Preparing for my next HRT appointment

I have my next appointment with my HRT (Hormone replacement therapy) provider this week and I am quite concerned about how it will go. Following my disappointing lab results, I modified my hormone regimen to hopefully improve my results however I did so without discussing it with them. At this upcoming appointment, I need to persuade my doctor to modify my regimen similarly without creating too much friction. This may be easier said than done, as they have been resistant to any previous changes that I have advocated for. In light of this, I have made some preparations for this conversation.

I have spent quite a bit of time preparing for this upcoming appointment. First, I have a rough outline of what I want to discuss with my doctor. I have never had a real conversation with my doctor about my transition or what I want from HRT. I am incredibly conflict-averse, so it was easier to just be agreeable in person and then do what I thought was necessary. I was quickly shot down every time I even hinted at diverting from their standard practice, which only encouraged my belief that expressing disagreement with my doctor was a mistake. This was incorrect and is no longer sustainable. I need to have an extensive conversation with my doctor and explain not just my goals for HRT and my transition, but also express my unwillingness to continue dosages and schedules that are not working. However, I am aware that I need to be very tactful about this, as I do not want to lose access to hormones and blood tests. This conversation will be a delicate balancing act of remaining honest and assertive without offending.

The other preparation I have made is collecting research and information to support my suggestions. Over the last few weeks, I have put together a substantial collection of research, charts, and standards of care that support my recommended changes. I have even done the math and put together a table comparing the different dosage regimens (admittedly, I put this together to convince myself before making any changes). Hopefully, this will be enough evidence to convince my doctor that increasing my dosages is not dangerous. I don’t intend to use all of this research during my appointment, only what is necessary. I don’t want to seem pushy or to give the impression that I think myself more knowledgeable than my doctor but I also don’t want to walk out of the appointment without anything changing.

My comparison of the medication levels achieved via different hormone regimens. Days 69 and 70 represent the troughs and peaks reached at steady state. Assumes a 10 day half-life.

Even with this preparation, I don’t know how this appointment will go. There is still a decent chance that my doctor ignores my desires to change my estradiol dosage and will only prescribe spironolactone (which I definitely do not want). They have not shown any interest in having an actual discussion with me for the last year, I don’t know if that will change this week. On the other hand, there is certainly a chance that this conversation goes well. Ideally, the doctor will approve switching from biweekly to weekly injections and will provide me the necessary materials and medication to do so. If they do, I can know if it works pretty quickly. Medications reach steady-state (hormone levels are steady) after 5 administration cycles, and since I will have already injected weekly three times by the appointment, I can get a blood test 2 weeks after the appointment. If my doctor approves the change, I will know quickly if the new regiment has gotten the results that I desire.

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