When I decided to finally begin medical transition, I agonized over where to even begin. I had a post here about finding medical professionals, and I did finally find somewhere that seemed like a good fit for me! Opened somewhat recently; a local university and teaching hospital started a "pride clinic" that was supposed to be a safe space for people who needed care that may have needs outside of the realm hetero-normative and cis-gendered people. The staff is (as far as I can tell) all part of the LGBTQIA+ community, or at least allies. I like going to this clinic because I don't just feel tolerated; I feel welcome!
I started HRT a few months ago. I was excited for estradiol no matter what form it came in, but they went with their organization's "standard of care" that was spironolactone and estradiol oral tablets, and some finasteride thrown in because, well, I'm old enough for hair loss to be a thing. I asked them if we could discuss injection monotherapy, and got a reply of "Sure, after your 3 month blood work". Two months in, I had to have a second set of labs done because the anti-androgens were wreaking havoc. Dizziness, fainting, high heart rate, low blood pressure, and several other issues. While I was generally happier and able to actually feel and express all the emotions that I couldn't before, the mood swings were so strong and so spikey that even my spouse was commenting on them. I was also frustrated with the lack of any physical changes to speak of, out side of maybe my scent changing for the better.
I started to pester the clinic to change my mode of therapy. After seeing a cardiologist who actually agreed with my concerns, I finally had my teaching appointment for estradiol valerate recently. I am in such a better place now! I have no mood swings, though I still get to keep my range of emotions. There is less random dizziness and no fainting. The best part is that there are physical changes coming along with the rest within a week of starting the injections. The litany of medications I took every day are gone, and the only thing that remains is a small shot once a week.
I'm celebrating a bit here, but I'm also recalling all of this to tell you that if you need something from a doctor, remind them that it's your healthcare you're looking after. Take an active role in it, including reading up on the benefits and drawbacks of what you're after and why. Sometimes you need to be your own advocate. I also want to point out that I'm still going to the same clinic. They're wonderful people providing great care in an environment that I have yet to find anywhere else! But, they're doing the job for so many patients that they sometimes just have to follow the guide book. Your care is for you, so make it personal
I've been pleasantly surprised with some of my doctors. For HRT, they've made a point to ask if I wanted anti-androgens or monotherapy and have frequently asked if I was interested in starting prog after 6 months. And with my eczema, my new doctor has done well in pushing me to actually try new things to get it better.
I had an Endo today tell me she believes there is no data behind progesterone but she will still prescribe it after six months. Wild but at least not gatekeeping
That's seems to be the accepted stance of doctor. Basically the view seen here: https://transfemscience.org/articles/transfem-intro/
Afaik, there aren't any scientific studies to back prog beyond it's use for blocking T. So switching is still probably an improvement over spiro for t-blocking alone. I think it's reasonable doctor share what medical science says (or doesn't say) so people are aware when they are taking something that is essentially experimental at this point but to also make sure the patient knows they have that option given its a normal hormone in the human body and a lot of people have positive anecdotes (although many also try it and decide it's not for them as well).
I'm glad you have had good experiences. It sucks how like hit or miss it is in that way. I've had very understanding and cooperative doctors and I've had doctors who are clearly doing everything they can to deny me care. My partner recently finished the process of getting an autism diagnosis, for example, and that process took them a year and a half of being shown the door and fighting to get another appointment.
If really goes well above and beyond just trans care. But I was gatekept for 7 years from getting reassignment surgery. I live in Canada, healthcare is public here, but the wait list for new doctors where I live is about a decade. So I was entirely dependent on 1 specific healthcare professional to provide the care I needed, just one person I had to convince and I didn't have any other options. Can't tell you how frustrating it is to run into a wall continously like that. If you have money you can just bypass that process, but if you don't depending on where you live you're stuck with whatever you get.
I'm sorry you have to deal with that. I really do wish universal healthcare was recognized as a human right for all and prioritized that way. Unfortunately, the Star Trek future I wish we'd get seems less likely every day. I will go to my grave holding on to hope, though!