Two completely different realities

I had a follow-up discussion with my HRT provider about my latest lab results and I don’t think that we could have been further apart. The very first thing they said was that they liked the trajectory of my hormone levels. My levels are exactly the same as they were 3 months ago, and they were bad then! We are looking at the same two numbers and reaching vastly different conclusions. We are talking about two different realities and I have no idea how to parse this gap in our perceptions.

I don’t think the doctor understands my perception or my goals. I see my current levels (as discussed here) as an abject failure and a massive disappointment. We should not be at the 8-9 month mark and still trying to figure out dosages. This isn’t entirely the clinic’s fault, I have been too passive. I didn’t want to cause any conflict or lose access to hormones, so I have not been very assertive or open about my personal goals. My goal with my hormones is to get ~200 estradiol and <50 testosterone through estrogen mono-therapy. That is what everything I have read and studied indicates will maximize the effects of HRT while minimizing side effects. I want my transition to go well and for that I need the proper levels and I need them sooner rather than later.

I do understand the clinic’s perception, even if it clashes with my own. They see HRT as a 3-5 year process and so taking a few additional months to sort out the levels is not a problem (they have said this to me). Slowly reaching the proper levels also more closely mimics puberty in cis women, which they see as a positive. In my opinion, this is an outdated approach and doesn’t provide any benefit over going straight to the proper levels. We also differ in our approach to hormones. The clinic really wants me on an anti-androgen and doesn’t seem to understand my desire to try mono-therapy. They also seem to have a different target for estrogen levels than is standard, which confuses me. The doctor has repeatedly expressed concern that my goal for estradiol is too close to 300, which is their threshold for safety (I am not, and have never been close to 300, so I don’t understand their concern). I can understand and appreciate the clinic’s views on transition, but they conflict with my own goals.

The end result of my conversation with the doctor was an earlier appointment to discuss injections, but I wasn’t able to address this difference in understanding. I don’t know if it worth trying to discuss it with them. I don’t trust the doctor not to withhold my hormones if I disagree with them, so I am reluctant to even bring it up. I have even been considering just DIYing my HRT and only going to the clinic for labs, but that is probably a bad idea. I just want to get my levels right, without upsetting my HRT provider in the process. Is that too unrealistic?

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