Thursday, July 19, 2012

Double Down

In blackjack when you are dealt an 11 you always double down.  Eleven is a lucky number, I feel lucky.

I went back to the doctor yesterday for a follow up on my tests from last week and to get refills for my prescriptions.  I got to the office on time at 11 AM.  The doctor was standing right there at the front desk where the receptionist was sitting and I saw no other patients in the waiting room.  He has a small downstairs office suite in the smallish 2 story building and there is one doctor, usually one nurse and only 2 examination rooms.  When I walked in the doctor spoke to me for a minute.  He is a very laid back older gentleman and he was looking me over as if he could tell something was different about me and he asked me if I had longer hair last time.  I thought it would be obvious but I told him I was wearing my wig last time.  He asked me if this was my real hair and when I said yes he said that it looked more natural.  I think that's obvious too but I did tell him I was more confident in my wig but that this was where I was going with it and I am working on it.

About the time I sat down in the waiting room the nurse called me back and weighed me.  I was one pound heavier than I was 9 weeks ago when I was last weighed there so I have gained one pound net during my first nine weeks of HRT treatment.  I guess that's ok but I feel I need to be going down not up but at least its only a slight change.  I also asked her to measure my height.  She did not measure this last time for some reason but said that she would.  My last reported measurement was in high school when I was read at 5'10" but I have been under the assumption that I am 5'9" because I knew I wasn't 5'10" anymore if I ever was.  My parents had always wanted me to be taller, in fact they would tell people I was 5'11".  I guess they did that in the fashion that a basketball team will "add" height to a player.  The measurement this day was 5'8" so I am relieved to know my true height and now I won't feel quite as bad wearing 4" heels, lol.  Actually this is quite good and not as much difference from average female height as I thought I was.  The only negative is I will have to rethink my ideal weight and adjust that down so that's another reason to get more serious about my diet and exercise.  I have been exercising more since going on hormones but also eating more and it seems I am hungry all the time.  Maybe that's just a symptom of going through a second puberty but people are still asking me if I have lost weight so I think I am on the right track, just need to work harder.

Next she took me in the examination room and took my blood pressure.  I have some degree of "white coat syndrome" and my blood pressure always tests high in doctor's offices.  I told the nurse I had an energy drink on the way up and it dawned on me that this was not a good idea before a blood pressure test.  The reading was 150/90 which is like borderline hypertension if not worse and she mentioned to the doctor as he walked in that I had an energy drink and they didn't seem overly concerned about it.  There was no waiting time, he was in before she had taken my pulse and he sat right down, asked me a couple of questions then handed me a gown and told me to take my top off and put the gown on, he was going to do a breast exam when he returned.  He came back in with the nurse to observe.  After he did a quick check I put the gown back on and sat up.  I had a feeling I was going to have to have to take some clothes off this day and that was the main reason for not wearing a wig, as well as the fact that the temperature was over 100 degrees.  He told me my blood tests last week (liver, kidney etc.) were normal and he was going to refill all my prescriptions.  I also asked him about some lidocaine cream to numb my face for my electrolysis treatments and he looked one up in the book and wrote me a prescription for that.  Its about the same thing I had gotten from another doctor but I needed more anyway.

Next he started to write me refills for my HRT and I asked him if he could increase the dosage.  He looked at me and told me he would increase the Spironolactone but not the estrogen.  I was prepared for this because 2 months ago when we set this appointment up I asked him if we would increase the dose then and he told me this was probably the dose I would be on while being treated by him.  That had concerned me because I know its typical to increase the dosages after an initial trial period.  My initial dose was good, right where I wanted it to be and I had seen results and knew the meds were working but I had also done my homework, talked to a lot of people and had information prepared.  I can be pretty persuasive if I need to be but I really didn't have to use that with him.  I pulled the information I had printed out of my purse and walked over to where he was sitting and told him I wanted to review some material with him while telling him it was my plan to increase both Spiro and Estrogen dosages after the first month or two.  I showed him the dosage table from the Endocrine Treatment of Transsexual Persons manual, a table from a Transgender Care manual for doctor's from British Columbia, an article from The journal of Family Medicine and the table for transition HRT doses from Ann Lawrence MD.  He didn't study the material much but I guess he was impressed by my knowledge, preparation and determination because he agreed to double my estrogen as well as the Spiro.  Yayy, this new dose is the recommended amount from my sources and I got exactly what I wanted so I was satisfied.  The new dose is two 0.1 estrogen patches changed twice weekly and 200mg Spirononlactone daily taken orally.  Hopefully that is the dose I will have to carry me through transition and the only reason I see now to adjust it up or down would be based on future blood tests.

