Friday, March 29, 2013

The Doctor: Hormone Report



I went to my doctor at the end of last month, as I reported here, but I have not followed up with posting the test results.  I went to see him on Tuesday, February 26th and I did not hear from him that week , so I called him on Monday.  He actually had tried to call me but he called my home phone and didn't leave a message so I didn't realize it.  This doctor is so cool that he personally calls me with test results and on the Monday I called him and left a message, he called me back within a couple of hours.  There was a mix up with my prescription at the pharmacy a couple of weeks ago and when the pharmacist called the doctor's office, she talked to him personally to straighten it out.  She said that is very unusual, she usually talks to a nurse, but I like the personal attention I get from my doctor.

This doctor is not an endocrinologist, he is a general practitioner, but he does prescribe and monitor my HRT.  There are some GP's that do this, but very few, and mine is a good one.  It works out great for me because I can have one doctor for everything and because he has such a small practice it is not hard to get in to see him for any reason or even talk to him by phone.  My spouse has always referred to him as my "hormone doctor" so I let the title of blog post allude to Dr. Hormone.  That's so cool, isn't it?

My everyday look in February 2013
So, I am on a schedule of going to get checked about every 4 months and I have had my hormone levels tested 4 times now, one baseline before starting and 3 tests since I started HRT.  The next time I go in, at the end of June, I will get a complete annual physical with tests run for everything.  On the 4 month visits he tests me for liver function and a few more basic system tests to make sure the medicine is not harming anything.  The last couple of times he has told me that they don't have to test the estrogen and testosterone levels, and it is more expensive for me to get that done, but I have chosen to do so because I want to know where they are.

I was very happy with my levels this time.  Estradiol was 183.6 pg/ml and testosterone was <10 ng/dl.  The Endocrine Society, regarded as the gold standard for HRT research and protocol, recommends estradiol levels of <200 and testosterone levels <55.  So my estrogen (estadiol) level is within the recommended range but very close to the maximum, and my T (testosterone) level is way below the recommended maximum.  Testosterone levels are like golf scores to trans women, the lower the number the better.  I don't know what my exact T level is because the test only shows that it is less than 10, it doesn't record the exact number when it is that low.  The link for those guidelines is located here

According to the National Institutes of Health, NIH, the normal range of testosterone for women is 30 to 95 monograms per deciliter, ng/dL, and 300 to 1,200 ng/dL for men.  eHow.com reports that typically a women aged 20 to 29 will have an average level of 149 pg/ml (pictograms per milliliter). A female aged 30 to 39 will average a level of 210 pg/ml. And those over 40 but not in menopause will have an average level of 152 pg/ml.

The doctor said all the tests look good except once again he said that my sodium level was a little low.  We did not discuss that in detail but he recommended me to again cut my Sprionolactone dose to 150mg/day.  The last time I was tested I had cut it that dosage because I was feeling dehydrated, but one month before this test I bumped it back up to 200 mg.  Apparently I am having some issues with the electrolytes and this is one of the things that is monitored because of this drug.  Spironolcatone, or Spiro, is actually a diuretic blood pressure medicine in pill form that is rarely used for that purpose anymore but is very widely prescribed in transsexual HRT as the primary agent of reducing testosterone. 

I love the effects of these pills because I feel that I had way too much testosterone for way too long, but apparently a little lower dose would be better for my system. I don't think the low sodium is serious at this point because he didn't seem too alarmed about it.  One of the effects of low sodium is decreased energy and I have been feeling a little lethargic, but in the last couple of weeks, with the lower dose I am feeling better.  The last time I was tested, when taking 150 mg/day Spiro, my testosterone was 14 ng/dl, which is still less than half of the low end of female range.  So apparently I am doing fine with the lower dose.  200 mg is the maximum recommended by the Endocrine Society as shown in this chart.   It's just that my feeling is the less testosterone the better.  Many feel that over time, as estrogen becomes the dominant hormone in the system, not as much testosterone blocker, if any, is needed.  I could probably do with an even lower dose but I am going to stick with the 150 mg/day for now.

Doctor visits

I have talked a little about it before, but it has been an interesting and evolutionary experience going to this doctor.  I was recommended by my therapist and had a letter of diagnosis of GID (Gender Identity Disorder), but I still had to go through the doctor's protocols.  My first visit was on May 2, 2012 and all we did that day was have an extensive interview with him asking me a lot of questions about being transgender and going over a long list of possible effects of MTF hormones.  It was sort of like a mini therapy session and I probably told him more than he needed to know but I was ready to get on with this program.  It turns out that because I was not there on a Tuesday or Thursday, when the nurse that takes blood is in the office, I would have to come back for them to take my blood and write the prescriptions.  I did come back on May 15,2012 for a complete physical with all blood work and got my prescriptions to Spironolactone and Vivelle Dot estradiol patches.  This was a good day!

People beginning transition have different approaches as to how they present themselves when going to the doctor. Some will go in wearing a wig (if they can't or haven't grown out their own hair) and full make up, possibly even a skirt and heels etc.  Some will go in full male mode, maybe because they have to go to work like that or maybe that's the only mode they have so far or it's how they are most comfortable.  I would say I started out going to my doctor as an androgynous person and I have to admit this was a little bit uncomfortable but the most natural for me at the moment.  I wanted him to see me and evaluate me just as I was at that point in my life, so I didn't want to crossdress, going in there with a wig, false breasts and a lot of makeup etc.  I had been growing out my hair for about 5 months but it was still fairly short and I dressed casually female with jeans, t shirt and tennis shoes.  I had on just a little make up but no foundation because at the time I thought it looked ridiculous to not look fully female and have on full makeup, although I was experimenting with that look at home.

