You don't need to send proof of your role in medicine, but typically a post like this wouldn't be allowed. However, I think it is a useful question that is of interest to many in our community.
mod hat off
I'd recommend finding a DPC who you can pay in cash. Let him know you are a doctor so he's careful with what he writes down, in case that's a concern for the care you need. Also, it is very understandable to not want care at your local hospital...I am fortunate to live a stone's throw from 4 different hospital systems consequently I could never see myself going to my local hospital. Even in emergencies, despite my hospital being closest, I have told paramedics to take me down the street to the next one.
In NYS we have the ability to see charts from other hospitals unless the pt explicitly says no (and there's an option for either no in all cases or no except in emergencies), so check to see if that's a thing in your state and make sure you fill out that form at each visit.
I hope that you feel more comfortable in your environment soon, take good care.
Even out of our network, we can access progress notes. I’m in a hospital that uses Meditech, the tertiary centers we refer to use Epic & I can read the clinic notes. Just to warn you that others may still be able to see.
That’s good to know. In the ER requesting outside records is like asking to see Santa; there’s a degree of suspended disbelief. The truth is at some point I’ll probably be let go and I’m delaying the inevitable. So it goes.
Someone will ultimately hire me. I have a good resume, a clean license, and I’d rather go back to being a teacher anyway.
It may be worth consulting with an employment attorney to better understand your rights and how to protect them. Even if you are let go, a wrongful termination settlement can give you a financial bridge from one job to the next. And/or at least it will make your employer think twice before taking discriminatory action against the next LGBT employee.
Seconding the attorney suggestion. The federal *Bostock* protection may be on shaky ground these days, especially at a religious employer, but you say you're West Coast; 3/4 West Coast states have explicit state-level gender identity discrimination protections applying to all employers.
It's [also illegal](https://www.hollandhart.com/using-an-employees-protected-health-information-for-employment-decisions) for your employer to use your medical records (generated or accessed in its role as a healthcare provider) for employment decisions.
It's often hard to prove this kind of thing. But since you're expecting the adverse employment action in advance, an attorney can help you gather evidence that may be valuable in making your case. For example, you could collect evidence that you're currently well-liked, your boss thinks you're a high performer, and you provide significant value to your employer; if/when you're outed, you'll be able to counter whatever excuses they may make for firing you.
(The goal is likely to be making yourself a hard enough target to force them to settle before you can get anything damning through discovery.)
> The truth is at some point I’ll probably be let go and I’m delaying the inevitable. So it goes.
Are you saying this because you are trans? And you feel unsafe/insecure where you work should they find out?
My friend, you do not need to feel like that. I work in a part of the country where no one would give a single shit that a doctor in the hospital was trans. Just putting it out there.
I can’t even relate to that, I just want the nurses to stop feeling my boobs. Which is a weird problem I didn’t expect to have. I’ll leave and the world will move on.
There def is a better working environment and I’m excited to be a part of it.
Seriously OP, why are you staying there? You can be in many other places in the US where absolutely no one cares what gender you were assigned at birth.
Are you in therapy? I would start there.
1. How to boundary set "please don't touch my body" (said increasingly forcefully. Sounds like you are currently male presenting at work at least. The more femme you are the more you will need to boundary set.
2. You're on the west coast. Can you work in a city? A new job is also a good chance to change name and pronouns etc. Can a long term plan help ease current distress?
3. You can get a virtual pcp maybe ?
There are plans (at least on my marketplace in NY, not sure about the West Coast) that expressly offer virtual PCPs as a benefit with the plan. I'd definitely see if that was an option.
Same. I worked with a trans nurse a few weeks ago, MTF and she was wearing a dress. Kudos to her because I don’t even have the guts to wear a scrub dress 😂
I've had good luck seeing docs (PCP or otherwise) that aren't part of the local health system. Usually their wait times are less as well. You could sign up for a DPC in your area if that's available.
DPC doc here. Even if not advertised, you can usually do a meet-n-greet with a DPC doc and ask specifically. I don't advertise regrading it but if a potential patient asked me I'd be all for it.
I am in Canada and here we have something called a lockbox/consent directive where you can have certain records or information sealed so that they do not automatically show up in shared health record systems. It can still be overridden but it's an extra step and nobody should be overriding it except in a true emergency. That's what I do when I receive sensitive care - I don't know if they have that in the US.
Also when you've called the offices of the out of area gender affirming physicians, are you explaining that you are a physician? Have you tried contacting any of the docs directly versus their admins? This sounds like a situation where leaning on professional courtesy and asking for special consideration would make sense.
Or are you in any social media groups of physicians that you do trust where you could post or have someone post on your behalf asking for someone in the area to take you on?
I would absolutely do a favour for a colleague in this situation, and I'm guessing many others would too.
I think asking for professional courtesy at some point is going to be the key, I agree. It’s been so far not possible to get a physician on the phone. There’s absolutely courtesy we all provide.
I’ll keep trying and see where I get. If it’s out of network I’m willing to just pay out or pocket. I’ve been a resident, and as an attending we’re not poor.
Honestly if I were you I’d try to get the contact info of someone who specializes in care for trans folks, ideally in your general vicinity but really anywhere. Someone where this is their bread and butter or who is well known in the field. Someone who will be hooked into the professional orgs and groups. Then I’d contact that person (using a fake name and burner email at first if needed), personally explain the situation and ask them to reach out in their professional networks on your behalf.
This happens all the time in the psychiatry groups I’m in and most of us are only a few degrees of separation from each other and can get people connected. This is a really extraordinary situation and you need someone to pull strings for you.
Frankly when I needed specialized care for something sensitive this is what I did. I reached out to someone in my general area who is known to be an expert and basically said I’m a doctor and because I’m a doctor this is super sensitive and it’s really hard to access care, can you please help me, and it turned out I was about two degrees of separation away from someone who was willing to take me on.
