#(I do have an appointment with my endocrinologist in two weeks and I WILL be talking to him about this)

[tj-crochets]

anybody else ever think "oh I'm the kind of stressed where I should distract myself and make something, like a stuffed animal" and then it turns out no, your blood sugar was just low? I've got a new record low (but technically still not hypoglycemia) blood sugar and a three and a half foot long worm plushie (it only occurred to me to check my blood sugar after I was done making the worm, I'm fine now but ugh)

[skullamity]

PSA for trans men and trans mascs on T who are afraid of/concerned about or experiencing male pattern baldness: Talk to your endocrinologist who monitors your T about hair loss before you talk to anyone else, you have options!

When the hair in the top of my head started to thin, I talked to my regular GP. She told me it should be fine to use Rogaine topically. There were no other options, either because she was somehow not aware OR was under the impression that alternatives might interfere with HRT. If this was the case, she did not relay this info to me, and if she had, I would have made an early appointment with my endocrinologist, who specialises in HRT for trans people specifically, and asked her about my options.

But, since I only have appointments once a year with my endo now because my levels are generally super consistent, I decided to try Rogaine. I lasted about a month, because it basically meant I had to wear a lined hat at all times to make sure I wasn't getting any on my pillow/cats/child. You need to apply it two to three times a day and leave it on your scalp for a couple of hours for the best results, every day, forever, and if you stop using it, your hair goes back to whatever it was up to before that made you concerned in the first place. I quit after a month and resigned myself to eventually going bald.

I finally had a phone appointment with my endo last week (was supposed to be in person but she had an emergency and was working remotely for the day), and when I brought this up and that I had tried Rogaine but couldn't deal with all of the above + my scalp was not reacting well to the alcohol in the foam so I quit, she was like ????? what? why didn't your GP just prescribe you finasteride???

I am now on finasteride! It is a dirt cheap, tiny ass pill. I only need to take a quarter of a pill once a day (my endo also helpfully explained to me that pill cutters exist and are also dirt cheap, so perfectly cutting a pill into quarters takes about 5 seconds and I got it for a whopping $8). Just like Rogaine, I WILL need to take it every day, forever, but it's not going to get all over my pillow and make my cats sick or cause my kid to grow a beard or whatever. It isn't going to dry my scalp out, and it also the cost comparison is a joke. I take it every morning at the same time I take my adhd meds, so it's easy to remember.

I have seen so, so many trans men and mascs online lately worried about this, probably because I've seen so many conservatives and the kind of detrans people that conservatives like to parade around put a lot of emphasis about how T will make you UGLY and make all of your hair fall out. I do feel sorry for any detrans women who are dealing with wonky hairlines or male pattern baldness, but also it sure is convenient that none of them see fit to mention that if you are experiencing those things, you can literally just talk to your endocrinologist about what your options are and then take a quarter of a pill every day to fix it. Almost like making you aware of that might move you away from their end goal, which is getting you to detransition.

[demilypyro]

I can remember exactly where I was when I got my HRT prescription.

It was march 16th, 2020, somewhere in the morning. I was at my grandmother's place, I used to sleep there when I was in college, she lived close to it. We'd just received word that a two week quarantine was going into effect for this rumoured "covid" virus. I was supposed to go to the hospital to have my interview about HRT, but quarantine meant the appointment would likely be moved, and I was bummed about it.

My phone rang. It was my endocrinologist, saying we could do the interview over the phone. The relief I felt was immense. I was approved. Picture me running down the street to get HRT like Charlie holding the golden ticket.

[wambsgansshoelaces]

omg a headcanon like the one you did for tom but for roman snd stewy? the period one i mean !! also gender neutral pls :>

thank you for requesting anon, i love u!!! enjoy xx

really craving pizza bianca rn

on your period (roman + stewy)

Roman

ᝰ has no idea what he’s doing

ᝰ he calls your period a full stop because ‘they’re synonyms lol’ (as his text said)

ᝰ just wants you happy

ᝰ so whenever you’re on your period he just

ᝰ does things for you??

ᝰ makes you breakfast in bed, attempts to pack you a lunch, botches dinner

ᝰ he’s trying at least

ᝰ he usually just settles for buying you whatever you’re craving and letting you lay your head in his lap

ᝰ he strokes your hair, your face, your neck, your back

ᝰ he makes sure you’re feeling good

ᝰ lots of chocolate all the time

ᝰ just so that he can eat it with you

ᝰ if you ever ruin any pants or clothing or even furniture, he replaces it without you knowing

ᝰ “didn’t i throw this pair of pants out last week?” you ask him one time

ᝰ “i got you a new one, don’t worry about it.”

ᝰ if you suffer with cramps or any sort of chronic illness regarding your reproductive health, he’s always quietly concerned

ᝰ “you sure it doesn’t hurt? you should tell me if it hurts.”

ᝰ keeps track of how long in between painkillers your pain returns

ᝰ makes you try a bunch of homemade remedies he googled

ᝰ the first time you go on your period while you’re living together, he goes out and buys you a heating pad, a weighted blanket, and a heated blanking thing all at once

ᝰ if you use pads or tampons, he gets really confused when out trying to buy some for you

ᝰ but he’s too embarrassed to ask

ᝰ so when you’re taking a nap he scuttles into the bathroom and takes a picture that he keeps on his phone

ᝰ and then gets the exact ones when he notices you’re running out or you ask him

ᝰ this man bullies the doctors that don’t listen to you

ᝰ like he is well known with the endocrinologists and gynecologists in the are as a nusiance

ᝰ and lowkey an asshole

ᝰ but it’s all ‘in your honor’ as he says

ᝰ “if they say they’re cramping, they’re cramping. aren’t you supposed to be helpful? how the fuck do you have a medical license?”

ᝰ has gotten kicked out of the appointment many a time

ᝰ but he always waits patiently for you outside

ᝰ and calls corporate like the diva he is

ᝰ has the means to get you the best care

ᝰ and he does get you it

ᝰ “you literally deserve so much more than i can give you. you’re my everything, remember?”

ᝰ “i love you, ro.”

ᝰ “fuck off with that sappy shit…. i love you more.”

Stewy

ᝰ knows enough about periods to be able to help you

ᝰ like he’s knowledgeable enough to cook things he knows your body is in need of during your period of ovulation

ᝰ urges you to work out specifically on your period

ᝰ “it helps clear your head,” he says

ᝰ but if you’re not up to it, he won’t make you

ᝰ maybe just a small walk around outside and he’ll let you just nap

ᝰ but if you even don’t even want to walk, he thinks you’re dying

ᝰ and showers you in affection

ᝰ which he does anyway even if he thinks you’re fine??

