them to the nurse before my appointment with her, which saves me big time because if she needed to do blood work, it would set me back nearly $100 per test! As far as the price of the meds go, My VA card knocks about 15 bucks off. It my seem a little round about, but I am very pleased with the way things are going thus far.

Cheers,


Jill

[Julie77]

I started on HRT almost a year ago at age 54. It was the best decision I've made in a long time. I'm not yet transitioning full time. I started in counseling for about 3 months before they started me on it. Once the counselor gave the sign off, the Dr wrote the prescription. It really changed my outlook.

[IleneD]

While the sisters of this forum are discussing the relationship of AGE to beginning HRT, I have one question for those who are on the treatment.

Has there been a "Fountain of Youth" effect on you and your body? Has it literally made you feel or be younger? I understand that HRT will effect moods and behavior. [I'd love to read the narratives of you who experienced a noticeable change in being.) I've heard about skin feeling softer? But is there an overall energizing effect beyond the overall sense of well-being that comes from liberation?

[Pat]

Absolutely skin will get softer. That's one of the few you-can-depend-on-it effects of hormone therapy. Did it make me feel younger? It made me happier -- is that like feeling younger or more like I stopped feeling so world-weary and old? Dunno. If that feeling would be the sole reason you'd want to go on hormones, that's not a good reason. I'd say don't start them for that and don't put off starting them because you might not get that.

[Dorit]

Having started HRT two months ago at the age of 70 I can already report a few effects. My skin is definitely getting softer, even my wife noticed it. My night time erections are gone, totally. I do not miss them one bit! Next week I have my check up with my endocrinologist, and after a series of blood tests and a bone density scan, she will decide how to continue.

[Chrissi]

One of the really significant benefits that I have found is a much calmer and more patient demeanor.
I no longer get riled by life’s aggressions and transgressions. So much less stress has indeed been felt as happiness and reflective introspection as opposed to a more testosterone fueled response.

I’ve consciously noticed the change that has all on its own become automatic.

- - - Updated - - -

Ilene, like Pat, I would say that my moods and emotions have allowed me to enjoy small things that sometimes I may have overlooked. Is it HRT? Or is it just me finally dropping all pretense of former self? I cannot say.

Am I happier? An unqualified: Yes. (Despite a rather crummy holiday). Does that make me feel younger? It makes me feel alive and connected. HRT is not the fountain of youth, it may, however, be the fountain of truth. At least it is for me.

[Kaitlyn Michele]

Try not to get caught up in the side benefits... they are all just part of "being" a woman...that is the number one key.... you are chemically changing your body and ANYTHING can happen.... hair on your face is the exception...if you feel your hair getting finer, its almost certainly just in your mind...

the only thing you can count on is those E and T numbers will change and improve ...the skin will get softer, and your feelings really will change...the other changes can take so long... i recall my breast almost immediatly became senstitive and started to grow...then it just stopped...my hips changed only after SRS....and now i have a fat ass...lol..... so take good care of yourself and enjoy whatever happens and dont get too caught up in the specifics...dont set up for any disappointment...you dont need it in your life with all the GD going on

[Rachel Smith]

Wishing I had a fat ass lol I am just a skinny assed old lady