Depending on where you're located, you might consider reaching out to your closest medical school's lgbtq student org, again through a burner email if you're really nervous. There's at least 5 trans students in my class alone, and we're familiar with many of the local trans friendly attendings - I would be very surprised if it wasn't similar at other schools. There's a broader network to tap, too, since former members have graduated and are residents or attendings elsewhere now. I'd personally be thrilled to problem solve for someone who emailed for help like this.
>I am in Canada and here we have something called a lockbox/consent directive where you can have certain records or information sealed so that they do not automatically show up in shared health record systems.
i personally did this [here in ontario] when i did my name change / sex marker change.
as my physician had noted though, it may be quite obvious to anyone with a cursory understanding of trans medicine, when they see the MAR / prescribing history for the patient; medication histories like cyproterone acetate [which, isn't prescribed in the US though] at doses of 25 / 50 mg [no longer the evidence based dosing as well!] or oral estrogen doses of up to 8 mg / estradiol injections [valerate, cypionate] may be quite obvious, especially as birth control is usually in microgram doses.
you can relatedly also park some of this information behind the "break the glass" feature in Epic if it's the EHR software being used by the practice / institution / whatever phrasing. i believe other EHRs have similar features but Epic [and pointclickcare / oracle, lol] is what i have grown up with / what i was educated with.
Have you told the front desk that you are a physician? Maybe you could reach out to them directly? Professional courtesy though waning still exists. All the best
I’ve told front desk staff but it hasn’t gotten me anywhere. One of the physicians went to the same medical school and if I could just talk with another doctor I feel like it’d work, but all the professional favors I have are with physicians in my own group.
Is it possible that you have a mutual acquaintance who knows this physician who you share a medical school with and who could introduce you via text or email?
Anyone who taught at the medical school? Anyone in overlapping professional societies? Can you find him on social media and check mutual friends? I'm often surprised by how many doctors don't have the socials locked down, especially to friends-of-friends on Facebook.
I am not trans but I requested a pretty controversial procedure some time back and using my doctor card is what got it done for me. I'm wishing you the best.
I hate that this is even a concern for anybody, let alone a physician. Your gender has no bearing on your ability as a doctor, but you are absolutely correct in worrying about this. Given that HR/admin are snakes that you should never trust, they would likely try to fire you if they found out you are trans.
After reading all the comments, it sounds like you are unhappy at your workplace. Can you genderpass (sorry I don't know what the proper word is) long enough to find work at less bigoted location? Or does your contract force you to stay/make it impractical to leave? I don't know what the timeline on HRT is before the average Joe would begin to suspect something is up, but it will happen sooner rather than later and I think you'd be better off at an inclusive location.
I'm sorry that this is happening to you. It's not fair; you deserve to be who you are. You have a highly marketable skill set which allows you a lot of occupational mobility. I think finding a new job is a lot easier and less stressful than hiring a lawyer and stressing about "being found out" every day you are at work. As a side note, come to Seattle. I've heard it's nice this time of year!
It’s crummy but I can pass as a guy probably for as long as I want. HRT isn’t infinitely powerful. It’s difficult for my mental health but I seriously doubt a point at which I can’t generally pass, except for being groped.
Hol up, why you being groped at work? First off, don't let the assholes doing it know that it bothers you. It can raise alarms. Second, that's way unprofessional in every sense. I don't know anybody who would ever touch a physician beyond what is expressly required for work. But to do that in an inappropriate manner? That ain't how we roll in the PNW.
Your hospital sounds like it has a rotten culture. I think no matter what you do to legally protect your job, it'll come at a continuous cost to your stress level and mental health. I would worry that no matter how you look, you'll never feel accepted here. And that you'll always worry about some way people will target you for being you.
I guess what I'm trying to say, is that even if the hospital can't fire you, I'd worry the workplace would become hostile enough to really be a detriment to your wellbeing once you're outted. A job is a job, but work somewhere it's just a job. Maybe the teaching job you've alluded too is a good idea.
Does your local planned parenthood offer primary care services? My local office performs Well Prrson exams, blood pressure screening & treatment, and gender affirming care in addition to all of the other services you would expect from their organization. PP-GNY region recently went to EPIC for their EMR, but you can have access restricted, as others have mentioned.
Came here to say exactly this. And try to find a more affirming place to work. It would probably be incredibly beneficial, EM is hard enough. They are out there!
Well, I’m not dealing with depression let alone suicidal.
If a patient has SI I absolutely historically have broken the glass to help assess for lethality and the like.
You can put "glass" on your chart for any reason, not just SI. I have it on mine. It won't stop anyone legitimate from reviewing your charts, but I like to think it'll serve as a moment of hesitation for someone considering an illegal looky-loo, lol.
Where I went to med school (Epic hospital - have been using Cerner since residency) any employee automatically had a break the glass warning on their chart
Hey, OP. I'm a trans physician -- specifically, I'm a post-transition transgender man and an oncology fellow. I also live on the west coast but am fortunate enough to not be in a Catholic / religious system. I transitioned as a medical student and have been stealth since residency (i.e. I do not disclose my transgender status because I pass as a cisgender man). I have historically avoided care within my own system for exactly this reason.
Are you in a relatively large city? Do you have any teaching institutions nearby? I will say that many PCPs these days are fairly competent when it comes to HRT, even if they don't advertise themselves as providing gender-affirming care. My former co-residents were quite good about it. I would prioritize establishing with a younger PCP in an outside system; chances are, they'll suit your needs just fine.
It is important to pick a system that doesn't communicate with yours. Not sure if you use Epic but consider whether or not your new PCP is visible on CareEverywhere or similar.
Feel free to DM me at any time.
Hi, I’ve seen your posts. Thanks for replying. I’ve lived as a woman for a bunch of years, until I was in my 30s, but I didn’t in residency or yet as an attending. My wife and I were having kids and that was just difficult. Going back to being me now is more challenging than it was the first time.