ᝰ he’s just dramatic

ᝰ he’s an awfully good cook

ᝰ he loves cooking

ᝰ especially for you

ᝰ he specifically makes you pho for dinner every first day of your period

ᝰ “it clears your sinuses, babe,” he says every single time

ᝰ it does, really

ᝰ he’s really big about the two of you sitting down at the table for meals

ᝰ but if you’re unable because of your period, it’s fine with him

ᝰ he bought one of those breakfast in bed trays just for those moments

ᝰ if you struggle with bad cramps or reproductive illness, he’s with you at every single appointment

ᝰ sometimes he even sits next to you on the patient bed

ᝰ he just likes swinging his legs over the side

ᝰ he scrambles off whenever the doctor comes in

ᝰ he’s so subtly evil with bad doctors

ᝰ “oh, i understand it’s your professional opinion, but i also understand this clinic operates solely on donations? huh, and i think those guys whose names are on plaques all over the place are my buddies! you know jeff? i know jeff!”

ᝰ holds your hand through everything

ᝰ pain, ultrasounds, examinations

ᝰ you’re both walking back to the car from a normal check up and he’s swinging your hands back and forth with his

ᝰ “you know, i’ll help you with anything you ask me to.”

ᝰ “thank you, stew. you’re sweet.”

ᝰ “i love you.”

[paranoidkid]

helppppp being disabled is so expensive fuuuck. i have like. an old insulin pump (~6 years old?) and my endocrinologist said I should get a newer model and the CGM that goes with it which runs in a loop, and that would be AMAZING for my blood sugar and keeping me a1c down but… out of pocket with the insurance I have right now (deductible not met) is $2,000 . and goddamn I do not have $2k . they have a payment plan but it’s like $50/mo for 4 years and I might die if I commit to that. but wouldn’t a new pump and cgm that work together be nice… on top of having a new service dog also??

just for the record at my current job I make $10/hr + tips and work ~25h/wk which obviously isn’t great and then I have to pay 525.60 to my dad for rent (cringe) and then leftover from that I have maybe $200 every two weeks to keep to myself but it doesn’t even keep to myself because I have a new puppy and I go to therapy and am disabled so I have doctors appointments and debts and it’s just like come ON man does everything have to be this expensive ???? why does my CGM sensor right now cost 37.99 a piece and my quarter yearly endo appointments cost $45 for just the appointment not including the debt I have accrued for the labs and other various testing that’s like $608 right now… ON TOP OF THE $1.4K DENTIST DEBT I HAVE ??!!?!? it’s over for me. fuck

[theconqueringchicken]

The Stress of Accessing Gender Care

It took me years to decided to have any type of gender care and the process of accessing it is really stressing me out.

I met with my provider in summer after waiting about a year and a half to establish care. I told myself I was going to treat my PCOS and get on birth control or other hormones like I was supposed to but the words stuck in my throat. I told her I couldn't do it, that getting care to be more properly a woman felt like going in the wrong direction, and I wanted to try testosterone therapy.

She was very supportive and so said we should schedule a longer appointment to talk more about that. I was expressionless, tense, and closed off throughout. I wasn't ready to talk about the what I want. I have been holding it in since I was a teenager hoping the desires I have would go away.

No one wants to hear about it. It's not even something I can talk to my trans relatives about. One told me to come back and talk when I knew what I was and what my pronouns were and not before. Another told me that I just needed to learn to be a woman properly and my problem was lack of guidance and community. Step by step aigot pushed back into the closet.

My therapist's first reaction was "There's a lot of ways of being a woman. Maybe you just need to find the right one." Basically asking if I've tried not being trans. Oh yes, I have, for 15 years. Subsequent conversations were just as unproductive.

At my next doctor's appointment we talked briefly about health risks and why I wanted to try HRT. Never mind I'm already facing those risks from PCOS. My body is already making enough T to give me extra body hair and stop my periods for six months at a stretch.

I didn't know how to articulate why I wanted HRR. I've never talked about it and I feel so numb from depression and am so used to repressing these feelings they just slip through my fingers.

I only know that they are there. A pang of jealousy when I meet a trans man, a stab of shame when I don't meet a standard that was never meant to apply to me. A burst of pride when I push my body. The secret, desperate joy when I started growing chest hair and facial hair. The deep wrongness of being too feminine or completely masculine.

I can clumsily say what I feel but I do not know why I feel it.

I told her I was never normal, being a girl never fit, and if someone had offered me HRT when I was a 14 I would have taken it without a second thought.

She listened though I knew she didn't understand at all and I thankex her though I knew it wasn't what she was looking for. I was no less closed off to her and to myself.

Heading home I finally let myself feel happy. It was such a a fragile feeling, like a soap bubble floating along beside me, and if I looked at it too hard it might burst and all my fears would come crashing down on me again. Letting myself believe that HRT was a possibility for me felt like asking for disappointment or humiliation but I let myself have that hope,to pretend to believe in it just for a little while.

Then the gender limbo began. I was supposed to have an appointment scheduled with an endocrinologist but no one ever called me back. I felt this spark of panic and paranoia. Was someone trying to hook up my care? Like the person at the front desk who angrily snatched my ID out of my hand when I used my chosen name and not my given name?

After two weeks I called to ask what was going on. That day the entire phone system at the clinic went down so I got up and I went in person and was assured they would get back to me asap. They did not so I called them.

I asked about the scheduling and they told me it was being held up because they didn't have my new insurance information. Then, after another week it was being held up because they needed to do "information gathering". They did not specify what information they were gathering or why it took more than three weeks.

The next week I got another call telling me that they still had not scheduled anything and had no idea when they would be able to fit me in. So I made an appointment with a different provider and started the whole thing over again.

I had so much anxiety about keeping that appointment. I could feelyself panicking as I headed out the door and then when I reached the clinic I felt excited and relieved and so so glad I came. Then I was told my appointment was at another clinic. There was no time to get there on the bus so I just had to go home.

I told the receptionist that it was okay, that's just the way it goes sometimes, and then I went to the restroom and cried quietly on the floor for a few minutes. I kept myself together as I left and walked past the weirdos prowling around the clinic. Then I made the call and told scheduling I couldn't make my appointment and they told me that there never was an appointment and I started crying all over again.

I cried half the way home, then got junk food and a face mask, and made up my mind to fill my day with chores and crafts and go out later so I wouldn't be stuck at home. Yes, I am aware, getting the address wrong was my fault. That really doesn't make me less miserable.

This whole process has been so exhausting I don't know how anyone even does it. I don't know how people in the UK deal with all the wait times and all the nonsense.

I don't know how folks in the US copewith finally getting that prescription and then finding out that a pharmacist can just refuse to fill it because they hate transgender people.

I don't think what I've been dealing with personally is bias, it's just that healthcare is a shambles and has been for years. It's so stressful and it must be for everyone. I hope your journies are going better than mine.

[lovethisfatcryptid]

After this, my next major health goal is to call my insurance and ask for a caseworker and also find out if they do free rides to appointments. I appreciate him offering to take me to all my appointments, but I don't think my roommate understands that sometimes chronically ill people can have appointments 3-5 days a week :/

When I lived in Phoenix I had a large care team made up of my PCP, gastroenterologist, rheumatologist, cardiologist, neurologist, psychiatrist, endocrinologist, pain specialists, and physical therapists. I might be missing one or two 😅 but yeah. Being chronically ill is a full time job.

