Appointment with the endocrinologist

I had my appointment with Dr. van den Berg in Victoria, BC earlier this week. It was all of… 20 minutes! I was a bit surprised by this; I was expecting to be poked and prodded a little more. She asked me some typical questions about my health and my family’s health history, took my blood pressure and weighed me.

Next, she explained the different kind of testosterone available:

  1. Injectable: Her preferred treatment. It works the most reliably and is the least expensive.
  2. Patch: It can fall off, and leaves a big mark on your skin, like a band-aid does.
  3. Cream: It’s not standardized (dosage can be variable) since it’s a compound made in the pharmacy, and has a shelf life but no expiry date.
  4. Gel: She didn’t say too much about it, but I know it’s expensive and you can pass it on inadvertently to people you come into contact with–OOOPS!
  5. Oral: The latest oral testosterone bypasses the liver, so the usual concern with this type of administration is not much of an issue anymore (contrary to what I’ve read on a lot of websites.) Nevertheless, Dr. van den Berg doesn’t tend to prescribe oral T to FTMs.

I didn’t expect her to prescribe anything other than injectable T, but some of this was new info to me (particularly about the cream and oral versions.)

She explained to me that she requires a letter from a psychiatrist in order to provide testosterone treatment. She refers to Dr. Johnson in Victoria. I find this a little frustrating because the psychologist I saw has training with gender issues. Does Dr. Johnson? Perhaps he does, but I can’t find any information about him online. Both the psychologist and my family doctor, who I have known for ten years, attest to my mental fitness to make this decision. In any case, it doesn’t look like this requirement will affect me since my treatment will be overseen by my family doctor, and she has confirmed to me that she doesn’t require me to do another assessment. I say “it doesn’t look like” I will need this second opinion because I didn’t really get a 100% clear answer about this from Dr. van den Berg. She did mention that she’s received threats in the past from treating people who didn’t have a psychiatric review, and I do understand the need for due diligence from this perspective. Perhaps this was a factor in her not being totally clear in her answer to my question about this.

She filled out a blood work requisition form, and that was it–I found myself being ushered out. There was no mention of risks, no informed consent forms, no questions about how much I actually knew about testosterone. I was rather surprised. Well, I had questions, so I whipped out my notebook and put a few to her, and then I left.

My GF and I went for a walk (I skipped part way), had a nice lunch at a nearby Thai restaurant (where my GF caught one of the young waitresses patting the female owner’s behind from the corner of her eye–caliente!), and then we hit the highway for the drive home.

The next day, I dropped in on my doctor to ask about when I could get the blood work done. Where I live, we can only get blood taken between 11:30am – 1pm on Thursdays. But for the testosterone level test, blood must be taken before 10am. So the following day, I traveled to a neighboring community where blood is taken from 8:30am – 10:30am. I will do this every three months.

The results of the blood work will be sent to Dr. van den Berg and to my doctor. Dr. van den Berg will then send a treatment plan to my doctor: 50mg of testosterone injected once every two weeks for six months.

I wasn’t totally clear about when dosage adjustments happen: will it be a steady 50mg for six months, or will this be titrated upwards based on results? She did mention that she will not go higher than 200mg. I know from what I have read, and from feedback from other patients of Dr. van den Berg, that her dosing is light. For example, the Medical Therapy & Health Maintenance for Transgender Men: A Guide for Health Care Providers recommends starting doses of 100-150mg. One of the guys I spoke to said that he found Dr. van den Berg’s low dosing a bit frustrating–changes don’t happen very quickly. That being said, I think I understand what she’s trying to do: ascertain the lowest possible dose required to achieve the desired changes. This makes a lot of sense to me, but I’m prepared to be a bit disappointed at the slow transformation.

A favourite quote comes to mind: “All good things in all good time.” (From Jerry Garcia’s Run for the Roses, lyrics by Robert Hunter.)

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