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torquillFinally, a doctor's appointment that didn't leave me wanting to spit nails.
That doesn't mean it got much of anywhere, but at least it wasn't upsetting.
My current PCP gave me a bad impression last time I saw her. This time she was much less brusque; she was relaxed and seemed to actually focus on me. I asked her what became of my request for an endocrinology referral. She apologized, saying she probably hadn't been clear last time, but she hadn't given me one because County Health doesn't *have* an endocrinology department.
(She checked a bit later and there's a two-month-old endocrinology clinic in Pittsburg now, open once a week, but it's staffed by Internal Medicine doctors who focus on endo issues. For a certified endocrinologist, it takes an out-system referral, and I don't need to say how rare that is.)
So that's where that went. We went over my test results, and when I told her I hate taking iron supplements, she shrugged and said diet was probably enough based on my level of anemia. She does want me to take B vitamins, but I find that hard to argue with in general. And she noted the very low pituitary hormones (LH and FSH) but feels it's probably because I haven't been off of birth control very long. It still might be GSE, but she knows nothing about that, so she couldn't comment.
We agreed that gynecology is my best bet, in the absence of an endocrinologist. She listened (again) to my account of my current symptoms, asked whether I'd like to see a therapist, and explained (as I kept asking why) that my depression and body image issues might be connected with what's going on in my life and the stress of my physical hardships at the moment. I politely declined, on the basis that my psychological problems are directly linked to the physical ones, and getting rid of one deals with the other quite handily. She later suggested seeing a "health coach", which I took her up on (why not).
I did finally come out to her as non-binary, because the absurdity was too great when she tried to reply to my description of the body-image problems with "You're a very attractive woman--" I had to stop her there, because the cognitive dissonance was simply too much. She took it well, largely without comment.
She made no mention of my weight at all. She asked about why there were no vitals, and why I had refused them, but took it at face value when I said that my adrenaline levels and my pulse were far too high to make a blood pressure test useful. We went on to why I was feeling anxious (because I hadn't had a good experience last time) and the subject didn't come up again.
She'll see me again after the gyno appointment in October. So I get to tread water until then.
I saw the health coach just afterward -- a psychologist who, as I understand it, helps people come to terms with their health issues and the strain of navigating the medical system. She was a lovely woman who asked a bunch of questions but mostly let me lay out the situation... the full situation, gender identity, personality shift, and all. She probed at my psychological symptoms and said, "You do realize that hormones can affect your mood, don't you?" I told her that's the reason I think it's all symptoms of one root cause, and she agreed. She was also taken aback by the fact that my first gyno didn't recognize the symptoms of estrogen toxicity -- "you'd think that would be part of her job" -- which was the first such reaction I've had from anyone in the medical community. I even went into detail about how jarring it's been to have my female parts go off the rails as I'm trying to adjust to being agender. She wasn't very familiar with non-binary issues, but she was a compassionate audience.
She asked whether she could help in any way, and I said quite truthfully that it was nice just to lay it all out and feel like I was being heard. She didn't recommend further counseling, let alone medication, and said that she would pass her overall opinion on to the doctor. I did pick her brain about the state of gender-identity counseling and support in the system... while such things are supported by the insurance plan, apparently they don't specifically provide gender-identity services here. If I wanted to get a therapist and potentially referrals for hormones or surgery, I would have to go to San Francisco. So that's something I may explore at a later date, but at least now I know where the entrance and exit of that little maze are.
No significant progress, but a great reduction in stress and frustration... I'll take what I can get.
That doesn't mean it got much of anywhere, but at least it wasn't upsetting.
My current PCP gave me a bad impression last time I saw her. This time she was much less brusque; she was relaxed and seemed to actually focus on me. I asked her what became of my request for an endocrinology referral. She apologized, saying she probably hadn't been clear last time, but she hadn't given me one because County Health doesn't *have* an endocrinology department.
(She checked a bit later and there's a two-month-old endocrinology clinic in Pittsburg now, open once a week, but it's staffed by Internal Medicine doctors who focus on endo issues. For a certified endocrinologist, it takes an out-system referral, and I don't need to say how rare that is.)
So that's where that went. We went over my test results, and when I told her I hate taking iron supplements, she shrugged and said diet was probably enough based on my level of anemia. She does want me to take B vitamins, but I find that hard to argue with in general. And she noted the very low pituitary hormones (LH and FSH) but feels it's probably because I haven't been off of birth control very long. It still might be GSE, but she knows nothing about that, so she couldn't comment.
We agreed that gynecology is my best bet, in the absence of an endocrinologist. She listened (again) to my account of my current symptoms, asked whether I'd like to see a therapist, and explained (as I kept asking why) that my depression and body image issues might be connected with what's going on in my life and the stress of my physical hardships at the moment. I politely declined, on the basis that my psychological problems are directly linked to the physical ones, and getting rid of one deals with the other quite handily. She later suggested seeing a "health coach", which I took her up on (why not).
I did finally come out to her as non-binary, because the absurdity was too great when she tried to reply to my description of the body-image problems with "You're a very attractive woman--" I had to stop her there, because the cognitive dissonance was simply too much. She took it well, largely without comment.
She made no mention of my weight at all. She asked about why there were no vitals, and why I had refused them, but took it at face value when I said that my adrenaline levels and my pulse were far too high to make a blood pressure test useful. We went on to why I was feeling anxious (because I hadn't had a good experience last time) and the subject didn't come up again.
She'll see me again after the gyno appointment in October. So I get to tread water until then.
I saw the health coach just afterward -- a psychologist who, as I understand it, helps people come to terms with their health issues and the strain of navigating the medical system. She was a lovely woman who asked a bunch of questions but mostly let me lay out the situation... the full situation, gender identity, personality shift, and all. She probed at my psychological symptoms and said, "You do realize that hormones can affect your mood, don't you?" I told her that's the reason I think it's all symptoms of one root cause, and she agreed. She was also taken aback by the fact that my first gyno didn't recognize the symptoms of estrogen toxicity -- "you'd think that would be part of her job" -- which was the first such reaction I've had from anyone in the medical community. I even went into detail about how jarring it's been to have my female parts go off the rails as I'm trying to adjust to being agender. She wasn't very familiar with non-binary issues, but she was a compassionate audience.
She asked whether she could help in any way, and I said quite truthfully that it was nice just to lay it all out and feel like I was being heard. She didn't recommend further counseling, let alone medication, and said that she would pass her overall opinion on to the doctor. I did pick her brain about the state of gender-identity counseling and support in the system... while such things are supported by the insurance plan, apparently they don't specifically provide gender-identity services here. If I wanted to get a therapist and potentially referrals for hormones or surgery, I would have to go to San Francisco. So that's something I may explore at a later date, but at least now I know where the entrance and exit of that little maze are.
No significant progress, but a great reduction in stress and frustration... I'll take what I can get.