[smalife1234]

This is our THIRD weekly smiles!!

What made me smile this week?

Monday, 8/12/24 - today is the dreaded doctor appointment but the one where we finally find out about my endocrinologist!! As most of you know, my endocrinologist left because of health issues or just because of retirement on the 8th, and we decided to meet at the next Dr appointment if we could find an endocrinologist in Asheboro that would fit me for a while! Sadly, we got news that I could get a new endocrinologist, but it would still be in Greensboro since none are in Asheboro! Which is disappointing! Then after that news, we checked height and weight! Sadly I lost weight and didn't gain any height :/ at my last endocrinologist appointment, which was May 8th, I was 99.12lb. Now I am 98lb so I'm back down a pound and a half! Which is a bummer. Then we needed three shots, one shot for a strain of meningitis, another for something else, and then a finger prick to test cholesterol! The finger prick didn't hurt at first until we put Gauze on my finger and a bandaid and those shots made our shoulders all sore which sucks :( but I'm happy to have it over with and I'll be having another one in September! Whoo appointments! I'm happy that the rest of the day is just doing dishes and chilling and some editing, but I'm smiling nonetheless!

Tuesday, 8/13/24 - today we are going to our grandma's house! In the morning, we woke up to sparkling water and yummy Takis and a good ol gallon of milk, wishing it was that restocked when we came back from Grandma's, but that's ok! We chilled until Grandma and Grandfather picked us up! We sat and chilled and watched Subway Surfers ads. Sadly, our arm soreness is not getting better. It's even worse than yesterday. Earlier this morning, Matthew was putting on my shirt, and it hurt, which was not fun, so thankfully, we're taking it easy! When we get to Grandma's house we will have a yummy turkey sandwich! With mayonnaise! It was very yummy, and then after that, we played uno for a while, and we had a fun time. Now we're chilling on the exercise bike for a few and did a few miles! Then, after that, we enjoyed a yummy dinner of ham, potato salad, creamed cucumbers, and macaroni and cheese! It tasted great, and then Matthew finished his last mile on the bike. After a little while, we got an ice cream sandwich, which was good, and then we went to bed at 10:00 p.m. The whole day made me smile!

Wednesday, 8/14/24 - today, we woke up around 8:00 Am and went upstairs to some yummy French toast. We ate it, and it was so yummy! Then we chilled downstairs and waited for our friend to get out of the shower so far just sleepy but enjoying the quiet morning later into the day we went outside and picked blueberries and took down the fence around the Berry it was hard work but we got to have it all rewarded with spaghetti 🍝 with some zucchini and Italian sausage! It was very yummy paired with our meal was a yummy sprit after our meal, we chilled for a while and watched Instagram reels. It wore us out, but tomorrow will be a less busy day! And currently, we're having ice cream sandwiches! Also very yummy! Now we're chilling watching ads on our tablets. Today was very tiring, but a good one made me smile!

Thursday, 8/15/24 - we woke up around 8:00 Am and didn't shower since we had taken two showers yesterday from all the hard work! We went upstairs to find yummy blueberry pancakes 🥞 sitting there and a fried egg 🍳! We sat down and got a glass of milk! And then our friend kept coughing and it made us laugh! My wife Emmie burped so disgustingly that it made us start dying in laughter! Until Grandfather came into the room, we were still dying of laughter. We hid our laughter from Grandfather. Willam was dying with his cup of milk. I was just trying to answer his remarks, lol! We still were dying after he left, lol. We then went downstairs, where I worked on weekly smiles! And then we chilled for a very long time just watching Instagram reels after hours of watching Instagram reels lol we headed upstairs around 3:00 P.m. to prepare a Mexican stew-type dish that contained green pepper onions hot pepper flakes and other seasonings we headed downstairs where we hung out and chilled until 6:00 Pm where we had the yummy stew surprisingly for having beans (which I don't like because of the texture) it tasted pretty good! It was great. Sadly, this is our last full day at Grandma's. That didn't make me smile, but the awesome day certainly made me smile!

Friday, 8/16/24 - today is the last day of Grandmas :( which sucks but we had a wonderful time! This morning we woke up to more blueberry pancakes 🥞 🫐! Yummy we talked a little about some vitamin gummies that me and our friends have to take since we're low on our vegetables! But that's ok. We headed downstairs, where I took my shower first. It's always nice to take a warm shower even though I can only feel it on my neck, my head, my top hand, and half my thumb. Fun :) now we're packing up and ready to leave around 1:00 pm! Before leaving, I was looking at old photos of me when I was first injured, which was almost 3 human years ago on September 1s,t, perfect for SCI awareness month! I saw how much strength I had originally since my SMA wasn't in effect and I didn't have ALS! It's always super cool to hear about my strength and see my strength back then it made me smile! Then after that, we had a yummy lunch, a yummy turkey sandwich with mayonnaise! It tasted great, and then we headed home, where we enjoyed new songs! That we never listened to. We said goodbye to Grandma and Grandfather! We had a lovely visit and it was amazing! But now we're home enjoying listening to music and watching many things! We're having fun. The first night at home made me smile! Later that night, I overheated, which sucked, and then during the night, something almost fell on me! Don't worry I'm fine now! It didn't make me smile, but the rest of the day did!

Saturday, 8/17/24 - today, I woke up and chilled. I woke up pretty early! Then I found out that our vitamin gummies had come in so I had to give one a try. We don't take two since we're underweight! But they weren't bad; they just had a slightly different texture than normal gummies. Overall, they were pretty good, and hopefully, I will enjoy a new flavor of gummy tomorrow! After that, I chilled until I started my chemo at 9:00 Am. During chemo, I watched reels and listened to good music! I Watched some Owl House and then got some brunch (breakfast for dinner). I had a sausage biscuit and eggs with ketchup (don't hate me..). After a while, I was done with the dishes, but two big knives almost cut my big toe. I'm thankful those knives didn't cut my big toe! And I also had esophagus surgery which sucks, but thankfully, I didn't experience any pain! Today made me smile!

Sunday, 8/18/24 - today, I woke up latish around 9:00 P.m. I watched a couple of shows and chilled the majority of the day. We finally got Luz into some jeans, and I got a cool new fancy outfit! It certainly made me smile! Although our friend Emmie overheated and needed the emergency aid bag which sucks since I had overheated ok Friday :( that's the rough part of being a Quadriplegic and then we took the second vitamin gummy! I tasted a new flavor and it might be my favorite so far! And currently, we're listening to music, and later on tonight, we're going bowling 🎳! With our friends but I'll go ahead and post this weekly smiles now so I won't forget 😅! But hitting the third weekly smiles! made me smile! Have a great day everyone!

What made you smile this week?

