A double dose of disappointment

I got my lab results back from my last HRT appointment and the results are bad. My levels are exactly the same as they were 3 months ago even with the addition of progesterone and 2 more mg’s of estradiol. I am completely devastated. I had hoped that the changes would resolve the hormone issues, but it is depressing to see that it hasn’t even moved the needle.

Three months ago, my estradiol level was at 130 pg/ml and my testosterone was at 83 ng/ml. Now, my levels are 132 and 80 respectively, a negligible difference considering the changes that I have made. And my situation is actually worse than those numbers would indicate. Both measurements were taken 4 hours before my next dose, which means that these numbers are still better than my real trough levels. It seems that I metabolize estradiol faster than is typical. This is a problem, as it means that it is likely impossible for me to get the proper levels while taking estradiol sublingually (it is unlikely that adding an anti-androgen would even help, as progesterone did nothing). I will need to come up with a new approach.

Fortunately, there is still one option available to me. If the problem with my levels is that I metabolize estrogen too quickly, then the solution is straightforward: I need to find a form of estradiol with a longer half-life. The solution is injections. Injected estradiol lasts much longer than oral or sublingual estradiol. The bad news is that I need my HRT provider to prescribe it. They haven’t exactly been flexible in the past, so I don’t know if they will be willing to make the change. The second and perhaps more serious problem is that my next appointment isn’t for another 4 months. If I can’t get them to prescribe injections without seeing me in person, I won’t be able to get my levels right before my first anniversary on HRT.

A few days after getting my lab results, I got another piece of bad news. I am not able to get an appointment for trans voice therapy at this time. I tried to make an appointment and got rejected. The speech pathologist requires a referral from a doctor and a letter of recommendation from a therapist. I figure that I could get a referral from my HRT provider but the letter of recommendation is a significant hurdle. I was never able to get one when I was first trying to start HRT. The legal counsel for my therapist’s practice refused to sign off on any letter for fear that I may change my mind and try to sue. I doubt that they have changed their mind in the year since then.

Between the bad lab results and getting my request for voice therapy rejected, I have felt pretty depressed this week. It stings to get my hopes shot down so badly. Trying to achieve my transition goals while being blocked at every turn by medical gatekeepers is unbelievably frustrating. It is not hopeless though. I still have a path forward with injections and I can probably get a letter of recommendation. I just need to get my doctor and therapist to cooperate with me. We will see how that goes…

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