Turnabout at Endocrinology

At a recent support group meeting, I voiced frustration that I was only able to get premarin from the VA health care system. Another attendee asked why I couldn’t just get a prescription for estradiol that I could fill out at any pharmacy I wanted. That question stopped me cold. How come I hadn’t thought of that? It didn’t even occur to me that this was even possible. I mean, these are real doctors I see there. Since the entire VA system is all encompassing, I just assumed that you had to go with the meds they offer. I’ve heard Kaiser is the same way. So, I made an appointment to see endocrinology (because that’s another way the VA works) to see if I could get estradiol prescribed.

I was tired of premarin. The VA seems to be the only place in the country to still prescribes it. It’s not very effective. And I don’t like the way it’s procured. It’s derived from pregnant mare urine. Hence the name premarin. When I finally did get approval to get hormones from the VA, I was told premarin was the only form estrogen they stocked. Over the last year, I’ve grown frustrated at premarin’s less than effective results. Right around the time I was asked whether they could fill a script for estradiol, I finally got fed up and ordered meds from online. But, doing so this way is expensive. If I order a 5 month supply of estradiol online, it costs me about $20 a month. But, if I fill it at Walmart, it’s $4. That’s a huge savings. And I get to relieve my conscious knowing I’m still getting my meds “legally”.
My appointment was this morning. The earliest appointment I could get was at 8am. Ugh. I so hate mornings. But, I set my alarm and dutifully made it there. Thankfully, I’m now within walking distance. It takes me less than 10 minutes to walk there. A couple of good things happened before I even saw a doctor. They take your vitals shortly after you check in. I’m glad to report I’ve lost about 10 pounds since my last appointment. And my blood pressure is now 132/80. I have a family history of high blood pressure. When I got out of the navy, my blood pressure was 250/130. No. I don’t know how I was still alive with those kinds of numbers.
I only had to wait about 5 minutes after getting my vitals done before a very handsome doctor came out and said my name. And when I say handsome, I’m talking HANDSOME. You know, like Kevin McKidd handsome. He had the most amazing eyes and a great smile. But, I digress. I know I’ve written about this before. But, the VA kind of has a backwards kind of way to dealing with transgender patients. You first see your primary care physician for a referrel to endocrinology. There, they take all sorts of blood and ask you all sorts of pointed questions (not all medical. Some questions reveal a bias by the doctor against transpeople). You also need a referrel from a mental health professional  before they will give you hormones. I’m a firm believer that anyone should get the hormones they need. But, again. Digress. Once you’re at endo, you talk with a resident (the handsome guy I mentioned above). After a few minutes, he goes and fetches one of the more senior doctors and they have a little chat about you while you’re there looking on. So, that’s what happened. I’m used to having very good conversations with residents, who typically are younger and generally get it. But, then when the older doctor comes in, that’s when things get frustrating. But, today that didn’t happen. It’s very rare that you get to see the same doctor in endocrinology. And today, I was very thankful for that. The lady I saw today was wonderful.
I went in to the appointment saying the premarin was bothering my stomach and that I wanted to see if it was possible to switch to estradiol. I came in ready to do battle. Because that’s what I’m accustomed too. But, that’s not what happened. I was greeted with a “Well, I don’t see why we can’t do that.” She told me they usually prescribe premarin because it’s more effective at a smaller dosage than estradiol. When she said that, I held back from laughing. I’ve never met any transgender person who believes premarin is effective. I then mentioned that I was told I couldn’t get estradiol at the VA. She scrunched her eyebrows together and leaned in at the computer, typed a few keys and said “No. We have it. There it is.” Even when she asked me how much estradiol I was taking before, she tended to agree that, although high (4mg a day), it was required to overcome the testosterone in my system. I was so stunned that, when the meeting ended I laughed as I shook their hands and said that it was the easiest endocrinology appointment I had ever been too. I’m still kind of in shock.
This was a very strange day. I got everything I wanted. Whose life is this? I’m not exactly ready to change my overall opinion of the endocrinology department at the Denver VA. But, today’s appointment went a long way in the right direction. I wish I could remember the doctor’s name I saw today. I think I may try to see her again next year.

About Frogtosser

A former sailor and pizza maker who is done hiding from the world and is now living life to it's fullest extent. I'm a single speed bicycle commuter who enjoys writing and photography. I'm a voracious reader. And a huge geek!
This entry was posted in Gender Stuff, NotAboutFamily, Transgender, VA Hospital. Bookmark the permalink.

5 Responses to Turnabout at Endocrinology


    Please look at your paperwork and get her name. Take a pic or save it somewhere safe. I am so proud of you! You deserve the best. Always.

  2. A good step forward, but you’re still getting oral estrogens. Even if you were in perfect health that’s far from ideal because it stresses your liver, which must devote a significant part of its detoxifying tissue to the estrogen received directly from the stomach. That’s liver tissue best used elsewhere. Trans women will generally agree that non-oral estrogen works best through weekly injection or 3-month pellet implant. The patches are effective, but their up and down nature makes them difficult to use for most, and they’re relatively expensive. I do IM injection of Estradiol Valerate twice weekly, at a cost of about $18 per month.

    • tossingfrogs says:

      The VA won’t do injections. I’m hoping as I make enough money to get better insurance, then I can find a doctor that will. Even if I did it from online sources, I’d have to pay for it. I’d prefer injections. But, I can’t afford it. When it comes down to it, I have to go with what I can afford. I don’t pay for my meds at the VA.

    • tossingfrogs says:

      Also, I tried patches years ago. They did nothing for me.

  3. Sarah G says:

    So glad you had a great experience there! I hope this trend continues and you and others have an easier time from here on out. Maybe your constant advocating for better treatment is making a difference and changing the world, eh?

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