mtf primary healthcare: the Narrm 101

i thought for this post i’d go through my history of accessing primary healthcare as a trans woman in Narrm over the past 5 or so years. some of this info is going back a few years now, but i can make a few recommendations to any tiny baby eggs out there who might be considering starting hrt or something like that. parts of this might well be useful also for folks out there who were AFAB, but i really can’t speak to that.

some parts of my story do still make me angry in hindsight, but this is not a tale of regret. i do hope it helps people have an easier time of it than me

early mistakes

when i first started transitioning in 2016 i had no idea whether i’d like to take hormones or ever have surgery, i didn’t use social media at all and really didn’t know any trans people in real life, certainly wasn’t part of any IRL queer scenes. in fact i was really isolated socially, very poor, unemployed, the works.

so my hunch was that i should come out to my gp as a matter of course and see what she could recommend for me to figure myself out. i was inbetween mental health plans at the time so finding a decent psych/counsellor who could help me with gender issues was the vague idea i had coming into it.

my gp was dr erin gordon, who i believe still works at the cohealth paisley clinic in footscray. she’s my favourite gp of all time, and a real gem, but had no real idea about lgbtqia+ health. we were figuring it out together, but she was super supportive and that counted for a lot.

this was my first mistake in retrospect however, as i really needed access to someone who was confident in lgbtqia+ health as my primary health practitioner. if you’re starting your (medical) transition now, make sure your gp is on top of all this stuff.

secondary healthcare (lmao)

her first move was to refer me to the northside clinic in fitzroy to see a psych over there. i ended up seeing zoe collins, who i found very useful in terms of my general mental health, and broadly in becoming more comfortable with who i am. unfortunately, out of everyone in this post, she is the person i have the most rage for.

one of zoe’s first questions to me when we spoke about gender was “would you like me to do a gender assessment on you”? i didn’t really know what she meant by that, and i can’t recall if she clarified for me, or if i (reasonably accurately) assumed that it was something you did before moving towards taking medical interventions. either way, i declined, which was the right decision for me at the time.

the problem here was that zoe never explained to me what my options were, that there was such as thing as informed consent, and that i didn’t need to have a psychologist assess me in order to start taking hormones. from zoe’s perspective, this was a service she could offer me, to do a WPATH assessment, but that would only really be good for if i wanted to undergo surgery. that being her only offer however, made me assume that in order to take any medical inverventions i’d need her to assess me. this, coming from someone who described herself as an LGBTQIA+ specialist on the northside clinic website, was super disappointing.

for those who might not be aware, northside has a reputation of being one of the very few clinics that trans people can rely on to get started on hormones etc.

after about a year of counselling i told zoe i thought i was ready to start hormones, and she asked be that same question again: “would you like me to do a gender assessment”? this cemented in my mind the notion that this was something i had to do in order to begin HRT. what she should have done was refer me to one of the many GP’s at the northside clinic who would have been happy to do informed consent with me. instead, i paid zoe extra fees for the assessment. at this point i’d already used up all of my mental health plan sessions for the year, so i wasn’t getting any medicare rebate on the appointments themselves, of which two were required in total. cost me around $500 all up.

it could have been free. it could have avoided me being asked questions about autogynephilia and my sexual orientation, and whether i enjoy receptive anal sex and how often i masturbate. have i been “living as a woman” blah blah blah, that kind of nonsense.

I WAS ENTITLED TO INFORMED CONSENT AND I WAS DENIED IT

actually starting hormones

anyway, the day i got that assessment i was just about the happiest girl in the world:

babby egg ULTROS, 27 and with a license to femme

i had another appointment lined up with my gp, and she set about very promptly referring me to dr ada cheung, an endocrinologist in heidelberg. my gp erin said she was totally happy to prescribe me hormones, and that she does it with her menopausal patients already, but that she wanted the endo’s advice for the trans-specific parts of it that she had never really dealt with before. this was great, and a wise move on erin’s part i believe. the tragedy being of course that i probably could have just asked erin to refer me for endocrinology in the first place, but we were both deferring to the expertise of the crew over at the northside clinic, and i’ve already pointed out how zoe betrayed that authority.