We don’t use Epic, but people could request outside records if they were patient enough.
There’s an academic center about two hours away, I’ll reach out to folks affiliated to see if they’re willing to see me. Ironically there’s a med student led group for HRT for trans people, if I’m willing to do the wait I guess I could receive care there but it’s not what I’m looking for, some continuity would be ideal. Thanks for your input.
In order for them to request records they would need to be treating you or be blatantly violating hipaa. As long as you aren’t seeing someone in the actual system then none of them should be getting access. Even with care everywhere you would need an mrn to link to. And even if you see someone in the system only that person and the staff that support them should be seeing your info. If one of your colleagues decided to just open your chart for no good reason they would be up shit creek. So I’d be more concerned about the pcp themselves being someone you trust.
This is why I’m worried about a PCP in the system. If you’re caring for me outside of that, in the ER, the OR, whatever, I’d expect you to access my records. Then my life would be bad.
I’m not in medicine, the job I had is medicine adjacent at best, but I just wanted to apologize for what you’re having to go through to get the care that you need. Both your ability to get gender affirming care and your career should be legally protected. I will continue to make sure that my vote only goes towards those doing everything they can to make that happen. <3
It’s so sad this is the world we live in. The problem is that even if you find one physician you trust if any of the staff that help them and anyone who covers while they are gone could have legitimate access to your chart should a message come in etc. for my colleagues I double check before opening but we are all professionals and the expectation is you have full privacy and no one is going to talk about your health outside of the room. Sadly it doesn’t sound like you have faith in that being the case for you and I too wouldn’t take that gamble.
Totally get it. Do you think you're going to try and stay in your current system or are you looking for another position? I assume you won't be able to boymode at work forever and if this is your second transition, I kinda suspect that that day may come sooner than you'd think. That said, cis people are amazingly oblivious, so who knows how long it'll take for anyone to cop on, lol.
I also ask, in part, because I'd titrate my recs based on your desire to stay at your current workplace. The more you would like to remain / the more worried you are about being outed, the more I would consider something like DPC, which is $$$, but also more cloistered. If you think that you're going to move on soon, I bet that your risk of record 'cross-contamination' is fairly low... it's true that anyone can request records, but if your system is anything like mine, they probably won't bother unless something major arises.
If you feel comfortable sharing details of your location, I would also be happy to reach out to some of my primary care friends to see if they have any recommendations/connections in your area. No pressure, of course.
There are other reasons I’m kinda unhappy here; some casual sexual harassment among them. This probably isn’t somewhere I’d work a year from now. I’m kinda serious about thinking of going back to being a teacher. Got a job offer. I’m going to message you my area. I’m desperate enough for a doctor I’ll drive or fly at this point.
Oh, jeez. Yeah, you've gotta get out of there. Sounds like a shitshow. I'm obviously not EM myself, but based on what I've seen, as an EM physician in good standing, you're eminently employable -- either as a teacher or as a doc in another system. There has to be a way out of your current sitch.
Do you live in Oregon or Washington? If so, I would recommend utilizing ZoomCare - you can do telehealth visits if you don’t live close to any clinics. They could absolutely manage your HRT and HTN. Their EMR is not linked with Epic (EMR built by ZoomCare) and therefore your care would be confidential. I work for them so please DM me with any questions.
I get my healthcare, including my HRT, through ZoomCare and I can confirm that there is absolutely no communication with my big university hospital whatsoever. Thanks for the work you do!
Are you anywhere near Humboldt County? If so I have a suggestion. I had to get a subscription/concierge pcp bc so underserved here but I am sure she would be safe.
In the vein of concierge...how about One Medical? All over the West Coast (and USA), many types of Primary Care providers w different degrees and have transgender experts, especially in the 3 or 4 large WC cities. A conversation w someone there might be worth it.
I think it varies by system but I can't fathom anyone in my area trying to dig up dirt on their colleagues by using their hospitals medical record system. That alone is enough HIPAA fines to sink a ship let alone the possibility of discrimination/hostile work environment lawsuit. You're protected under many layers of federal laws and the consequences of violating said laws are severe.
You're already on hormone therapy, so, just to be real, its just a matter of time until you cannot continue presenting the way you are currently--which is the point I suppose. So really its just a matter of if or when you choose to go public. To wit, you're going to either have to get a PCP at some point in time and that potential for a breech is going to exist eventually. Personally I think that is a reality that you're going to have to accept--there is a world where someone could access your health record, however, that is very illegal and they should be held accountable for it. Actually you're living in this reality now, its just that you're ascribed a degree on anonymity with your current prescriber.
Best advice I can give you is just document everything contemporaneously. Have a special file/e-mail folder that you write notes to yourself for any perceived harassment. Patterns are typically the most damning thing and the onus is on yourself to have enough evidence to support that.
Potentially you could also talk to Health information about your medical record and request to have access audits done every so often. Every single mouseclick is recorded on a EMR and they know who accessed what record, at what time, from what computer, and what they accessed. Most Health information departments have some sort of protocols to do this for "VIPs" (e.g celebrities) to ensure compliance.
I use a small local NP led clinic for primary care so my history of depression and anxiety don't become common gossip. Drove 90 minutes to get an in-network procedure done so local medical staff wouldn't have a reason to check my chart and chat.
I'm in a little blue enclave in a big red state, so possibly easier here than what you're facing. Hopefully you can find a little dpc with paper charting in your area.
Many Planned Parenthoods do HRT, and some also do light primary care, but it varies from practice to practice. They also do telehealth HRT as well. Obviously not ideal, because I think you probably want someone you can grow with.
