What’s a girl gotta do to find doctors who know more about trans care than I do?

Today I had an appointment with a new endocrinologist that was recommended by my wife’s endocrinologist. I was hopeful, because the doc that recommended her is exceptionally talented but just isn’t qualified to do trans medicine. Sadly, in the first five minutes of the visit I could tell that this doctor’s protocols are over a decade out of date. She demonstrated multiple attitudes that revealed her to be of the old-school pre-WPATH mindset.

• She doesn’t prescribe progesterone, asked why I was on it, wasn’t satisfied with my answer.
• She was astonished by my breast development (not surprising given her stance on progesterone).
• She wanted my blood E level lower than half my current level. That’s low even for cis women.
• She claimed I was at high risk of blood clots (not true with injected E)
• She tried to code my lab work using the deprecated “Trans-sexualism with heterosexual history” ICD code (I corrected it to the GID code)
• She had never heard of trans women experiencing cyclical period symptoms (again, not surprising if none of her patients are on P).
• Several times she said things about her patient history that made me think “No, your patients just don’t trust you, Gatekeeper.” 😒

I did learn a few useful things from the appointment. My prolactin level was elevated above normal in august, and she told me that prolactin can cause insulin resistance, making it harder for me to lose weight. When I got home I ran with that and learned a ton more. Prolactin reduces the ability of adipose tissue (fat) to absorb and store sugars and fats, which causes the body to produce excess insulin, leading to insulin resistance. Prolactin also inhibits the production of adiponectin, which is a hormone that causes stored triglycerides to break down into free-roaming fatty acids to be consumed by the body. That means it keeps your body from burning the fat that you have. So lowering my prolactin levels will, in theory, make it easier for me to lose weight.

She thinks my prolactin is elevated due to my estrogen levels. Thing is, it can also be elevated due to serotonin, and SSRIs often cause hyperprolactinemia. I’m not sure she knows that lexapro is an SSRI, or perhaps she doesn’t know SSRIs do this. In any case, I now have an idea why my lifestyle changes didn’t lead to any changes in weight.

I won’t be returning to her, I can get diabetic care anywhere, and she’s almost 40 miles away. But she gave me a Metformin scrip to try, so I’ll see how that goes, and will take advantage of the labwork she ordered. I can take all that to my own doctor and he can work from there.