At home with make up and no wig on May 14,2012..the next day I would drive to my doctor and get my first hormone prescriptions. 

He has a small waiting room so there are not a lot of people sitting around me but I do notice that the only women that ever come in this office (or practically any doctor's office I visit) "dressed up" are pharmaceutical reps.  Most women come in casual but not sloppy.  The staff asked me what name I wanted to be called.  They had me down as Tammy from my therapist's letter but my medical records are in my male name.  Of course I told them I wanted to go by Tammy and that is what they have always called me.  Everyone in that office has always been super nice to me and always addresses me as Tammy, using female pronouns etc.  I have never felt out of place there, even in the beginning when my presentation was androgynous at best.

This particular doctor sees a wide variety of patients.  He is located in an upscale suburb of Raleigh, NC and his clientele reflects that demographic.  A lot of patients in the waiting room are elderly, but I guess that is typical for most doctors as elderly people see their doctors a lot more often, in general.  He only has about 10 transgender patients and I am told a couple of them are FTM, although I have never seen anyone in the office that appeared to be trans.  On this last visit I asked him if he has ever had a patient go all the way through with him, from starting HRT to GRS, and he said there was only one, a MTF, and he has not seen her since she had surgery.  I guess she wanted a fresh start post op, going to someone who did not know her as a pre op. 

After the initial 2 visits in May I went back in July to have my basic system tests done to make sure none of the meds were harming my liver etc.  One this day I did wear my wig and full make up because I wanted to show them my best presentation at the time.  I was a work in progress (still am) but I had learned to make a pretty good and fairly passable female presentation.  The general idea was for my appearance to become more female over time, as I progressed through transition, but this one time I wanted them to see how I could look.   I didn't actually meet with the doctor that day but he did see me and speak to me in the hall.  I went back in a week to go over the test results with him.

Driving to the doctor, in the waiting room and getting my blood taken...July 9, 2012.

When I went in the following week I didn't wear a wig and wore only light make up.  The doctor asked me if I had been wearing a wig the previous week.  I thought it was obvious but I guess even with a small office he does see a lot of patients.  I would have to have had some miraculous hair growth between May and July to have had that wig be my own hair.  He did tell me that my own hair looked more natural and I told him that was what I was working towards.  He did not test for hormone levels in July and I don't think he was going to alter my dosage but I did talk him into doubling the doses for both of my medications.  He was a little skeptical but I was armed with printed information that justified this increase to the recommended doses for transition.  He listened to me and wrote me new prescriptions but wanted me back in a month to test everything. 

July 18,2012...Driving to the doctor's office on the day he increased the dosage on my medications.

He has since told me that I am the his only patient on this higher dose and that this is the highest dose he will give me.  Since my last test confirmed my estrogen levels at the high end of the recommended range and my testosterone levels much lower than the low end of that range, I think everything is good and I am happy.  I did manage to talk him into giving me 2 extra patches a month on this last visit, with the reason being the prescription was based on a 28 day supply and I wanted it to be a 30 day supply like the Spiro pills.  Apparently I am the only person I know that has asked for and received anything like this.  I have learned that we have to ask for what we want and have good reasons for it.  You never get anything unless you ask for it and I have learned that even when dealing with medical professionals you have to be your own best advocate.

On this last visit in February he told me I looked good when he came into the examination room.  He didn't perform an actual exam, he just sat down and talked a little bit then wrote my prescription refills.  He looked at me and remarked that I looked different than I did when I first came to see him and that the medicines appeared to be working.  It had been about 9.5 months since I first walked into that office.  I asked him how I looked different to him now.  He said I was more busty, my hair is longer and thicker and my skin appears softer.  I am a small B cup now and when I first came in I was not wearing a bra and had little budding breasts from herbal hormones and some Spiro I had gotten from my dad.  My hair has been growing out the entire time, except for trim ups, but it also seems thicker since I started estrogen.  My skin is softer, my pores smaller and I don't have to wear as much make up as I used to.  My cheeks have filled out some to make my face look more feminine.  I know there are other changes but these are the ones he pointed out when I asked.  On his way out the door he told me one more time that I was looking good.  I know I still have a long way to go, I am just getting going good with transition really, but I am happy with the results so far and I think my doctor is too.  Of course the greatest effect of the hormones is how I feel inside.  I finally feel normal but a little more emotional and I am finally at peace with myself.  I wouldn't trade this feeling for the world and I am never going back to that hollow shell. 

 I am finally becoming myself...

Before and after..
First visit to the doctor and most recent visit
Top photo is from May 2,2012, bottom is February 26,2013. 

 I think I look like a kid in the first picture and I should be smiling in the new one.  At my age looking young isn't bad and maybe I was tired of wearing that band aid over my skin cancer surgery scar, so I didn't smile.  I am trying to just use concealer on it now but I am still not happy with it.  I Am happy with my life now and very happy with my transition so far. 

Thank you doctor!


3/25/2013...Almost a month after my last doctor's appointment and with concealer instead of a band aid over my scar. Still a little bit of black eye on that side too, but I am happy!

Life gets better and better.