He did say the medicine would be more expensive and there was a generic form but he did not like those patches as much.  I told him I had not had the problems I was worried about with patches which would be getting them to stay stuck to the skin or irritating the skin underneath.  Perhaps the bad reports I hear about patches come from the cheaper generic models.  He seemed surprised and a little concerned when I told him that insurance had picked the prescriptions up and all I was paying was a copay.  I have been paying $45/month at Wal Mart and I assume that will now be $90.  That will be a little high but I can budget for it and without insurance it would be over $200 now for the patches alone.  The doctor asked me if the insurance company contacted him if it was ok to release my medical records and I said sure.  I have talked to a lot of people online about this also and a lot of girls do use insurance to get their meds and I haven't found anyone yet who has had a problem.  I don't need to lose my insurance now but I have my fingers crossed and I'm not worried.  I had heard he was the most cautious doctor as far as insurance and I am paying all transition related bills with him with cash so he is happy.  The other doctor here that deals with hormones is an endocrinologist and I am told she is more creative when billing through insurance but I also know for a fact she will keep people on a low dose for a very long time and I know at least one friend who went to a doctor outside the area for that reason.  I am happy with my doctor.  Like he says he is not an expert he is a family doctor but I can communicate with him and he listens to me and when the time comes I will listen to him.  I like the small practice and the friendliness and I am treated very well there so all is good on the medical front:)

The Curse of The Imp continued here this past weekend but despite some setbacks  I had an Awesome weekend with my boyfriend and spent the night in downtown Raleigh with him at a hotel where we attended the Carolina Meeting Place party there in the hotel bar.  This weekend I will be home all weekend and he is working out of state.  So y'all come back to Tammy World this weekend for another new post on last weekend, the party and the curse. 


  1. Can't wait for next installment Tammy.

  2. It's interesting how you say you are more confident with your wig. For me, I found losing the wig made me a lot more confident. Even though I look less feminine, I fell I am more me which is what I am striving to achieve. Since I went out without a wig in May, I haven't worn one since - anywhere! But you need to do what's right for you and at your own pace (your real hair looks fabulous BTW).

    Your BP, 150/90 in the UK for a female (which you now are with your hormones) of your age (I'm pretty sure I know roughly what it is!) is hypertensive. It seems your doctor wasn't too worried but for your own sake I would be looking to get this down. Mandy had a history of white coat hypertension and we ended up buying a monitor for home so we could discount this. They were expensive all those years ago and now are inexpensive so perhaps you ought to think about this. Hypertension is not something to ignore, and no more energy drinks before appointments! (and don't forget they are stacked with calories anyway!)

    I'm enjoying this blog, oh for the day when I get on hormones, I'm waiting on our slow health service to approve (or not...) my funding at the moment.

    Lucy x

  3. Lucy, the blood pressure is something they are keeping an eye on and one of the medications (Spiro) is supposed to help with that. It may not be enough, we will see, I used to take meds for hypertension but I lost a lot of weight and didn't think I needed them anymore.
    At this point I am more confident going out with my wig but it seems to be getting to a tipping point where it almost doesn't matter to me. I don't seem to get looked at or stared out now so i think I belnd in either way. It is a matter of confidence and how you feel and i am getting there. I am glad you were able to ditch the wig before going full time and I may never give up mine completely but it can be something to be worn occassionally, not everyday.
    I wish you luck in getting through the system and getting your medication. Its just a matter of time but if the finances are there maybe it is a good time to work on hair removal.