I posted yesterday about my frustration with the medical system relating to trans healthcare (sort of — it was a series of haiku). I went to my appointment with the doctor today and discovered that it’s not quite as bad as the people on the phone made it out to be. Apparently, I don’t actually need a letter from a therapist stating that I’m mentally competent to transition in order to have a doctor review my hormone levels and monitor my dosage (which is good because that’s just ridiculous).
I still hold an immense about of frustration with how the U.S. medical system deals with healthcare and trans people (and don’t get me started on health insurance). I firmly believe that hormones (“Hormone Replacement Therapy”) should be prescribed based on a theory of informed consent, which is how it works with Howard Brown Health Center’s THInC (Trans Hormones — Informed Consent) Program, Chicago Women’s Health Center, and Mazzoni Center in Philadelphia (of the places of which I know). The fact that letters from therapists are required for most trans-related surgeries is ridiculous to me, given that most other types of surgeries have no similar therapy requirements. That medical professionals are considered more knowledgeable about our gender than we are infuriates me.
However, in terms of my life as an individual, it’s not quite as bad as I thought yesterday. Even though I thought I was clear about the fact that I just wanted the doctor to monitor my T levels and let me know whether anything is going wrong, the person scheduling my appointment insisted that because I was scheduling a “transgender” appointment, I needed to have a letter from a therapist stating that I’m mentally competent to transition.
This, of course, frustrated me on a number of levels. Why do I need a therapist’s letter for something I’ve been doing (with a doctor’s initial approval) for almost three months? What if I don’t have a therapist? They’re generally very expensive, you know (not to mention, not necessarily trans-/genderqueer-friendly or knowledgeable). Why do I need to have someone declare me “mentally competent”? If I wanted the doctor to check my cholesterol levels, would I need a therapist’s letter for that? All of this is setting aside the fact that I don’t think we should need therapy in order to get hormones in the first place, as I’ve said before.
What especially frustrated me is that I’m trying to do this whole T thing the way the medical profession thinks I should. I got a legitimate prescription from a doctor and have faithfully followed it. I didn’t start without a prescription; I haven’t deviated from what the doctor prescribed (of course, friends on T also advised me to not just up my dose on my own, and I trust their judgement). I’m still at 0.25mL/50mg a week, even at almost 11 weeks. I got my T levels checked after a month, just like I’m supposed to, even though it required multiple calls with three different clinics, and the person drawing my blood messed up and left me with a huge bruise for well over a week (actually, that’s just me complaining because I felt like a pincushion).
In short, I’m following their rules. And now they want to make it harder for me to have a doctor monitor my progress? That just makes no sense. It’s practically encouraging me to just go off and do whatever on my own. Fortunately, while most of the problems are still there, this particular one was just a case of misunderstanding (and/or people not actually knowing the rules).
I met with the doctor today. I chose her because she was highly recommended by people in the local trans community as being knowledgeable about T and hormones for trans folks, and that seems to be the case. Once we got the whole “I don’t need you to write me a prescription; I already have one” thing out of the way, it went smoothly. My T levels from the first month look good (and she explained what “free” versus “total” meant). Apparently, I have really good blood pressure (I never remember what it is, but I’ve always been told it’s good, so that’s a plus) — that’s not trans-related, but it’s still nice to hear. I wasn’t called “lady” or “Miss” or anything like that. And I got a list of therapists who could potentially write letters for me to the insurance company for surgery (provided, of course, that I actually went to them for therapy), at least one of whom apparently understands the concept of gender not being a binary.
All in all, it went well. I am nowhere near as stressed and frustrated about all of this as I was last night, although when I think about it on a systemic level, I still get infuriated. On a related note, two months and twelve days until top surgery!