Img desc #1: shows Doc and Emmie at an event. Emmie, seen right of the image, is wearing a black short-sleeved shirt and grey jeans with black shoes! Emmie's arm is resting on the side of Doc's electric wheelchair. Emmie is in her manual wheelchair doc, seen on the left of the image, smiling in a pink long-sleeved shirt and beige colored pants paired with dark brown shoes. Doc's atrophied hands are resting on the joystick of her electric wheelchair.

Img desc #2: Luz, her friend, is smiling while wearing a sleeved grey jacket over her white short-sleeved shirt paired with her shirt is her grey pants. Luz is wearing a cross necklace and is in her pink manual wheelchair.

Img desc #3: doc is seen with her head tipped back off of the brown headrest of her electric wheelchair docs right arm is seen propped up holding the right side of the purple pants that's on doc, doc's left arm is stretched out Infront of her doc is wearing a black short-sleeved buttoned up shirt and overly large purple pants that weren't sized down to her size!

Img desc #4: doc is seen in a comfy seat. Doc is frowning while wearing a grey shirt and grey sweatpants. Her atrophied arms are resting on her lap near her phone. It is dark in the room.

Img desc #5: doc is seen smiling away from the camera. She is wearing a pink long-sleeved shirt paired with a dark blue bowtie. She is wearing beige colored pants and dark brown shoes.

Img desc #6: doc is seen smiling at the camera while wearing a pink long-sleeved shirt paired with a blue bowtie. She is wearing beige colored pants and dark brown shoes.

Img desc #7: Emmie is seen looking down at the camera with a funny stare. She has a fork in her mouth, and there is a bowl of pasta. In front of her, she is wearing a white Hawaiian-themed shirt and grey shorts (covered by the table).

Img desc #8: Emmie is seen in a car. She is smiling with sunglasses on. She is wearing a white Hawaiian- short-sleeved shirt and grey shorts. On her lap is a red bungy cord she uses to go to the bathroom and her grey adaptive fork (since she has no finger function).

Img desc #9: doc is seen in a red short-sleeved shirt. She is staring at a lamp while near her laptop. Her Atrophied wrists are on top of each other, and the thumb of her left hand is near a blue cup that has a red straw in the cup she is giving a blank expression.

Img desc #10: doc is seen laying in bed with a white short-sleeved shirt that has colors and words on it but is mostly covered up by Doc's arms being crossed over her chest along with her white short-sleeved shirt she is wearing black/grey shorts she has no socks or shoes on and is laying near a white lab dog and giving a bright smile towards the camera moments before doing a Catheterization or overheating!

[nokingsonlyfooles]

Stupid Doctors. Stupid Eyes.

So, did two doctors in one day. Two separate issues, remarkably similar difficulty in communicating and getting healthcare. Part of it MUST be the autism, but that CAN'T be all.

Doctor #1 was following up on a previous phone appointment. I had asked for an in-person appointment to lay out my case, told him I had almost a clean sweep of hypothyroid symptoms, told him I need a doctor who can handle my thyroid and "female hormones" (no other polite way to say, Can you handle all my hormones or not, you are a hormone doctor) because they interact with each other and if I have to keep ping-ponging back and forth between two doctors to work on this, I will not get adequate care. He started to ask about what estrogen I'd been on before during that appointment, but he backed off and tried to get me to see another gynecologist when I mentioned Canada kept running out of the patches I'd been prescribed. I tried to reiterate that if I have to square my treatment up between two doctors, I may die, but he said I might prefer an "expert."

I heard "you can use this other doctor if you're more comfortable with them," which I wouldn't have been, so I ran off and got a referral that would OK him to handle the estrogen and progesterone. He meant, "Under no circumstances will I handle that for you, even though I could. It's too complicated for me."

This became clear over the course of a five minute phone appointment, which I only accepted because it was the soonest one available. I thought he'd follow up in the office. And, although he wanted more blood work, I reminded him he told me the numbers were unreliable and he would need to address the symptoms, and he agreed with me, he just wanted the numbers too. Yesterday, numbers in hand, he told me my thyroid levels looked too high, so he was decreasing my dose, and I could have another blood test in three months. Bye. No discussion of unaddressed symptoms that don't look ANYTHING like hyperthyroid.

Did he get the referral? Could he address my "female" hormones? Well, he'd told my family doctor to refer me to that gynecologist! WHAT family doctor? That's not my family doctor anymore, he was fucking with my thyroid treatment that YOU prescribed me, among other very bad things, AND I LEFT HIM. I swear, I told the guy that LAST TIME.

OK. So I need a new endocrinologist who will actually handle all of my hormones, and I need to do all the research and find this person for myself, then ask the clinic to refer me to them. I could've started on this weeks ago if the fucker had just expressed himself in clear language. I TRIED to tell him as many ways that I could, "If you can't do that for me, I NEED ANOTHER DOCTOR," but he didn't hear that.

Doctor #2 was the surgeon who "fixed" my eyes so I can't maintain focus or acuity. I had a fight with the tech, and then with him, trying to explain the difference between, "I can read this, even though it's blurry, because I can guess what the letters are based on their basic shapes and the other letters in the line," and "You can read that just fine!" I tried to verbalize my struggles and this confused them. "Stop trying to focus on the letters, just read them." DON'T FOCUS ON THE LETTERS, JUST READ THEM???

They also had difficulty understanding the nature of the visual distortions. "Is this better or worse?" "My eyes get tired and stop focusing. It's not consistent." "But is it better or worse?" "I've been focusing on details for multiple letters now, and my eyes are refusing to stay in focus. I don't know." "Your prescription isn't consistent." *a pause, while my verbal ability crashes and I try to reset* "Wh-Why would it be?"

The doctor didn't know what binocular vision dysfunction was. Last time I saw him, I swear, the nurse asked what it was, and he explained it to her. It was brief and light on the details, but he did. Now he doesn't know what it is. He forgot since last year?

Also, I should not call the thing where a faint double of the image or text appears above or below it "double vision." "Double vision" is some other specific thing, not seeing two things, one of which is fainter. It's confusing for them when I call that "double vision." Cool. That makes very little sense to me and makes it even harder for me to keep talking. Thanks.

Anyway, they put me in front of a couple machines to take images and this time, FINALLY, I coughed up numbers that say something is wrong. My lenses are supposed to let light through at a "10." The left one is at a "9," which the doctor thinks is "not bad" and then he never addresses the blurriness in that eye again. Because the right one is at ".89". There's a decimal in there. It's less than one. This is severe. I must have a cataract.

But I only had the surgery because they thought my lenses looked fine and I wouldn't have cataracts for a decade or more! All of a sudden I have a cataract? "Well, let's dilate your eye and have a look!"

No cataract. He can't see anything. Yet he is holding an image with a number that says YES cataract.

Well, okay, I can read, so my vision isn't that bad (Oh, dear god) but let's give it a month, come back and see if the machine says the invisible cataract has progressed any. If it's still there and still invisible, you can have a referral to a cataract specialist. Oh, this has gone on so long, all the techs are at lunch. Well, they'll call you to make an appointment when they get back.

