I got up early this morning and made the cross town journey on my bike to the VA hospital here in Denver to see my primary care doctor about getting back on hormones. What I was met with was more government bureaucracy. I guess I should have expected that.
Two months ago, I finished my last dosage of hormones and spironolactone with the expectation that I could get back on hormones the right way. That is those prescribed by a physician. Going off hormones is not something I enjoy. But, I thought it would be a temporary thing. I was encouraged to hear that the VA had changed their policy from requiring living full time for a specific period of time before prescribing. And it would be cheaper to get through the VA. So, all positives.
At the time, I didn’t have a primary care doctor at the VA. I had only been there for mental health care. So, I went about getting one assigned to me. They gave me an appointment and I met with him. He’s a very nice man. And he told me that he works with several transgender patients. He told me he didn’t have a problem prescribing me hormones. But, that he needed to look at my blood work first. So, I had that done. Then, it was off to endocrinology where I was told that their primary concern was that I wasn’t full time. That caught me off guard and it was extremely frustrating. No wonder my blood pressure was high. But, I do have a family history of high blood pressure. They put me on medication to control it. And before I left the hospital that day, I spoke with the patient advocate. She told me she sent an email to my doctor asking him to speak with endocrinology before my next appointment.
My appointment back with my primary care doctor was this morning. I wanted to speak with him about bypassing endocrinology since medically, I’m fine. My blood pressure was low when I arrived for the appointment. And it was even lower at 117/80 at the end of the appointment. But, he seemed reluctant to rock boats. The system was the way it was for a long time. And apparently that’s the way he still sees it. He has never heard of WPATH and doesn’t know anything about the directive from the VA changing the way transgender patients are helped by the VA. He explained that doctors are first taught to do no harm. I explained that I felt like by holding back from giving me what I needed, that that is indeed what was happening. He knows I was on hormones for over a year. I told him that by going full time before hormones feels like they want to put the cart before the horse. We spoke about my treatment for PTSD and that it’s going very well. I told him I’m out to just about everyone I know. And that I’m working on my voice and learning what steps I will have to take to do my name change. I just have this big concern about going full time before hormones. I can’t do it.
He seemed to understand. I hope. He told me he would call endocrinology later today to see if he could change their mind. God help me, I don’t understand why endocrinology needs to be the gatekeeper here. My blood work is fine. And I would think that a primary care doctor could monitor my health satisfactorily. Heck, I know someone who was prescribed hormones by a psychiatrist. She also was a member of Kaiser at the time. And I’m sure her health was properly measured. But, it wasn’t endocrinology who prescribed. And that was probably a decade ago. Before I left, he told me there would be two possible outcomes of his call today. The first would be a call from his office telling me I could come pick up the meds I need from the pharmacy (I told him I prefer pickup vs. mail delivery since mail takes about 10 days). The other would be a call telling me I need to make an appointment with endocrinology. I really hope it’s not the latter. I really don’t want to see Dr. Cecilia Wang again. But, then again, I could ask for another doctor.
My doctor really is very nice. And I’m sure he’s a great doctor (This is only the second time I’ve ever seen him). But, I really wish he had some balls. I don’t get the impression that he’s scared to prescribe me. I just think that this is the way things have been done for years. Perhaps ever since he’s been there. It’s extremely hard to change a culture. Especially a government culture. I know someone who is having an extremely hard time getting her name changed in the VA’s computer system at the same hospital.
This is also another example of the patient knowing more than the doctor. I tried not to throw it in his face. I tried to be patient. But, it’s really hard. I’m not the first transgender person I’ve heard of having more knowledge about the condition and how it’s treated than her doctor.
I’m trying to be patient and positive. But, it’s hard. Everyday without this medicine means another day living this life as a male. I’m sure it will eventually happen. And I should be looking on the bright side. At least I’m not paying for this circle jerk.