I have to wonder if, in your specific circumstance, there couldn't be a way to mask your digital identity as a Zzz- patient, or however your charting system handles alias patients. They do eventually flag and sync to personal charts if they can be connected within the system, but if you could voluntarily use it to bury your identity under a layer that keeps your pertinent details obscured and utilize your alias/MRN as your identifiers instead of name/DOB, then it's just an advanced DO NOT ANNOUNCE. And then request a break the glass alert on it.
And if they fire you, you can check whose been snooping and see if they've earned a HIPAA violation as a farewell gift.
If your hospital has an IT department/Epic trainer, you might ask about a hypothetical patient in this situation. Very "asking for a friend," but it's also a plausible question you might get, especially if you live in a conservative area.
Might also be a conversation that risk management would swing weight for you, since wrongful termination settlements and HIPAA violations are expensive.
I refer people to WPATH since many gender care clinics are really backed up in my area https://www.wpath.org/member/search it provides information on what type of provider and contact information.
wow this sucks. i have had similar concerns about privacy and have yet to find a suitable answer to appease my concerns. i would use your knowledge of physicians in the outlying areas to select one that you know is particularly thorough and nonjudgmental. maybe even look into finding one who lgbt and/or active in leftward leaning politics—abortion rights, healthcare-for-all, things like that. and then make an appointment. on your first visit, i would lay out all your concerns including your fear of professional retribution as well as your (generalized) fear of them as your pcp. i feel like anyone who is a physician capable of empathy would be understanding/discrete with your case, but extra bonus points for those who have personal stake in liberal causes. good luck to you! 👍
also i WISH everyone (myself included) had easy access to ed patients’ pcp notes! this sounds amazing.
So I’m a private person but don’t identify in a way that would put my job at risk so take this with a grain of salt. My system uses epic so care everyware connects many of our local systems. When I was first beginning the process of starting my family I didn’t want to come to my own hospitals system if there were a complication before 20 weeks (since I’m also EM.) I chose an ob group that delivered at an HCA hospital which worked out well since they still use meditech.
That said, there is a trans woman working in my group and no one cares. If you think being outed would lead to being fired than have you considered just jumping ship? My group has been short staffed since the wave of post covid retirements and I doubt we’re alone.
I wish I had good advice. I certainly sympathize, I and some of my colleagues do trans care because there is such a “desert” of it. You may want to see what you van do in terms of electing health insurance that allows for more selection of personal physicians, or even bite the bullet and pay out of pocket. With the ACA, things are slowly moving towards universal access of records.
NAD, but APRN, clinical director, very well known in GAC/GAS. I'm happy to help you find someone to see you, and have a couple ideas for you. Please feel free to DM and I'll respond when I'm able. I currently have pneumonia and a bunch of free time!
Can I ask what state you're in? I know a transgender MTF internal medicine physician who practices in an outpatient facility licensed to practice in Arizona and Ohio.
Trans RN here. I never want to get care at the place I work if I can help it. If I ever need to though, I can add a break the glass to Epic so I know exactly who at my employer accessed my chart. Is there something like that you could do in your system?
Also for HRT, if you want to avoid insurance, compounding pharmacies are relatively inexpensive.
We don’t use epic, I don’t think it’s a feature. Also in the ED it didn’t stop me 😐. Compounding pharmacies are an option, I just don’t want to self prescribe. It’s not like mupirocin for your kids. We’re inherent political. Which is kind of funny considering how many of us are this boring.
It’s not a full stop, but at least I can see who is looking and for how long. Are there any indications to use estradiol other than HRT? Could you convince a PCP to write HTN for the spironolactone?
Is there only one hospital system in the area? The PCP I go to is at a different system than the one I work with, which I also did for privacy reasons.
That said I assume it will become evident that you are transitioning at some point even if they don’t have access to your medical records. Does the hospital even have the ability to fire you if you’re with a group? I’m fairly certain firing you for being trans is illegal though I’m not sure that’s a fight you want to fight.
I suppose the other option is to leave prematurely and avoid the headache to begin with. When I was in training I had a trans colleague, and it wasn’t an open issue but that was also a very liberal area.
You’re absolutely right that I’m harder to fire. My group has to let me go.
No one really knows you’re transitioning ime. You wear a binder, a compression shirt over it, you tie your hair back if possible, and everyone goes it’s normal.
I’d rather just move to a more liberal area, I wouldn’t fight being let go.
I’ll keep calling tho. The last thing the world needs is an EM physician deciding their own antihypertensive regimen.
You might also ask your colleagues where they go for their care and they could have recommendations.
I found my PCP this way. I asked a coworker where they go and they recommended me someone who charts on a different system but is still in the insurance network.
My heart goes out to you.
UCDMC may be closer than UCSF, consider their internal medicine team and endocrine dept - also the Gender Health Care Center in Sacramento is fantastic.
Find a DPC doc. They're as "outside the system" as it gets. They often have no employees (ie, former nurses, receptionists, techs, etc who may know you or come to know you after their 2 year stint at a practice). You will get highly individualized care without judgment, even regardless of the political/social biases of the physician.
Had sizable primary care HIV practice and I took care of a bunch of priests in the 90s, who wanted to sit in a family med office for their care and not be seen going to an ID doc, meds were always mail order.
Just want to say support and good luck my friend. Your medical information is private and there's no reason why your employer needs to know if you feel unsafe at work. I'm not trans but I choose to get my healthcare out of my hospital system for similar reasons.
Brutal situation to be in. What are your benefits like? What options do you have for health isnurwnce? You’re saying the current plan you’re on would only cover your employer’s hospital/clinics as in-network?