ada was great, it cost around $70 a session, i had a couple of sessions early on, at one month, then after three months, then after six, then at annual intervals. at our third appointment, after being on 2mg of estradiol valerate for a month, i asked when i could stop worrying about getting my girlfriend pregnant. she looked me in the eye, and asked “do you want to be sterile?”. i eagerly answered yes, she said, “are you sure?”, warned me it would be my last chance to freeze sperm and then prescribed me cyproterone enough to nuke my t-count, possibly permanently. (compare this to how trepidatious a whole range of practitioners had been towards my partner in their post about obtaining a hysterectomy (sterilising trans women is uncontroversial it seems! (transmisogyny is a real ride!)))

ada was also great because she referred me onto a couple of studies, she’s a trans health researcher at melbourne uni and really devoted to (re)establishing the knowledge of trans healthcare and endocrinology.

after a while ada started bulk-billing me, i’m not sure why, but maybe her policy changed at some point.

back to primary healthcare

eventually i moved away from the western suburbs and started seeing gp’s at the northside clinic. for a long time i had a really hard time seeing a gp regularly, and at some point they changed their policy on bulk-billing trans women. it started getting expensive: $70 out of pocket just to get a script renewed by someone i’d never met and who had no knowledge of my history or other health conditions.

at this point i started searching out somewhere else to go, so far as i could tell there were two options as of 2018/2019: the monash gender clinic (other side of town, hard to get into) and equinox (private health, in collingwood, hard to get into). i decided to contact equinox to see if i could get in, stressing that i just needed a steady doctor. the person i spoke to was pretty good, and said that seeing as i was already on hrt that it should only be a 90-day wait.

i’m still in that 90 days lol.

i’ve written a couple of times, they’ve reassured me i’m still on the main waiting list (there’s a waiting list for the waiting list) and said i should hear from someone soon. obviously that never happened.

eventually a new gp showed up at northside, dr erica tomlinson, who was fucking excellent. she was happy to bulk bill me and extremely thorough and steady. unfortunately she went on parental leave last christmas and i haven’t seen her since!

i found out about a new place in preston, your community health (ych), which had a pile of gp’s who were good with trans health, some of them from northside. i booked in an appointment, and had to do a little bit of manual followup to get in touch with the intake team, but once i was aboard it was great. elle void, a fellow tran, is the community liason and puts in the hard work to set you up with the services you need and has a really good understanding of trans healthcare, as someone who has been in the system for quite a while now!

ych also has a really good set of allied health practitioners, so it’s kind of a one-stop shop. i started seeing dr michelle dutton here, who was from northside, and is also fantastic. recently for example she pre-empted my questions about the estradiol shortage and set me up with alternative meds and all of that. this was something i was stressed about coming into the appointment, but she already knew about the issue and had it in hand. so good!

unfortunately something must have happened at ych, because a bunch of the gender gp’s stopped working there around the same time. maybe it was funding, maybe it’s not a good place to work? luckily michelle has been able to see me at northside and i’m still using all the allied health stuff out at your community health.

tldr;

if you’re new to this the best advice i can give you is to try and get an appointment at your community health. i don’t know much about services anywhere other than the northern suburbs, so maybe there’s options elsewhere starting to pop up. (sing out and write an article if you have any experiences with that!)

there’s not many gp’s doing this kinda thing in general, the main thing to ask them about is whether or not they’re willing to do informed consent. any gp in so-called victoria can prescribe you hormones. my old housemate had been waiting for ages and ages to get a spot at equinox to start taking t, before realising they could just ask their gp to do it.

if your gp is not across trans healthcare, then ask for a referral to dr ada cheung, or another endocrinologist (if you can afford it). they’ll make sure your levels are good and keep you safe in case your numbers go awry at any stage.

if you find yourself struggling to get an appointment with a popular gp my advice is to simply always maintain a booking. my gp is generally booked out 4-6 weeks in advance, so after each session i just book in for her next available. if the appointment is coming up and i don’t need it, i just cancel with a couple of days’ notice and rebook for later. i’ve only cancelled once or twice in all this time, there’s usually something to talk about, but my health is a mess lol.

hope this is helpful to anyone, again, if you’ve had different experiences, or if you’ve got information from somewhere else in the continent then please contact me to share your experience on this blog!

<3

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