They still haven't called me, I guess they've been at lunch since yesterday.

I want my money back. I really, really do. If I have early-onset cataracts they missed, I did not have the information I needed to consent to that surgery. I don't think it's going to happen, though. Cataract surgery would be covered, if I just got a regular lens. But if I'm letting them cut into my eyeball and risk more pain and severe dry eye after all I've been through, I want a better lens - if that would work for me. God alone knows how I'll find a doctor whose opinion I trust to ask about that.

I still have no idea why the left eye is blurry and THEY CAN'T SEE ANY CATARACTS. This doctor is painfully nonchalant about having no idea WTF is going on. Hey, the surgery was a success! I can read! According to him! I don't have the endurance to draw or the speed to drive, but that's cool. No big deal.

Bleh. This is probably poorly-worded, with typos, but this is what's going on with me. This is what I'm trying to accomplish while still telling stories and enjoying life as the world falls apart. I'm a little tired and distracted, that's all.

[transsextual]

hey, i hope this isn't too invasive but I was wondering if you could talk a bit about the appointment you had to get your gender dysphoria diagnosis and get on testosterone? and also how you got to that point. like did you talk with your primary doctor first and they said you needed the diagnosis? and then after the diagnosis your doctor gave you a prescription? I'm hoping to start testosterone in a year or two and I have kaiser, so maybe the process I need to go through will be similar to yours. if this is too invasive feel free to just ignore, no worries! just thought I'd ask

hi! okay. it's been a year or so but from what I remember:

- once i turned 18, i talked to my doctor about wanting to start testosterone bc I'm trans and asked for a referral to a gender clinic

- she wrote me a referral that day, got a call the following day to schedule an appointment about 6 weeks out

- during appointment, spoke to therapist from gender clinic & got gender dysphoria diagnosis, scheduled a follow-up appointment

- at follow-up, got a rundown of changes to expect once on testosterone, ways it can be administered, etc

- from therapist, got a referral to endocrinologist, got a call to schedule appointment, also about 6 weeks out

- during endocrinology appointment, my endo tried to give me the schpeel about how i'll become infertile, a lot of changes are irreversible, etc, and i just said, yeah i know and i'm giving you informed consent because i've wanted this for years

- she wrote me my prescription for testosterone injections

- my prescription was for intramuscular injections, and i was fine going to my doctor's office for those, so i had to call the scheduling center to make my first shot appointment, which took me a while because i struggle with phone calls

- after a few weeks, scheduled the appointment for literally the following day, went in, got my shot done, super easy

it's worth noting that a) if you're administering testosterone at home, you can often pick up your prescription from the pharmacy the day it's prescribed to you and b) you can request a prescription for testosterone gel, patches, and either subcutaneous or intramuscular injections thru kaiser.

additionally, if you want to do shots at home, my clinic has the option to schedule essentially a "how-to" appointment with an RN where they teach you how to do your own injections.

your endocrinologist will probably not tell you what kind of injection they're prescribing you unless you specifically request a certain kind, but afaik there's really no difference aside from the length of the needle (in my experience subcutaneous is 5/8 inch, and intramuscular is 1 inch... not sure about the gauge). you can pick up your needles + syringes + T or your tgel / patches from the pharmacy like you would for any other prescription :)

[marmolita]

(medical stuff cw behind the cut)

I really dislike being in this state where I have weird headaches and no idea if they're from chronic sinusitis, hormones/perimenopause, my thyroid meds being off, allergies, tension, migraine, or something else entirely 😑

What makes it worse is that I now have the world's most useless primary care doctor, so there's no point in even going to see him, and every specialist is only gonna treat the thing they're a specialist for. The three weeks of antibiotics the ENT gave me did improve things! But they're degrading again now and he said the next thing he'd do would be surgery, which I don't wanna do when I'm not even sure that's the problem.

My endocrinologist previously had me tweak my synthroid dose down, which appeared to help, but then all my hypothyroid symptoms started coming back, so I bumped it back up, and that was fine for a while but now not so much. But would I rather have headaches or constant joint pain? When I asked him about whether it might be hormonal at my last appointment he blew me off and was like "if you want to go back and forth between these two doses to manage your symptoms that's fine" which is not very useful.

There's also the dimension that it might be related to not getting enough exercise, and my schedule is a disaster right now so I'm not getting any exercise beyond walking the dog at the moment. Or maybe it's related to food! I get a worse headache when I'm hungry.

In any case idk I guess I need to find a new primary care doctor who actually is useful, if such a thing even exists anymore

[soulmvtes]

I'm waiting for my appointment at the endocrinologist mid may. Now to that appointment I will have to bring a certificate from my psychologist who I have to see every four weeks. About 6-8 weeks later I might finally get access to hrt. This process has been tearing at me for months now and today I looked into my calendar and realised that I missed my appointment with my psychologist on monday. I was so caught up with uni and trying to find comfort in expressing myself without hrt and I've just been so restless and all over the place it's so stupid. It' sunday and tomorrow is a holiday so on tuesday I will be able call and see if rescheduling is a problem or not. I've spent the rest of the day imagining how this could maybe lead to my endocrinologist meeting needing to be rescheduled. Then I read

spending days waiting for better days. waiting quietly, restlessly, alone, among a crowd. doesn't the present already hold within itself the promise of perfect moments that shouldn't be lost to a vague hopeful fantasy of the future? do two shadows get any darker when they're together?

and I teared up, thank you so so much 🖤🖤

i'm so sorry to hear about your situation + i completely get your frustration, sending so much love 🫶🏻🫶🏻🫶🏻 everything will be okay :)

[multifandumbmeg]

Random update per my fics:

Sorry I haven't updated in the last few days. I usually try to write some every day, but I took a day off to plan Golden Glint and then finished the mini fic (Reckoning of Mike Carrera) I started before it because that's what I wanted to write and I wanted to finish it.

On the topic of all my in-progress fics, my writing just isn't consistent right now. I mentioned a while ago that I'm going through AO3 author's curse and would eventually expand on that, so since I'm extremely frustrated and paralyzed from being productive today I'll do that now.

Starting from winter/late fall of 2022 I got sick and basically never got better. I was having illness after illness that meds weren't solving, and my headaches just got more and more frequent until they were every day for at least three months. By the time I came home from Korea, I was having full-blown debilitating migraines every day and attacks where I would almost pass out and couldn't breathe. It took me a couple months but I got on insurance, started a new job, and managed to convince my parents to let me focus on getting my health together this year.