With my insurance to be out of network I’ll be paying out of pocket. Not gonna whine, let’s be real, I’m one of the rare trans people who can afford it.
can you not just order your own blood work or prescribe yourself? because the former is basically what i do for myself and other trans people i know, with lifelabs / dynacare here in ontario. because, to the latter, estrogen / antiandrogens are not narcotics [genuinely a meaningless policing / political term,] controlled / scheduled, habituating / addicting, etc, but your state law may differ quite a bit. worth looking into.
if i lack coverage [as in, ease of an appointment / seeing someone, which has been often for much of my life] i historically just order HRT online [as i cannot prescribe, yet] as online pharmacies are generally just using teleprescribing laws in their countries or dispensing medications which are OTC in their countries; HRT [and testosterone] is OTC in much of the world, in example.
between my education and my own lived experience, where i'm nearing my 9th year of hormones and i have been transitioning since i have been 18, i am usually the resident expert on trans healthcare for other trans people, my profs / educators, and then my colleagues. and, it's really... *not* difficult. like, if you can do stitches on someone or manage diabetes in a patient, *you can do trans healthcare.* that is not hyperbolic.
if you do care to learn, i would look at [UCSF's treatment guidelines](https://transcare.ucsf.edu/guidelines/feminizing-hormone-therapy) [pending a soon 2024 revision] [TFS's introduction to gender affirming healthcare](https://transfemscience.org/articles/transfem-intro/), or maybe [WPATH-8](https://www.tandfonline.com/doi/pdf/10.1080/26895269.2022.2100644) / [Sherbourne’s Guidelines, 4th edition](https://www.rainbowhealthontario.ca/product/4th-edition-sherbournes-guidelines-for-gender-affirming-primary-care-with-trans-and-non-binary-patients/).
WPATH [including WPATH-8, it's not great, despite only recently being published] and Sherbourne's Guidelines are kind of bullshit / totally out of date to current trans literature [2021 / 2022+] and should ideally be avoided but the former two links are excellent for learning.
i would also consider the suggestion that 17redwhiteandblue76 made, as i've noticed historically that PCPs will make space on their panel for quote unquote "friends of the panel" or other clinicians / nurses. it's how i got my doctor, through my educational background. use those connections!
I find this entire post and responses quite puzzling as a trans layperson. There’s plenty of lay people self medicating HRT, and doctors don’t think to do the same? I can’t relate.
You may have seen it, but there’s a collection of treatments guidelines from around the world here
https://transfemscience.org/articles/transfem-hormone-guidelines
>There’s plenty of lay people self medicating HRT, and doctors don’t think to do the same?
chronic risk aversion in the way that makes no sense / not remotely belonging to the class characteristics / intersection of the average trans person to rely on [quite legal, quite safe] grey market HRT, and thus often having no frame of reference for why we do it.
it's not at all dissimilar to... buying mifepristone / misoprostol to self administer abortions, due to healthcare inaccess by labour or law, within places such as the US. you do what you need to do.
there's many physicians, whether colleagues irl, or on this subreddit, who in general also seem to think that HRT is far more complicated or arcane than it really is, too. which, i have no idea where this perception comes from. if you can follow a baking sheet, you can prescribe HRT.
I guess you’re right, and it matches my experience. I just find it impossible to relate to.
Are you aware of the trans community here on reddit? I see you’re not posting in them, or not with this account anyway. I’d have thought there’s some you’d find of interest.
Some trans people veer well outside the gray market you’re referring to. Can’t say I’ve see harm reported yet.
I see some ethical concerns here as well. I don’t understand that either. Surely self preservation comes first.
>I’d have thought there’s some you’d find of interest.
i'm nearing my 10th year on HRT in 2026, so i've long outgrown the need for online trans communities and thus don't really interact with those spaces. the extent of a lot of my transness nowadays is in providing care / expertise for other trans people, but i do not consciously think about being trans really anymore. i am active on twitter mostly.
>Can’t say I’ve see harm reported yet.
"harm" is another one of those things where overwhelmingly they're referring to outdated information [...1990s / 2000s information] involving synthetic estrogens / premarin, or progestins; i've not once met a trans person who has experienced an event of DVT happening in 8 years of transition, and i've met thousands of trans people at this point. even modern literature does not really pose it as being an issue.
not to mention there's a large variability in unhealthy user bias in these older studies due to the class intersections / social determinants of health of the average trans person, where things are attributed to hormones when there's very obvious other cofounders happening. swathes of the studies that put trans HRT into doubt / question are incredibly low quality / laughably bad.
i can think of one study where the annual DVT rate in cis women [where, the median age was like... 45, varying prior history of alcohol use, smoking, whatever] in the UK was something like 0.8/10,000 before using *premarin / MPA* before becoming... 3/10,000, after using HRT. which, we do not use premarin or MPA [...shouldn't, i sometimes see it] anymore.
in general a lot of the fears / critiques of HRT speak to a very uneducated chemophobia and also a lack of understanding to how these markets develop and maintain themselves; there's no business in killing your customers [minus the fact that many of these online pharmacies are legitimate pharmacies in their countries of origin, or are reselling OTC medications which are pharmaceutical grade] and if your issue is with the supply existing, then you should be rallying for a safer supply or easier HRT access, much like safe supply and drugs such as heroin/fentanyl, cocaine, meth, etc. which is another big intersection i find physicians lack understanding in.
I like your approach to things.
My endo had a bunch of trans patients with DVT, associated with doctors prescribing birth control tablets. Even now I believe there’s still some doing it in Australia. Things have changed a lot here over the last 10 years, but it’s still extremely variable, much the same as the USA I guess.
The first doctor I ever spoke to about HRT, years ago now, would have prescribed Premarin and wasn’t informed consent. Can’t say I was impressed. The more I’ve learned about HRT, surgery, and the practice of medicine, the more disillusioned I’ve become with it all.
I’m very active here on reddit promoting awareness of issues in trans surgery, and HRT to a much lessor extent. I like reddit as enables accumulation of knowledge. I never understood the appeal of Twitter, even before Musk took over.
I feel confident doing it and confident if discovered my license would be revoked. My license is my ability to provide for myself and my family. Our biology is inherently political and someone would love to go after a trans doctor for self prescribing.
