HRT Appointment: a frustrating partial success

I had my hormone replacement therapy appointment last week, and I am pretty disappointed in how it went. In terms of tangible goals, it was a complete success. I got the exact change to my medication that I wanted without any fuss. However, I did not achieve any of my more abstract goals that I had for the appointment. This partial success has left me feeling pretty frustrated.

My conversation with the doctor went downhill from the very start. I started the conversation by expressing concern about my poor lab results and how the current hormone dosage did not seem to be working. The doctor responded to these concerns by questioning the validity of the lab results. They said that my hormone levels should not have been that bad on the current regimen, and so something might be wrong with the lab results. Instead of adjusting my dosages, they were going to redo the labs. If my levels were really as bad as the previous test indicated, we could discuss dosage changes afterward.

This approach presented two problems. First, my entire plan for the appointment was to use the poor lab results as a springboard for discussing my transition goals and adjusting my medication. I was very disappointed by the last blood test, and I wanted to express my disappointment and frustration with the whole process. This was not possible if the lab test’s validity was rejected. Any disappointment I expressed was swiftly met by “we don’t know if the results were accurate” or “that is why we should do another lab test”. I was unable to have the conversation I desired if all my concerns were dismissed.

The second problem was that I had already adjusted my medication regimen without consulting the doctor. I had increased the frequency in which I took hormones nearly three weeks prior, and so a lab test that day would have proven nothing. If my results improved from my previous test, it would only show that changing my dosage worked, not that the previous test had been wrong. Similarly, a poor result would only prove that my new dose was still insufficient. Unfortunately, this meant that I had to tell the doctor that I had already changed my medication, which was not received well. Their response was something to the effect of “oh. Then you can keep doing that I guess” followed by a swift end to the visit. I guess it could have gone worse.

Honestly, I do feel kinda bad about changing my medication on my own. This is the second time that I have done this, and both times the doctor brushed it off and then ended the appointment. And that does not even include smaller changes that I did not discuss with them, like taking my estradiol sublingually instead of orally. I understand that I am kinda a nightmare patient in that regard since I go off and do my own thing, but so far every change that I have made has had a positive outcome. Switching from 6 mg to 8 mg orally improved my hormone levels and the labs that were taken at this week’s appointment showed a significant improvement over my previous results. I am not at the levels that I want yet, but increasing the frequency of my injections has gotten me out of cis male hormone ranges. I do not regret making these changes, I just wish that it was not necessary.

All in all, the appointment was not awful but it was not great either. I was thrown off by the doctor questioning the previous lab results and that hampered my ability to advocate for what I wanted. It didn’t help that rejecting those results removed any justification for my suggested changes. I did get the primary thing that I wanted out of the appointment, even if I forced it by changing my medication myself. I wish that this had not been necessary but I don’t see a better way for me to have handled it. My next appointment is in a couple of months, hopefully, that one will be more straightforward.

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