this post was submitted on 27 Feb 2025
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New to the community, but lurking for ever and stuck inside my egg for the past decade. I finally hit the wall where I was either going to come out or break down. So far, I'm super lucky to have a fantastic and understanding spouse who has my back, but that's literally the extent of my support network. I've always been pretty shy and impersonal, so I have a very tiny friend group. That said, I'm over 40 and can't wait to transition any longer. I just can't seem to find any physicians in my area that I don't think will either deny me care or treat me like I'm a liar. I'm fine with going straight to an endochrinoligist and signing an informed consent, but I really think I should see a therapist or counselor about some things I've been struggling with. I'm just having a difficult time of knowing who I can and can't trust, and I don't really have anyone around to ask. The only out transfem I know is a professional acquaintance and I'm way too scared to out myself to her yet. I've gone through most of the publicly available lists and tools for finding practitioners but they either don't take my insurance or don't cover my area. Does anyone have any advice on how to approach this? I want to get started so badly because I feel like I already missed out on so much of life as my true self, but the roadblock now seems to be that I can't even trust my family physician to know who I really am.

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[–] [email protected] 8 points 2 days ago (1 children)

You will have to tell your family physician eventually once you start to medically transition, or if that's really not an option, you will have to find a new primary care physician (PCP) who you are willing to work with.

If you want to see an endocrinologist, it starts by getting a referral to the endo by either your PCP, or sometimes by a psychiatrist.

I live in the southeastern U.S. and here we have the Trans in the South Guide. I was in a similar position as you when my egg broke: older, supportive spouse, but not much else - I tend to be a hermit and cloister myself.

I used the Trans in the South Guide to find an endocrinologist in my area, and I called my PCP and told them I have gender dysphoria and I would like to be referred to the particular endo that was in the directory. By sheer luck my PCP was trans-affirming, and by coincidence already has some other trans patients (though I am his first trans woman patient).

The city I live in has a local LGBT+ Pride group, and there is a trans support group that meets - I started to go to support group meetings and just talked to people.

Connecting with your local community is usually the best way to find out which providers are good, which are bad, which insurance companies are good and which are bad, etc.

So first of all, find your local pride group, start going to regular in-person meetups and get to know people. You can ask questions there, but you will also get to hear people's stories as they have tried to navigate what you're about to go through. Even if there is no trans-specific group, just going to LGBT+ events will hopefully increase the odds of meeting other trans people that you can network with. Forming a group chat (or getting invited to one) was really helpful for collecting and sharing resources.

Finding a psychologist that works with trans patients is important, but the advice is about the same: research online (my local pride group has a directory of providers, I actually used the Trans in the South Guide to find my psychologist), and connect with community to benefit from word of mouth (talk to people and ask which therapists they went to, who they recommend, etc.).

I had to change my initial therapist because, even though she was trans affirming, she had never written letters or dealt with the bureaucratic process of patients going through surgeries - I needed someone with more experience because I was not prepared to guide them through that myself.

If you have to move forward and none of the recommended people work, you can always just take the risk and try to see a provider that hasn't been vetted. Worst case scenario, you can try to navigate this with heuristics: in my experience a provider is more likely to be safe if they are younger, queer themselves, and / or a woman. It seems like straight, older, and male doctors are more likely to be overtly transphobic (obviously this is not always true, these are just stereotypes to fall back on help guide you when all else fails - there are plenty of counter-examples, my endo was old and male, my PCP is straight and male, etc.).

Much luck to you dear, I wish you abundant gender euphoria in your future.

[–] [email protected] 4 points 2 days ago

This is fantastic advice, and I'm glad to know I'm not alone. It's honestly been quite difficult and frightening to try navigating this. I also feel like I was putting too much weight on my spouse to help me and that's not fair to them.

I realize I have to tell my PCP eventually. My last one I'd have told in a heartbeat, but the good ones get promoted out of my area because the backwoods aren't a priority. The new one is quite clinical and has his degree from a highly conservative/evangelical area and frankly scares me. I'll be looking anyway, I guess.

My "local" communities are all a little over an hour from me, from what I can tell. I'll try to find a way to get in touch with some of them in the meantime.

Thank you very much for sharing!

