Every tick of the clock that is sitting next to you is a reminder of time moving forward. With each second that passes you are getting closer to the day you felt would never come; the day you meet with a medical provider to begin hormone therapy. Prior to this appointment you may feel nervous, anxious, excited, ambivalent, scared or all of these emotions at once. As much as I hate using the word “normal,” these feelings are all “normal” reactions. I remember prior to going into my first appointment I began doubting myself, mostly because I realized that being on testosterone meant my transition was real, physical changes would happen and people would notice.
Even though I was scared, nothing would have kept me from my appointment. The night before, I kept thinking of all the things I was going to ask my provider, but by the time the meeting happened, my mind went blank and all I could do was say “uh” and “um” and “yeah.” To prevent this from happening to you, something that may help is making a list of questions prior to going into your appointment so that you feel more prepared. This is also a great way to begin assessing whether the medical provider you have your consultation with, is the right provider for you.
If you are feeling overwhelmed, then try staying focused on what it is that is most important to you. I generally suggest three areas to focus on when you have your first appointment, these are:
- To assess the provider’s knowledge and comfort with different forms of treatment.
- To go over side effects and what to expect from starting on hormone therapy.
- And to begin building a relationship with a healthcare provider that hopefully will be based on trust and openness.
It is important to be able to assess the provider’s knowledge and comfort because you want someone that can properly screen for any health issues that may be a problem in the future. If you are someone that identifies as nonbinary or genderqueer you may want to communicate with a provider there are some things you are looking to physically change, but others that you wish to remain the same. Lastly, having a provider that is up-to-date with the different types of dosing and methods to administer hormones is always helpful because then you are given options, and in my opinion, options are extremely important when it comes to hormone therapy because a certain method may work well for one person, but not so well for another.
So, when learning about your provider, questions that may help you assess their knowledge and comfort are as follows:
1) What methods do you give as options when prescribing hormones?
- Current options for estrogen include: injectable, sublingual or oral, and transdermal.
- Current options for testosterone include: injectable both intramuscular and subcutaneous, transdermal and implants. (It is not recommended to take testosterone orally due to health risk from it going through your digestive system.)
- Learn more about dosing options here.
2) Are you familiar with the different methods and doses used? Are you open to trying different methods/doses?
- The answers to these questions will let you know how open your provider is, and also how knowledgeable they are regarding advances and new forms of treatment in transgender healthcare.
3) How many transgender patients do you currently work with?
- If you are the first, second, or third, you are most likely going to be learning together. If you are with a provider of over 20, 30 or 100, then they most likely are more experienced.
4) Do you follow the most up-to-date and current guidelines for transgender care?
- Although the World Professional Association of Transgender Health is not the only organization that provides Standards of Care, they are the most well-known. In September of 2011 they issued version 7 of their Standards of Care, referred to as WPATH SOCv.7. If your provider is still using lingo like, you need to live a year as the gender you are transitioning to (a.k.a. real-life experience), they are not up-to-date. You may even bring a copy of the WPATH standards in with you as a friendly reminder of the up-to-date version.
5) Do they know other providers in different areas of transgender health in case you need a referral for specific care?
- You may have some health complications that require monitoring by a specialist. Or in the future you may require specialist care for something (it doesn’t have to be trans related) so having other providers names is always helpful. If your current provider has a trans-knowledgeable referral list it may also be a sign that they are more knowledgeable and connected.
Questions to ask about hormones:
1) What are the side effects?
- If there are things they go over that causes you concern, ask for more information.
2) How will hormone therapy affect my fertility/reproductive options?
- If you are considering or would like the option of having (biological) children in the future, then being informed of options and also risks with being on hormones therapy is something you should consider.
3) What is the general timeline for seeing changes?
- The World Professional Association for Transgender Health (WPATH) has a general timeline that can show you the expected changes. You can find it here. When going over expected changes it is important to remember that hormones affect us all differently so there will be varying timetables for each individual.
Questions to build a relationship:
1) What questions do they have for you?
- Questions they ask may bring up more things that you want to ask them, but hadn’t thought of before.
Finally, if you are ready and feel good about your relationship with the provider then ask,
When can I get started!?
Ryan Sallans is a national speaker, consultant, trainer, author and publisher working to increase awareness and services offered to trans-identified individuals, both within academia and healthcare. His memoirs, Transforming Manhood and Second Son are available nationwide.