A friend recently mentioned that she has decided to take a short-cut, to self-medicate with estrogen rather than submit to the interminable wait for hormones through official channels.
It's her choice, and on reflection I don't think it would be mine. Though I'd be happy if I could secure a hormone prescription before going full-time I'm at peace with the notion of an RLE requirement if that's what it comes to for me because I subscribe to the view that living as a woman is more important than accessing any particular treatment. But she's at an advanced stage of desperation and who am I to judge her decision. I've made my views clear enough in the past on the whole sorry mess of self-medding becoming the de facto route into hormone therapy.
Something she said made me take notice though, something I'd heard the same thing from others but had never before considered the implications. Her doctor is happy to give her regular blood tests to allow her hormone levels to be monitored, but is not prepared to give her any advice or referral based on those tests.
That's right. We do endocrinology here, but you? You're on your own!
It's understandable I guess, they stray into a huge legal quagmire if they offer official support for strictly unofficial use of medication. Sure, they are qualified and experienced to give advice on basic endocrinology even if they aren't world-class experts - they do it every time a natal woman comes in for HRT, to name but one of many endocrine issues they face - but they need the endocrinology in question to be under their control to be able to do it properly. In offering the blood tests they're going out on a limb somewhat, doing the best they possibly can for their patient without exposing themselves to malpractice claims. Can't blame them for that.
This is not a good situation though, because even though it provides the requisite information it still means the patient relies on DIY endocrinology. You'll probably have heard the DIY endocrinology line somewhere in this sphere, that endocrinologists just use a trial and error process to get the levels right and it's so simple anyone could do it. How dangerous a half-truth can be.
I can't help thinking yet again that the whole situation is an unholy mess. A lot of transgender people seen to end up self-medding through necessity and though the medical profession frown on it they provide just enough help to facilitate it. But not enough help to enable the patient to do it in complete safety.
Yet again I wish there could be a grown-up conversation on the subject. I see other clandestine medicine being provided without question - to drug addicts, or to teenagers needing contraception - and I can't help thinking that if it's legally safe for those kind of services to be provided then there must be a way for it to be so for endocrine advice to be given to a self-medder. I wonder whether the atmosphere of reluctance to do so comes from fear within the medical profession of a perceived rather than genuine legal threat.
After all, there are people facing real medical issues because of this, and isn't fixing that what a doctor does? Can you be nicked for simply practicing your profession in that situation?