[–] [email protected] 4 points 2 days ago* (last edited 2 days ago) (2 children)

If you're in the US, here's a big list of resources that could help you figure out where you want to go! There are multiple provider finders for gender-affirming care, therapy, financial assistance, and all sorts of stuff. I do recommend seeing a therapist (like a LICSW)! Not only is therapy wonderfully helpful in finding out who you are, but if you're looking for some types of care further down the line, insurance may require a letter from a qualified professional (sometimes even 2 different ones depending on what you want; I have a therapist and a psychiatrist so I go to them). Getting things documented and tracked would be to your benefit if you ever need a letter.

I wish you luck on your journey!

EDIT: Gender Justice League is based in Washington State, so there will be many resources specific to Washington, but there are also national resources listed that you can search through!

[–] [email protected] 4 points 2 days ago (2 children)

Also check out the resources in the sidebar and this list!

[–] [email protected] 2 points 1 day ago

GitHub is my favorite markdown editor

[–] [email protected] 4 points 2 days ago

Of course there's a github-awesome list for us. I definitely should have looked for that earlier!

[–] [email protected] 2 points 2 days ago

Thank you for the info! I've been reading about the need for letters already, and definitely want to see a therapist. The one time I saw one locally for possibly? unrelated issues didn't go so well ("you shouldn't schedule further appointments with me", what?). I'm actually in NJ, so I don't know if I'll be able to use your list, but hopefully others who run across this post can!

[–] [email protected] 3 points 2 days ago* (last edited 2 days ago) (1 children)

I go through a service called Folx Health. They have been absolutely AMAZING for me. I would highly suggest anyone in the US to look into them. I had one video appointment, and that same day was picking up my HRT. Outside of labs once or twice a year, you're only required to meet with them again annually for another video appointment. You can definitely setup more appointments and even use them for general care/pcp things - I just had one to get tretinoin prescribed to me. You can use insurance or not; I'm currently uninsured and paying out of pocket, and they have super reasonable prices. They can also provide lists and resources for different doctors if you choose to undergo any surgeries.

[–] [email protected] 2 points 1 day ago (1 children)

You're the second person to recommend them, so I'll definitely consider them if I can't find a local provider. I was just hoping to find a practitioner who knew the area and would be able to also recommend places for other services I (or my spouse! They're part of this journey, too) may need down the line.

[–] [email protected] 2 points 1 day ago (1 children)

I think the only problem is that Folx and Plume are extremely over-priced. DIY is much cheaper, for example, as is going to a normal doctor with insurance.

[–] [email protected] 2 points 1 day ago

That might be the case! It's been super affordable for me vs the convenience of it all... and I'm currently unemployed and without insurance. I have too much dysphoria and trauma associated with pinning, so injections are a no-go for me. The patches that I am prescribed are just magic 🪄 They also have great discounts for labs, and goodrx super helps with the hrt costs.

[–] [email protected] 3 points 2 days ago (1 children)

I'm in a similar situation, over 40 and just starting the process.

A lot will depend on where you live and your insurance situation. I decided to start with finding a therapist. I have an employer-funded Aetna plan that offers enhanced gender-affirming benefits, but I will need to get a gender dysphoria diagnosis if I want to claim things like hair removal and surgeries.

I haven't tried going to an endocrinologist first, but if I did, I would find an LGBT+ clinic. They are pretty common in larger cities.

[–] [email protected] 4 points 2 days ago (2 children)

Thank you for the advice! I'm on a weirdly hepful but also restrictive FEP Blue program. They cover basically nobody around me. P.S. I like your username!

[–] [email protected] 2 points 2 days ago* (last edited 2 days ago) (1 children)

Thanks! The random word generator must have known I was into Star Trek. I admit I looked up that registry number when I saw your post. I hope you're sleeping well. No one going on about eyes in the dark and one moon circling when you try to sleep?

Have you tried Alma? My therapist takes my insurance, but it's through Alma. It wasn't clear that they took insurance on their website.

Maybe try to find a psychiatrist instead? With them being an MD, they might work better with insurance.