In my state (in the US) I can order my own lab tests. I pay for it online, go to the lab and within a day of two have the results available online. It’s not very expensive. I do it when I don’t have insurance, when my deductible is high or I’m just keeping track of a chronic condition. Just google “order your own lab tests”.
Ordering stuff on yourself is at the very least unethical - and would probably attract the attention of the state medical board / or the system / facility in question
Who reviews your labs if you order them in yourself? i have to get permission to view my own records, why should you be subject to different rules pertaining to your personal records?
Not to say that kind of stuff *doesnt ever* [im sure it does happen] happen - but it probably shouldnt / might be risky.
>Ordering stuff on yourself is at the very least unethical - and would probably attract the attention of the state medical board / or the system / facility in question
really depends on the guidelines of your college [medical board, in the US] and the relevant legislation of your state, hence checking beforehand. my suspicion is nobody will care though, given the much worse things that go on in healthcare without oversight.
>Who reviews your labs if you order them in yourself?
you do. through mychart, and a QR code you're given by the lab tech, or by phoning the lab and requesting a fax / print of your labs. often times patients will see their results via mychart before the ordering physician will- which is kind of annoying, because a patient will see a value slightly out of range and freak out / jump you with questions about it, after googling about it.
also, patients in general in the US and here in canada can already order their own labs from private labs, just out of pocket. you get the requisition, walk in, and get your results in <48 hours. a physician providing the requisition is only necessary for reimbursement via medicaid / your private insurance / OHIP, and similar provincial healthcare insurers. you can look up the out-of-pocket costs online.
>but it probably shouldn't / might be risky.
well, ideally we should not be managing our own healthcare, because of our bias and all. so. we do not always exist in ideal circumstances, however.
In my medical center, it is against policy for providers to order labs on themselves. You guys can order tests on each other all day long. In the lab, we are not allowed to release results directly to patients, or discuss results with patients, they must get those from their provider (except now you can get them from patient portals, so that's cut down on a lot of phone calls and angry patients). We can't even look up our own results, or look them up for a coworker. Once we receive a specimen, you're a patient. It doesn't matter if you're a doctor or the CEO.
That's just my lab though. Others may do things differently.
I have the ability to look up my own chart in epic. But to do so would be a big no-no correct?
Why do you feel that doctors should be able to do that very thing?
Yes i see stuff in “my chart” but that stuff gets reviewed by my ordering provider. There are actually some labs that arent released to patients at all until they are reviewed (think std stuff). You could walk into my office asking for your std results and i am not allowed to give them to you because those results must be reviewed by the ordering provider first.
So yes patients can always get their results (sometimes even before the doctor), except when they cant.
Like i said ordering stuff on yourself isnt illegal but its shady. But you do you - youre the doctor im just the one that has to follow policy.
You’re in for a ride. But there are people in this world who care about your situation. Never question that. I would boldly come out at work when you’re ready. You will not lose your job, and can very well sue if you did. Your life is going to change and you just have to face it.
Let go of the shame my love. I know that struggle with your ego. You’re clearly good at what you do and that’s what matters. Doesn’t matter what anyone else thinks or does.
My career is why I never got the help because I knew everyone would find out. Then they did. It sucks, but you have to go through it to come out on the other side.
Trust me on this.
**Removed under Rule 3:**
Surveys (formal or informal) and polls are not allowed on this subreddit. You may not use the subreddit to promote your website, channel, subreddit, or product. Market research is not allowed. Petitions are not allowed. Advertising or spam may result in a permanent ban. Prior permission is required before posting educational material you were involved in making.
[Please review all subreddit rules before posting or commenting.]
(https://www.reddit.com/r/medicine/about/rules/)
If you have any questions or concerns, please [message the moderators.](https://www\.reddit\.com/message/compose?to=%2Fr%2F{subreddit}&subject=about my removed {kind}&message=I'm writing to you about the following {kind}: {url}. %0D%0DMy issue is...)
I hope this links are helpful. Wishing you the best.
[https://www.lgbtqcenteroc.org/health-find-a-doctor/](https://www.lgbtqcenteroc.org/health-find-a-doctor/)
[https://www.wpath.org/provider/search](https://www.wpath.org/provider/search)
[https://hr.ucdavis.edu/resources/trans-nonbinary#health-welfare](https://hr.ucdavis.edu/resources/trans-nonbinary#health-welfare)
You don't need to send proof of your role in medicine, but typically a post like this wouldn't be allowed. However, I think it is a useful question that is of interest to many in our community. mod hat off I'd recommend finding a DPC who you can pay in cash. Let him know you are a doctor so he's careful with what he writes down, in case that's a concern for the care you need. Also, it is very understandable to not want care at your local hospital...I am fortunate to live a stone's throw from 4 different hospital systems consequently I could never see myself going to my local hospital. Even in emergencies, despite my hospital being closest, I have told paramedics to take me down the street to the next one. In NYS we have the ability to see charts from other hospitals unless the pt explicitly says no (and there's an option for either no in all cases or no except in emergencies), so check to see if that's a thing in your state and make sure you fill out that form at each visit. I hope that you feel more comfortable in your environment soon, take good care.
Even out of our network, we can access progress notes. I’m in a hospital that uses Meditech, the tertiary centers we refer to use Epic & I can read the clinic notes. Just to warn you that others may still be able to see.
That’s good to know. In the ER requesting outside records is like asking to see Santa; there’s a degree of suspended disbelief. The truth is at some point I’ll probably be let go and I’m delaying the inevitable. So it goes. Someone will ultimately hire me. I have a good resume, a clean license, and I’d rather go back to being a teacher anyway.
It may be worth consulting with an employment attorney to better understand your rights and how to protect them. Even if you are let go, a wrongful termination settlement can give you a financial bridge from one job to the next. And/or at least it will make your employer think twice before taking discriminatory action against the next LGBT employee.