It's been extremely difficult and frustrating because US healthcare, but I found out I do not in fact have ANY allergies despite doctors telling me I do, literally putting me on allergy shots for a year, and telling me that was the cause of migraines, inability to breathe, and constant illness, none of which were true. I had to prove this to them by fighting to see an actual allergist and getting re-tested which costs me hundreds of dollars out of pocket, but at least the allergist was a good dude who wrote a SCATHING letter to my primary care demanding I be sent to the proper specialists for my symptoms. Several blood tests and medications later, we have whammy number two:

The hypoglycemia I was diagnosed with as a teenager was not in fact random. Instead, I have hyperthyroidism caused by Graves Disease. Except I ALSO have Hashimoto's Disease, because I am just so special like that. Basically, rather than allergies like I was always told, I have been getting every single sickness that rolled by for the past several decades and because I was so used to being sick and so criminally gaslit about it, I didn't even know I was ill and just kept going. Thyroid also has tumors on it. I may also have other autoimmune disorders, or thyroid cancer, but I won't know until I finally see an endocrinologist an hour away later this month.

Though my daily migraines stopped last summer, I still get frequent headaches and now extremely bad ones (or migraines) every time it rains. Generally, there seems to be some kind of inflammation issue where my body over-reacts to literally everything by swelling up and causing more problems.

Possibly tied to that, I was in pain every single day at work. Considering my age, there is no normal reason I should be crippled by joint pain but that is yet to be solved. I now only work two days a week, which has helped significantly, but I am still consistently in a ton of pain two days a week, sometimes three as a rebound.

In January, before I had gotten any diagnoses, my parents gave me an ultimatum that they were kicking me out in May. I had to beg them to go part-time because I simply could not keep up with job applications while I was so constantly tired and pain. After sobbing for two straight days about the inevitability of becoming homeless because I can't afford to or logistically live on my own, my mom convinced my dad to let me go part time on the condition that I continue to pay the same rent Ive been paying to live in one of their empty spare rooms.

In February, I went in for the first appointment toward getting an Autism screening. The therapist suggested I get an ADHD test and recommended me for the official autism screening, saying I have a solid case for suspecting. After a little computer game and another talking appointment, slightly to my own surprise (especially because of how easy it was) I was clinically diagnosed with ADHD. I recently started meds for that and it has made basic tasks and job applications infinitely easier to the extent it's insane, plus my final Autism screening is next week and based on my results every step of the process so far diagnosis seems likely.

All that said, the job search process has been soul-destroyingly frustrating. I have a masters degree in a specialized field, backed up by a Bachelor's in a relevant field, years of study abroad and work abroad (which is relevant to my career path) and a track record of excellent academic achievement. I also speak French and Korean near-fluently and am conversational in Romanian and Russian, as well as knowing a fair few phrases in a number of other languages. Every job I've had has stressed me out to the point of quitting by around a year (hello Autism), but also none were related to what I studied at all, highly customer service oriented, and still every one would tell you I was one of the best employees they ever had and begged me to stay. Even with this track record, after literally HUNDREDS AND HUNDREDS of applications (which in my field almost always require a cover letter, often questionnaires and lengthy short answers, or even writing samples in addition) I have had ONE interview in four years. ONE. And I was so heinously underqualified for that hail-Mary I'm 99% certain they only interviewed me to meet a quota. As you can imagine, for someone with highly probable AuDHD, doing the same thing over and over for 4 years with a 100% failure rate is enough to make me want to dive into a lake with a pile of bricks chained to my back.

I'm still months out from seeing a neurologist about my headaches and general constant pain, I don't have a plan of action for my buck-wild medical anomaly thyroid, and I don't know if my parents are kicking me out next month. They haven't brought it up so maybe with my recent headway on the Peace Corps application (was told I stand a very good chance, but that's another contract job overseas, further pushing back my ability to find a stable, long term career job) and slew of diagnoses and medications, my dad is cooling off a bit. I don't know.

All that to say my body is crumbling out from under me, my job is stressful, and despite being extremely qualified and putting in so much effort, I have zero long-term life prospects. Sometimes, that results in me diving whole-hog into writing for fun and as an outlet, other times I'm too tired or need to bury myself in mindless content consumption or days of spending every spare moment staring at my ceiling in silence until I maybe fall asleep. Did I also mention the crippling lifelong insomnia which my ADHD meds (along with rapid weight loss I'm desperately trying to curb because I'm already borderline underweight due to my thyroid) are exacerbating?

Anywyay. Point is I'm very tired and stressed so my writing is going to be much less consistent than in the past. Hope you understand. Also just an update for my online friends. TMI but I needed to rant and put it out there for those wondering to lower expectations.

[religion-is-a-mental-illness]

By: Leor Sapir

Published: Feb 27, 2024

The U.S. Endocrine Society (ES) is updating its clinical practice guidelines on “gender-affirming care.” ES, however, appears to be putting its thumb on the scale in favor of medical interventions by appointing experts with serious conflicts of interest to its guideline-development group, ignoring its own standards for how to write trustworthy medical recommendations, and trying to keep the process hidden from the public.

On January 4, Yahoo! Finance reported that ES had decided to appoint John Pang, a surgeon from Align Surgical Associates, Inc., a California-based clinic that specializes in “gender-affirming” surgeries, to its Guideline Development Panel tasked with updating its existing gender medicine guidelines. Because the article concerned Pang and a colleague at Align who was appointed contributing editor at the prestigious journal Plastic and Reconstructive Surgery, and not the ES guideline group, it flew under the radar of those of us following the U.S. gender medicine debate.

Two weeks ago, a colleague alerted me to the Yahoo article, and I decided to write about what was going on at ES. On Wednesday, February 21, I sent the ES media-relations team a notice of my intent to write about the new guideline group and included a list of questions about their process, why they hadn’t made it public, and what they were doing to manage conflicts of interest. I pointed out a 2022 article in which ES explained its commitment to increase transparency and adopt a more rigorous method of guideline development, and asked whether they were planning to adhere to the standards announced in that article. I asked them to respond by Monday, February 26, at 5:00 p.m. EST—a request from which they could reasonably infer that my article would run in the following day or two.

I received no response, but on Monday, at 5:48 pm EST—less than an hour after that deadline passed—CNN published an article by Jen Christensen, a reporter and vice president of NLGJA: The Association of LGBTQ+ Journalists, titled “First on CNN: Major Medical Society Re-Examines Clinical Guidelines for Gender-Affirming Care.” The article is yet another puff piece for the controversial medical treatments and celebrates ES’s role in promoting them. In fact, it’s a particularly lazy puff piece. Christensen makes the usual unsubstantiated claims about “medical necessity” and “evidence-based individualized care,” not mentioning why European countries have taken a more cautious approach. The short piece reads like it was put together hastily—almost in a state of panic. Christensen quotes Joshua Safer, a WPATH endocrinologist chairing the guideline-development group, who assures her that “we’ve been following our usual guideline process that we apply to anything that we do, whether it’s diabetes or thyroid etc., to transgender medical care.”

Did ES panic about being exposed for something that it was apparently trying to keep quiet—and get in touch with an allied journalist at a major news outlet, one whom it knew would toe the activist line and vouch for its process? Obviously, I can’t prove that such a thing happened, but the timing of the CNN piece certainly seems suspicious—as does Safer’s unprompted assurance that ES is following its own guideline-development procedures. What exactly is ES up to?

