Putting a few things together
Feb. 19th, 2012 02:43 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
agent_daniLast week I had two appointments of note.
Appointment the first: Counselor. I've decided to pursue my surgery letters since there's a reasonable possibility of having the finances in place to cover surgery by 2015. Fortunately, the one I saw I was able to without co-pays as it turned out she had the wrong degree to write the letter - she has a Ph.D. but in a nurse counselor discipline rather than psychiatry or clinical psychology. She's going to refer me to someone who meets the requirement, though.
Appointment the second: Endocrinologist. This one didn't go as well. She was adamant that my dose be reduced to 2x 100mg Spiro and 2x 1mg Estradiol per day, ending 2x 0.10 Estradiol transdermal patches, changed twice per week. She asserts that the only possible answer for the 76 pg/mL serum Estradiol result in October was a defective test (I still believe it was that I was 12 hours from my last dose - compare to 186 pg/mL at 6 hours and 357 pg/mL at less than one hour.) Finally, she is insistent that I take the Estradiol tablets orally (swallowed) rather than sub-lingually. I have always understood this to be A Bad Thing for doses of this level. For those who wonder, oral birth control contains that active ingredient, but at less than 2% of my current daily dose (and they contain another active ingredient with which I am wholly unfamiliar.)
Honestly, I'm mostly tired of dealing with this. As the appointments are roughly quarterly, this appointment rounds out three full years since I first darkened an endocrinologist's doorway. At all but two of those were there adjustments to my HRT - October 2011 and May 2009 (the first appointment, which meant she refused to prescribe HRT until my second appointment, which was October, 2009.) There's a part of me debating just living with this until I can have SRS. What they have me on is a typical post-op dose and it's clear they have no problem with that, just with the higher pre-op dose. Having several years of feeling less than great, though, isn't attractive.
This also makes me wonder about the common wisdom about remarkable physical changes from HRT immediately post-op. If this holds true, I'll bet I will experience that, but only because SRS likely means then having appropriate HRT instead of vastly too low.
I'm going to try scheduling with Dr. Jones in Mebane - she typically isn't accepting new patients, though. Failing that, Dr. Marlowe, an Informed Consent provider in Charlotte, which means 300+ miles/500+ km of travel and at least half a day off of work for each appointment. That prospect worries me, though, as it means more expenses that will likely delay surgery.
Appointment the first: Counselor. I've decided to pursue my surgery letters since there's a reasonable possibility of having the finances in place to cover surgery by 2015. Fortunately, the one I saw I was able to without co-pays as it turned out she had the wrong degree to write the letter - she has a Ph.D. but in a nurse counselor discipline rather than psychiatry or clinical psychology. She's going to refer me to someone who meets the requirement, though.
Appointment the second: Endocrinologist. This one didn't go as well. She was adamant that my dose be reduced to 2x 100mg Spiro and 2x 1mg Estradiol per day, ending 2x 0.10 Estradiol transdermal patches, changed twice per week. She asserts that the only possible answer for the 76 pg/mL serum Estradiol result in October was a defective test (I still believe it was that I was 12 hours from my last dose - compare to 186 pg/mL at 6 hours and 357 pg/mL at less than one hour.) Finally, she is insistent that I take the Estradiol tablets orally (swallowed) rather than sub-lingually. I have always understood this to be A Bad Thing for doses of this level. For those who wonder, oral birth control contains that active ingredient, but at less than 2% of my current daily dose (and they contain another active ingredient with which I am wholly unfamiliar.)
Honestly, I'm mostly tired of dealing with this. As the appointments are roughly quarterly, this appointment rounds out three full years since I first darkened an endocrinologist's doorway. At all but two of those were there adjustments to my HRT - October 2011 and May 2009 (the first appointment, which meant she refused to prescribe HRT until my second appointment, which was October, 2009.) There's a part of me debating just living with this until I can have SRS. What they have me on is a typical post-op dose and it's clear they have no problem with that, just with the higher pre-op dose. Having several years of feeling less than great, though, isn't attractive.
This also makes me wonder about the common wisdom about remarkable physical changes from HRT immediately post-op. If this holds true, I'll bet I will experience that, but only because SRS likely means then having appropriate HRT instead of vastly too low.
I'm going to try scheduling with Dr. Jones in Mebane - she typically isn't accepting new patients, though. Failing that, Dr. Marlowe, an Informed Consent provider in Charlotte, which means 300+ miles/500+ km of travel and at least half a day off of work for each appointment. That prospect worries me, though, as it means more expenses that will likely delay surgery.
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no subject
Date: 2012-02-19 09:24 pm (UTC)The dose she has you on is a typical post-menopausal dose.
My endo likes measurements to be taken at between 4 and 6hrs post dosing, and he likes a level of over 450pmol/L (122pg/mL).
Personally, having followed your trials and tribulations with your current endo, I do think it is well beyond time to jump ship for someone else.
Even post-op 2mg/day could well be low, but only time will tell with that.
no subject
Date: 2012-02-20 08:38 am (UTC)I'm long post op as you know and take 4mg which is fairly standard although it can be tailored to suit.
What is it with endos in your part of the world? Are they afraid being sued?
If you prefer sublingual, just ignore the 'advice'.
I'd also support the 'jump ship' view! In the end, you pay, you say what goes!
no subject
Date: 2012-02-20 05:57 pm (UTC)(*at least for trans women. the one who almost killed my mother and then accused her of lying from the ER was pretty bad too.)
no subject
Date: 2012-02-20 06:11 pm (UTC)There just seem to be so many incompetents around the treatment of trans folks- perhaps they know we're unlikely to complain for fear of not getting treatment of being refused HRT?
They almost killed my MiL a few years back, so I know that one!
no subject
Date: 2012-02-20 06:22 pm (UTC)Seems likely. That's the most plausible explanation for why there seem to be a higher number of incompetents and abusers in the treatment of many vulnerable populations (poor, elderly, etc.). It sucks, but human nature is often awful.
Yikes, your poor MiL. My mother is at least about 40 years younger and sturdier, so she was fine in the end, but scared.
no subject
Date: 2012-02-23 12:50 am (UTC)