I have an HRT appointment in a week and I am pretty nervous. I have had minor gripes with the clinic before, but nothing serious. Typically, I just try to get in and out as quickly as possible with my prescription. Unfortunately, that isn’t an option this time around. I have to have a serious discussion with my doctor about my treatment and dosages.
To receive hormone replacement therapy from the clinic, they required that I sign a form saying that I would follow their medication and dosage instructions. Even at the time, I knew that I would disregard their guidance if it didn’t make sense. Now that I think about it, I actually started ignoring their guidance at that first meeting. I was told that I was supposed to swallow the estrogen that they prescribe and I have only ever taken it sublingually (the bioavailability is far higher and it avoids metabolism by the liver). I have never told them that I do this, there is no way for them to find out and I didn’t think it was worth potential conflict. I have just quietly done what I believed was best for my transition.
Unfortunately, I just can’t keep quiet about my dosage change. After the clinic refused to increase my estrogen dosage at my last appointment, I unilaterally increased it myself. While this has done wonders for my transition, I doubt the clinic will be so understanding. I can’t avoid saying anything, as the effects will show up in the blood test. If I don’t tell the clinic and the blood tests show that my levels are now fine, they will assume that the lower dosage is fine. If I don’t tell them and the levels are not good, they will increase the “official” dosage to what I have been taking for months, which wasn’t good enough. Neither of these scenarios gets me what I want: the clinic to prescribe me a dosage that gets my hormone levels in or near the proper ranges. Self-acquired hormones are considerably more expensive than hormones from the pharmacy. While I can currently afford to continue supplementing, I would prefer to not have to.
The best option seems to be to tell my HRT provider about my dosage changes. The world professional associations for transgender health (WPATH), the primary guiding organization for trans healthcare, advocates harm reduction in their standards of care. This includes providing prescriptions for hormones to patients who are taking unprescribed hormones or other medications. My clinic states that they follow these guidelines, so they should prescribe me the higher dosage. However, this is no guarantee that they won’t react negatively. My (completely irrational) fear is that they will drop me as a patient or refuse to prescribe me any more hormones. I don’t think they can even do that legally, but it still a fear of mine. Regardless of my fears, I will tell my HRT provider about my change to my dosages. There is no good alternative.