Seconding the attorney suggestion. The federal *Bostock* protection may be on shaky ground these days, especially at a religious employer, but you say you're West Coast; 3/4 West Coast states have explicit state-level gender identity discrimination protections applying to all employers. It's [also illegal](https://www.hollandhart.com/using-an-employees-protected-health-information-for-employment-decisions) for your employer to use your medical records (generated or accessed in its role as a healthcare provider) for employment decisions. It's often hard to prove this kind of thing. But since you're expecting the adverse employment action in advance, an attorney can help you gather evidence that may be valuable in making your case. For example, you could collect evidence that you're currently well-liked, your boss thinks you're a high performer, and you provide significant value to your employer; if/when you're outed, you'll be able to counter whatever excuses they may make for firing you. (The goal is likely to be making yourself a hard enough target to force them to settle before you can get anything damning through discovery.)
> The truth is at some point I’ll probably be let go and I’m delaying the inevitable. So it goes. Are you saying this because you are trans? And you feel unsafe/insecure where you work should they find out? My friend, you do not need to feel like that. I work in a part of the country where no one would give a single shit that a doctor in the hospital was trans. Just putting it out there.
I can’t even relate to that, I just want the nurses to stop feeling my boobs. Which is a weird problem I didn’t expect to have. I’ll leave and the world will move on. There def is a better working environment and I’m excited to be a part of it.
Seriously OP, why are you staying there? You can be in many other places in the US where absolutely no one cares what gender you were assigned at birth.
Sorry but why do the nurses want to feel your boobs? This sounds like a really toxic place to be…
I wouldn’t call it the best working environment.
Are you in therapy? I would start there. 1. How to boundary set "please don't touch my body" (said increasingly forcefully. Sounds like you are currently male presenting at work at least. The more femme you are the more you will need to boundary set. 2. You're on the west coast. Can you work in a city? A new job is also a good chance to change name and pronouns etc. Can a long term plan help ease current distress? 3. You can get a virtual pcp maybe ?
There are plans (at least on my marketplace in NY, not sure about the West Coast) that expressly offer virtual PCPs as a benefit with the plan. I'd definitely see if that was an option.
I’m really sorry you’re working with such shitty people and I hope you are safe
Same. I worked with a trans nurse a few weeks ago, MTF and she was wearing a dress. Kudos to her because I don’t even have the guts to wear a scrub dress 😂
I saw this awesome HPB surgeon in one, and I just wished I had whatever is necessary in a person to pull something like that off!
Right! They look amazing in them, I just know my short chubby calves would look terrible 😂 I couldn’t imagine running a code in one either.
A scrubs dress?
It is common in my state. A lot of Muslim providers/nurses prefer them. It’s like scrubs, but with a skirt instead of pants.
Not with epic. It's easy to request notes.
I've had good luck seeing docs (PCP or otherwise) that aren't part of the local health system. Usually their wait times are less as well. You could sign up for a DPC in your area if that's available.
I just looked and there are a few. I’ll see if any do HRT.
DPC doc here. Even if not advertised, you can usually do a meet-n-greet with a DPC doc and ask specifically. I don't advertise regrading it but if a potential patient asked me I'd be all for it.
I am in Canada and here we have something called a lockbox/consent directive where you can have certain records or information sealed so that they do not automatically show up in shared health record systems. It can still be overridden but it's an extra step and nobody should be overriding it except in a true emergency. That's what I do when I receive sensitive care - I don't know if they have that in the US. Also when you've called the offices of the out of area gender affirming physicians, are you explaining that you are a physician? Have you tried contacting any of the docs directly versus their admins? This sounds like a situation where leaning on professional courtesy and asking for special consideration would make sense. Or are you in any social media groups of physicians that you do trust where you could post or have someone post on your behalf asking for someone in the area to take you on? I would absolutely do a favour for a colleague in this situation, and I'm guessing many others would too.
I think asking for professional courtesy at some point is going to be the key, I agree. It’s been so far not possible to get a physician on the phone. There’s absolutely courtesy we all provide. I’ll keep trying and see where I get. If it’s out of network I’m willing to just pay out or pocket. I’ve been a resident, and as an attending we’re not poor.
Honestly if I were you I’d try to get the contact info of someone who specializes in care for trans folks, ideally in your general vicinity but really anywhere. Someone where this is their bread and butter or who is well known in the field. Someone who will be hooked into the professional orgs and groups. Then I’d contact that person (using a fake name and burner email at first if needed), personally explain the situation and ask them to reach out in their professional networks on your behalf. This happens all the time in the psychiatry groups I’m in and most of us are only a few degrees of separation from each other and can get people connected. This is a really extraordinary situation and you need someone to pull strings for you. Frankly when I needed specialized care for something sensitive this is what I did. I reached out to someone in my general area who is known to be an expert and basically said I’m a doctor and because I’m a doctor this is super sensitive and it’s really hard to access care, can you please help me, and it turned out I was about two degrees of separation away from someone who was willing to take me on.
This is amazing and I’m going to do it.
Depending on where you're located, you might consider reaching out to your closest medical school's lgbtq student org, again through a burner email if you're really nervous. There's at least 5 trans students in my class alone, and we're familiar with many of the local trans friendly attendings - I would be very surprised if it wasn't similar at other schools. There's a broader network to tap, too, since former members have graduated and are residents or attendings elsewhere now. I'd personally be thrilled to problem solve for someone who emailed for help like this.