While gender clinicians frequently tout the consensus among almost two dozen American medical associations in favor of pediatric sex-trait modification, ES is one of only three groups (the others being the American Academy of Pediatrics and the World Professional Association for Transgender Health) to have issued treatment recommendations based on cited research. ES’s current guidelines, published in 2017, recommend pubertal suppression and hormonal treatments for adolescents, despite recognizing the “low” or “very low” quality of evidence supporting these recommendations.

Experts have questioned the soundness of ES’s guidelines. Last year, Gordon Guyatt, a world-renowned expert in evidence-based medicine at McMaster University in Canada, told the British Medical Journal that ES’s 2017 guidelines have “serious problems.” Similarly, of a panel of six evidence-evaluation and guideline-development experts convened in 2021, only one concluded that ES’s guidelines were trustworthy in their current form.

For reasons not entirely clear, ES’s 2017 clinical practice guidelines made recommendations on behalf of surgery, not just hormonal interventions, and the appointment of a plastic surgeon to its guidelines panel suggests that it might do so again.

The appointment of Align Surgical’s John Pang undoubtedly constitutes a major conflict of interest. The most obvious type of conflict of interest is financial. Pang’s practice, and by extension Pang himself, stand to benefit directly from a recommendation to provide gender-affirming surgeries. (The practice specializes in unusual genital surgeries such as “nullification,” “penis-preserving vaginoplasty,” and “vagina-preserving phalloplasty.”) Moreover, hormonal treatments are often a steppingstone to surgery. A 2018 study led by Johanna Olson-Kennedy, a prominent “gender-affirming” clinician, found that girls’ discomfort with their breasts (“chest dysphoria”) increased with every month they were on testosterone. The researchers noted “a common clinical phenomenon” in which “a honeymoon period after testosterone initiation . . . quickly becomes eclipsed by the greater disparity between a more masculine presentation and a female chest contour.” Thus, even recommendations on behalf of hormones would likely benefit Pang and his employer. Conversely, if the data indicate that, for example, mastectomies for minors are not a beneficial intervention, or that surgeries should be provided only after extensive evaluations, Pang’s practice stands to lose business.

Align Surgical promises clients that it is “quite adept at working with most insurance plans.” Public and private insurance programs usually cover procedures (and under Section 1557 of the Affordable Care Act may be compelled to do so) when these are considered “medically necessary.” A strong recommendation from ES on behalf of hormones and surgeries would help ensure that clients can access the expensive and experimental procedures that Align Surgical performs. Insurance companies can then spread risk and recover costs by raising premiums for everyone else.

Evidence-based medicine also recognizes nonfinancial conflicts of interest. A leading textbook on evidence-based medicine notes, for example, that such nonfinancial conflicts “may have even greater effect than financial conflicts,” and “include intellectual conflicts (e.g., previous publication of studies relevant to a recommendation or strongly held views) and professional conflicts (e.g., radiologists making recommendations about breast cancer screening or urologists recommending prostate cancer screening).” Pang, a member of the hormone- and surgery-promoting World Professional Association for Transgender Health (WPATH), has both financial and intellectual conflicts. He has published research supportive of medical interventions. One of his studies, for example, which examines whether estrogen use in trans-identified males increases risk for perioperative complications, concluded that “estrogen [hormone therapy] suspension is not necessary for the transfeminine patient undergoing gender-affirming surgery.”

Ideally, a guideline-development committee would be free of conflicts. The panel would include experts in research methods and evidence evaluation as well as subject-area experts. In practice, however, including subject-area experts on such committees almost always introduces intellectual conflicts of interest, requiring committees to balance competing perspectives. This doesn’t always happen, of course; recently, we learned that the World Health Organization convened a guideline-development group on “gender-affirming” hormones and gender self-identification that was made up almost entirely of advocates for hormones and gender self-identification. Of the 21 empaneled experts, 17 had significant conflicts of interest.

A 2022 article, “Enhancing the Trustworthiness of the Endocrine Society’s Clinical Practice Guidelines,” published in ES’s Journal of Clinical Endocrinology & Metabolism, laid out ES’s intended steps to ensure that its guideline-development process was more transparent and methodologically rigorous. Explicitly noting the trade-off between subject-area expertise and minimizing actual or perceived bias, ES adopted the National Academy of Medicine’s recommended standards, which prefer a more aggressive conflict-of-interest management strategy, even if this means loss of subject-area expertise. ES’s clinical guidelines committee, which oversaw the policy change, “trust[ed] that its guidelines [would] achieve full credibility via methodological rigor and transparency.” Assuming ES’s current panel is made up of experts who share Pang’s opinions and have similar conflicts, it is almost certain to make recommendations that contradict the direction or strength of the evidence.

In evidence-based medicine, “discordant recommendations” are recommendations in favor of an intervention where evidence for that intervention’s safety and efficacy is weak. Such recommendations are generally discouraged, but a number of scenarios exist where they are acceptable.

An example of such a scenario is when non-treatment with a proposed intervention is likely to lead to death. Despite repeated claims about “trans youth” being at high risk of suicide if not given access to hormones and surgeries, evidence suggests that the elevated rates of suicide and suicidality (the two are distinct) in this population are very likely due to coexisting mental health problems, which are extremely common among the trans-identified, and not because of gender dysphoria or transgender “minority stress.” A recently published Finnish study, arguably the most important so far on the question of gender medicine in relation to suicide, shows that suicide is, thankfully, a very rare event and is better explained by the comorbid conditions. Last year, ES’s president drew criticism from 21 international experts when he used the “suicide prevention” narrative to defend his organization’s approach. As noted by Guyatt, a major flaw of ES’s 2017 guideline is that it did not invoke any of the exceptions that would justify the “discordant recommendations,” making its guideline non-transparent and untrustworthy.

In evidence-based medicine, recommendations for or against treatment are never based on studies alone; patients’ “values and preferences” are also relevant. Values and preferences are especially important where the quality of evidence is poor. Ideally, the ES guideline panel’s members would rely on high-quality research on the values and preferences of those who experience or are candidates for a medical intervention. In gender medicine, however, patients’ values and preferences have not been systematically researched. Instead, those preferences are conveyed to survey proctors by clinicians who are themselves “gender-affirming” and who believe strongly in the value of hormonal and surgical interventions. This introduces a serious risk of bias in the characterization of values and preferences.

ES’s 2017 guidelines for adolescents prioritized “avoiding an unsatisfactory physical outcome” over “avoiding potential harm from early pubertal suppression”—likely an assumption about how the most determined and satisfied trans-identified adult patients would rank these two outcomes. A more rigorous guideline-development process would systematically collect evidence of values and preferences from all individuals who go through transition procedures as minors and from parents who are involved in these decisions, not just from patients who happened to come out satisfied.

Such a process would track outcomes into adulthood to see whether or how these values and preferences change. For example, the values and preferences of a 20-year-old woman who had a double mastectomy at age 16 may change a decade later, when the meaning of her inability to breastfeed begins to dawn on her. The same goes for teenagers who give up their future fertility, believing “I can always adopt.” In a recently presented Dutch research study, 20 percent to 30 percent of the respondents in the carefully chosen cohort indicated that they regret having lost their fertility. A significant number are single and in their thirties.