[–] [email protected] 2 points 2 days ago

Heh, I don't sleep well. Too many worries and mental battles over dysphoria vs. being out. And I feel like I'm still stuck in that rift. The username felt appropriate, since Miranda is on my shortlist for possible names, too!

Alma

I hadn't looked at that yet. Thank you for pointing it out!

[–] [email protected] 2 points 2 days ago* (last edited 2 days ago) (1 children)

Eyyy, same insurance. FEP Blue AKA BCBS AKA Anthem AKA Elevance Health now apparently? Almost nobody lists FEP blue specifically but they do list the other names, if that helps

[–] [email protected] 3 points 2 days ago

Yes, sort of. In this area it's Horizon. FEP seems to just be a branch of whatever the regional blue cross and/or blue shield is. I have been using their "Find a Doctor" tool to tell who's in-network after finding people on the lists like pridecenter.org or outcare or WPATH, but so far nobody's been covered.

[–] [email protected] 3 points 2 days ago (3 children)

Your decisions are your own, obviously. I don't know where you live, but in many places, DIY might be your better option for hormones. Given the state of things where I am (U.S.), I honestly regret going 'legit' and changing my documents sometimes. For a few hundred dollars, you can acquire everything you need for a lifetime supply of estrogen. This means never having to rely on a doctor or other gatekeeper to allow you to be who you know you are or giving you so little of the hormones you need that you are living in a perpetual state of perimenopause. It does seem scary, but the truth is everyone has unregulated amounts of hormones in their body. Happy to chat more about DIY or trans stuff via DM if you like.

To directly answer your question, if the standard answers like Folkx or Galileo don't work for you, you may want to visit some local queer spaces and ask around. Folks who are already navigating this stuff will know what's around and who's trustworthy already.

Also, congratulations!

[–] [email protected] 2 points 2 days ago (1 children)

Yeah, I personally went the DIY route. I started my transition in August of last year, and started HRT January of this year. I had predicted things were going to get bad pretty fast, so I have avoided being 'official' for the time being until I can figure out what to do. I, personally, would like procedures in the future, and the unfortunate reality of that is the fact that my insurance requires a letter from someone actively prescribing and monitoring the progress of HRT for 12 or more months consecutively to cover any of those services, so if I'm gonna have to make a choice in the future of if I'm going to set myself back for years to avoid the potential consequences of being 'official', or go to a provider for a prescription so that I can get the necessary letters. Right now, I'm just biding my time while I see how things go (though that won't stop me from activism).

[–] [email protected] 2 points 2 days ago

insurance requires a letter from someone actively prescribing and monitoring the progress of HRT for 12 or more months consecutively to cover any of those services

That's precisely why I wanted to find a doctor do to this with. I've already missed too much with the wrong outside.

[–] [email protected] 1 points 2 days ago (2 children)

I'm in NJ, but not the progressive part of it. I guess Philly would be my closest friendly place to find anyone, and I definitely hear you about the "going official" issues in the US right now. It's one of the reasons I'm so frightened of telling the wrong people.

I don't know if I like the idea of DIY. I believe that it works, but I also know that I'm clumsy and forgetful enough to do something wrong. I also really need to talk to a therapist because I will definitely want my letters for surgery someday.

Folkx or Galileo

This is the first I've seen of either of these, so thank you! I'll have a look!

[–] [email protected] 1 points 1 day ago

If you want recommendations in Philly, DM me, I have lots! And some people I know are in New Jersey, too!

[–] [email protected] 1 points 1 day ago

It's actually not that complicated to do DIY! You don't need to make the stuff yourself, but if you do it's really cheap. In either case, gel is simple and easy and you essentially can't do anything wrong. With injections it's possible to make some mistakes in terms of dosages and such, but the consequences aren't really that bad (mostly some discomfort that will pass).

I'm a rather forgetful person and sometimes I will take my injections a day late with no issue. When I took gel I would occasionally be late with my doses then and that was more noticeably uncomfortable.

If you aren't comfortable with DIY however, then absolutely go look for a legit way of doing HRT. In either case, best of luck! I hope you can find a good way for you.

[–] [email protected] 1 points 2 days ago* (last edited 2 days ago)

If you do go with DIY we have an active DIY chat on the matrix server, or you can check out the resources posted in c/diyhrt or make a post