by Gianna E. Israel
Copyright © 1996, all rights reserved.
Abstracted from a Public E-Mail Response.
I am not surprised at all to hear of the responses of physicians and nurses who flee examination rooms when a transgender person asks for hormones. However before confusing you with this statement, I will share my reflections and approach to first-time hormone requests. Those who appreciate my doing so can send me kisses, just make sure however that they are chocolate. As some of you may be aware, in addition to being a local community counsellor, I also provide nationwide telephone consultation across the United States. As a result, I have talked with hundreds of persons who are on their first-time journey to the doctors office for hormones.
In hand the individual should have a hormone recommendation letter. Preferably one which not only provides information about the client and transgender persons in general, but which also points the physician to information sources about blood laboratory testing. The letter should also state that hormone administration is a routine medical treatment for transgender men and women. These statements will help support the physician's needs, particularly since many physicians across the country may have never encountered a transgender patient and may be reluctant to prescribe an unfamiliar regimen.
People who have already been on hormones, should if possible take along a copy of an old prescription.
When dealing with physicians who are not informed about transgender medical needs, the client's presentation also plays a key role in persuading a physician that the individual's needs are real. If at all possible the client should present "in role." Neat, casual clothing, well-groomed, and not overly made-up cosmetically. If this is not possible, then the client should present as androgynously as possible. MTF's should not wear ties and a suit, and FTM's should not wear dresses. Some people may think such a notion is amusing, however a prescribing physician who is unfamiliar with transgender persons is typically not going to think to highly of a man in a tie and suit asking for female hormones.
If you are a transgenderist, after providing the physician your hormone recommendation letter, you might "simply" explain to the physician that you are a transsexual but do not see genital reassignment or living in role full-time as a realistic option currently due to employment or relationship circumstances. Generally, physicians who are not familiar with gender issues will understand that a transsexual takes hormones, but may have not heard of transgenderists before. I have found it is best not to confuse physicians with this gender-specialized detail.
The attitude the transgender person carries into the physician's office is an equally important consideration. No tears, outbursts or emotional antics! Save that stuff for your therapist, who is paid to deal with that. Before going into see your physician, you should be prepared to tell him or her that: #1) You are transsexual or transgender person. #2) You welcome his questions about your identity and presentation. #3)That you have consistently been interested in hormones for _x_ amount of time. #4) That you understand that hormones will give you an opportunity to further ascertain if a permanent transition is right for you. #5) And, that you appreciate the Doctor's time listening, and that you appreciate the Doctor's sensitivity to your needs.
If you are concerned about HMO coverage, ask the physician to diagnose with you a hormone imbalance. "Transsexualism" should not be written in your chart, particularly since you do not want your employer finding out in an untimely fashion through your insurance company. Also, after the physician has read your hormone recommendation letter, ask for it back.
All this may seem a great deal of information to tell the physician, however if you are good actor or actress you will practice your script before going on stage. Of all things, do not alienate the physician by stating statistics on how many transsexuals have killed themselves, or that you have contemplated killing yourself if you do not get a hormone prescription. Save that type of drama for a different acting class. If you are an individual who has been suffering from depression, let the Doctor know that you are receiving help for your depression and that you will keep him or her informed if the hormones exacerbate that condition. Many transgender men and women fear being rejected when requesting hormones for the first time. Acknowledge you feel nervous, and then set those feelings aside by handling the appointment like a business meeting.
Be prepared to ask the doctor why he or she is unable to grant your request. If the doctor does not have enough information about prescribing hormones or transgender persons, is there anything you can do to help meet that need? If the doctor states you have a medical condition which prevents you from taking hormones, is it possible the Doctor could help you research realistic alternatives? In some circumstances a physician or medical staff may respond very negatively to the idea of providing hormone administration for transgender men and women. If you encounter this situation you have several choices. First you may choose to utilize the opportunity to confront bigotry by providing information about transgender issues. Or, you may choose to simply tell the doctor that if he or she remains inflexible and insensitive to your needs, you may be better off finding a new physician.
As I have provided referrals and recommendations across the United States, I have noticed approximately 1 out of every 5 doctors is unwilling to learn about transgender medical needs. If you are rejected or feel you cannot communicate with a Doctor, consider finding a new one or asking a third party to help you negotiate the process.