Assembling a guideline-development panel of experts with different viewpoints is therefore necessary not only for a more objective assessment of the quality of evidence but also for a more rigorous examination of values and preferences. For example, a 2022 study published in the ES’s Journal of Clinical Endocrinology & Metabolism found a hormone discontinuation rate of up to 30 percent—some of it possibly due to harms experienced from hormones. A panel that includes detransitioners and the clinicians who treat them will likely reach different conclusions than a panel in which only “affirming” clinicians and trans-identified patients are represented.

It’s noteworthy that most of the authors of ES’s 2017 clinical practice guidelines were also big names at WPATH. Two—Peggy Cohen-Kettenis and Louis Gooren—were Dutch pioneers of pediatric gender medicine. Despite the perception that ES and WPATH are separate entities, and that recommendations on behalf of “gender-affirming care” are not just made by trans advocacy groups but also by run-of-the-mill U.S. medical groups, the truth is that WPATH members used ES as a guise for embedding hormonal interventions as an accepted standard of care in the United States.

ES’s actions—which include repeated evasion of transparency and accountability, willingness to speak only with ideologically aligned journalists, and appointment of a president who is himself a gender clinician and whose views are out of step with those of his international colleagues—do not inspire confidence that its new guidelines will be ethical, trustworthy, and in accordance with well-established principles of evidence-based medicine.

[haberdashing]

I feel like one thing a lot of transphobes don't appreciate is how many hoops you have to jump through to medically transition even in an area that's largely pro-trans with laws that reflect that.

I live in the suburbs of Chicago, in Illinois, a bright blue state. So going on hormones should be easy as pie, right? Just hop into a doctor's office and get my T fix?

Not quite.

I'm not going to count the years spent wondering whether going on T was the right choice, or figuring out my gender identity. This is just about what it takes to get hormones when I want them.

And before any of this, I got a legal name change and got top surgery, so it's not like this is the first step I'm taking to transition, either.

Here's how the process has gone for me:

Start to wonder if I'm considered low on testosterone even for someone AFAB, and if that could be causing/contributing to some of my chronic health problems, even aside from gender stuff.

So I make an appointment with my primary care doctor.

This is September 2022.

She says "well maybe" and orders some blood tests.

I get blood tests, they show I have borderline-low testosterone even for someone AFAB.

This is October 2022.

I decide this is a sign, I should pursue testosterone.

I make an appointment with an endocrinologist. It's not for a few months out, because that's all they have available.

I meet the endocrinologist.

This is January 2023.

She says "well maybe, but I don't do that kind of thing."

Does she know who DOES do that kind of thing? No, no she does not, except "maybe in the city".

She orders more blood tests just to confirm the low testosterone and check a few other hormone levels just in case.

Results come back, still borderline-low testosterone, everything else is normal. This blood test costs me $300 out of pocket by the way. Not like I'm bitter or anything.

This is February.

I try to find someone who actually does this sort of thing in the medical systems I'm used to, but no dice. They don't do that.

If I want T, I only have a handful of options in the whole Chicago metropolitan area, I find when I look into it. A few are in the city. A few others are in the suburbs, but not the part I'm in. The closest one is half an hour away, on a good day.

I give them a call. They're booked up this month. What about next month? Well, they don't have next month's schedule together yet. Try back in a couple weeks.

I try back in a couple weeks. Now they have times available. A few weeks off, but that's not the end of the world.

I go half an hour's drive to the nearest place where I might be able to get T.

This is March.

I meet the nurse practitioner. She's lovely.

Takes my vitals, which takes a couple tries for some reason. Takes a blood test to check my hemoglobin levels. Listens to me and says "sounds like testosterone would work for you, what kind do you want?"

I say not needles because needles wig me out, she puts in a prescription for T gel.

A week later I call them, or they call me, for some clarification about the order. I forget the details, and checking my visit summary isn't helpful. Whatever.

Two weeks after that I call them. They're still dealing with my insurance.

This is April.

Three weeks after that I call them. They're still dealing with my insurance.

This is May.

A couple days later, they call back. Good news: insurance got back to them. Bad news: they won't approve the gel until I've tried the needles, unless I have some documented severe medical reason not to try them. "Looking at needles going into skin makes me feel nauseous" does not count. I'm getting the needles.

A week later, they call and get the details and send in a prescription for the needles. I pick it up, but just the idea of injecting myself wigs me out. I need the gel.

A week later, I get the actual letter from my insurance and notice that they didn't say I needed to try the needles specifically, just that the formulary only covers some specific kind of testosterone gel, which is presumably not the one initially prescribed. I call them. They send in a prescription for T gel.

Right now it's June. It's been over two weeks since my prescription got sent in. According to the pharmacy, they are "reviewing my prescription". I don't know what the issue is this time--whether it's that I picked up the needles so they won't give me the gel until a certain amount of time after that, or if my insurance won't approve this prescription for the gel either for whatever reason, or if my insurance is just dragging its feet again for whatever reason.

That's nine months since I started this journey. Three months since I saw the nurse practitioner. And I still don't have T in a form that doesn't make me feel sick just thinking about administering it. (Something about seeing needles go into skin, it just messes with me...)

But sure, tell me more about how every kid who decides they're a boy or a girl or a dinosaur can pick up hormones at their friendly neighborhood doctor's office before the week is out.

[bylightofdawn]

Just came from the endocrinologist and they legit just tried to charge me a $150 copay when I know for a FACT specialist are $50. So I called my insurance and verified that shit right then and there with them.

And because I am a born and bred Texan I did not let any of my seething anger show at them trying to fucking rip me off for 3x the rate of my copay. This is the second rocky visit with this place in less than two weeks so I'm not overly impressed.

Last week, the doctor was super rude and grumpy with me which...not a great first impression. She was nicer this time ago so maybe she was just having a bad day. She's slicing my methimazole dosage because I guess my levels are super low so that's gonna be interesting. I also need to get a glucometer and be a responsible person who has to not only keep up with daily readings but she wants me to freaking stagger the times and keep a rotating log of different samples at different times a day which....fine, makes sense. Am I going to manage to actually keep up with this? Lemme check my little black 8 ball. Outcomes says....unlikely.

I have a follow-up in 2 months, I'll give them one more appointment but if they pull any more shit like this I will find a new endocrinologist, even if I have to go to San Antonio or someplace else cause I've definitely reached an age where I have zero guilt about breaking up with a doctor if I feel like they aren't treating me right. I'm the client after all and I will take my business elsewhere.

I also called like 10 therapist offices today and left VM's man this...is a shitty system. I go to my PCP next week so I think I'm just going to ask her if there's a better way of doing this. Or maybe I need a fucking referral like everything else. Either way, I am drained and I think I'm going to take a damn nap.