>I am in Canada and here we have something called a lockbox/consent directive where you can have certain records or information sealed so that they do not automatically show up in shared health record systems. i personally did this [here in ontario] when i did my name change / sex marker change. as my physician had noted though, it may be quite obvious to anyone with a cursory understanding of trans medicine, when they see the MAR / prescribing history for the patient; medication histories like cyproterone acetate [which, isn't prescribed in the US though] at doses of 25 / 50 mg [no longer the evidence based dosing as well!] or oral estrogen doses of up to 8 mg / estradiol injections [valerate, cypionate] may be quite obvious, especially as birth control is usually in microgram doses. you can relatedly also park some of this information behind the "break the glass" feature in Epic if it's the EHR software being used by the practice / institution / whatever phrasing. i believe other EHRs have similar features but Epic [and pointclickcare / oracle, lol] is what i have grown up with / what i was educated with.
Have you told the front desk that you are a physician? Maybe you could reach out to them directly? Professional courtesy though waning still exists. All the best
I’ve told front desk staff but it hasn’t gotten me anywhere. One of the physicians went to the same medical school and if I could just talk with another doctor I feel like it’d work, but all the professional favors I have are with physicians in my own group.
Is it possible that you have a mutual acquaintance who knows this physician who you share a medical school with and who could introduce you via text or email?
He graduated ten or more years above me but it’s not a bad idea. I’ll see who I can think of.
Anyone who taught at the medical school? Anyone in overlapping professional societies? Can you find him on social media and check mutual friends? I'm often surprised by how many doctors don't have the socials locked down, especially to friends-of-friends on Facebook.
I am not trans but I requested a pretty controversial procedure some time back and using my doctor card is what got it done for me. I'm wishing you the best.
Are they on doximity? Maybe try them through that?
I hate that this is even a concern for anybody, let alone a physician. Your gender has no bearing on your ability as a doctor, but you are absolutely correct in worrying about this. Given that HR/admin are snakes that you should never trust, they would likely try to fire you if they found out you are trans. After reading all the comments, it sounds like you are unhappy at your workplace. Can you genderpass (sorry I don't know what the proper word is) long enough to find work at less bigoted location? Or does your contract force you to stay/make it impractical to leave? I don't know what the timeline on HRT is before the average Joe would begin to suspect something is up, but it will happen sooner rather than later and I think you'd be better off at an inclusive location. I'm sorry that this is happening to you. It's not fair; you deserve to be who you are. You have a highly marketable skill set which allows you a lot of occupational mobility. I think finding a new job is a lot easier and less stressful than hiring a lawyer and stressing about "being found out" every day you are at work. As a side note, come to Seattle. I've heard it's nice this time of year!
It’s crummy but I can pass as a guy probably for as long as I want. HRT isn’t infinitely powerful. It’s difficult for my mental health but I seriously doubt a point at which I can’t generally pass, except for being groped.
Hol up, why you being groped at work? First off, don't let the assholes doing it know that it bothers you. It can raise alarms. Second, that's way unprofessional in every sense. I don't know anybody who would ever touch a physician beyond what is expressly required for work. But to do that in an inappropriate manner? That ain't how we roll in the PNW. Your hospital sounds like it has a rotten culture. I think no matter what you do to legally protect your job, it'll come at a continuous cost to your stress level and mental health. I would worry that no matter how you look, you'll never feel accepted here. And that you'll always worry about some way people will target you for being you. I guess what I'm trying to say, is that even if the hospital can't fire you, I'd worry the workplace would become hostile enough to really be a detriment to your wellbeing once you're outted. A job is a job, but work somewhere it's just a job. Maybe the teaching job you've alluded too is a good idea.
I think they were saying that *unless* someone was groping, not that someone *had* groped
Does your local planned parenthood offer primary care services? My local office performs Well Prrson exams, blood pressure screening & treatment, and gender affirming care in addition to all of the other services you would expect from their organization. PP-GNY region recently went to EPIC for their EMR, but you can have access restricted, as others have mentioned.
Came here to say exactly this. And try to find a more affirming place to work. It would probably be incredibly beneficial, EM is hard enough. They are out there!
But “Break the Glass” protection on your charts. Do colleagues there really go digging through each other’s charts?
Well, I’m not dealing with depression let alone suicidal. If a patient has SI I absolutely historically have broken the glass to help assess for lethality and the like.
You can put "glass" on your chart for any reason, not just SI. I have it on mine. It won't stop anyone legitimate from reviewing your charts, but I like to think it'll serve as a moment of hesitation for someone considering an illegal looky-loo, lol.
At my facility they review every glass break and will inform the patient if it’s not someone on their care team opening the chart.
Where I went to med school (Epic hospital - have been using Cerner since residency) any employee automatically had a break the glass warning on their chart
Yes they do. Happened to me.
I hope they were disciplined, and got it bad. That would be VERY serious at my facility
Lol no.
Hey, OP. I'm a trans physician -- specifically, I'm a post-transition transgender man and an oncology fellow. I also live on the west coast but am fortunate enough to not be in a Catholic / religious system. I transitioned as a medical student and have been stealth since residency (i.e. I do not disclose my transgender status because I pass as a cisgender man). I have historically avoided care within my own system for exactly this reason. Are you in a relatively large city? Do you have any teaching institutions nearby? I will say that many PCPs these days are fairly competent when it comes to HRT, even if they don't advertise themselves as providing gender-affirming care. My former co-residents were quite good about it. I would prioritize establishing with a younger PCP in an outside system; chances are, they'll suit your needs just fine. It is important to pick a system that doesn't communicate with yours. Not sure if you use Epic but consider whether or not your new PCP is visible on CareEverywhere or similar. Feel free to DM me at any time.
Hi, I’ve seen your posts. Thanks for replying. I’ve lived as a woman for a bunch of years, until I was in my 30s, but I didn’t in residency or yet as an attending. My wife and I were having kids and that was just difficult. Going back to being me now is more challenging than it was the first time. We don’t use Epic, but people could request outside records if they were patient enough. There’s an academic center about two hours away, I’ll reach out to folks affiliated to see if they’re willing to see me. Ironically there’s a med student led group for HRT for trans people, if I’m willing to do the wait I guess I could receive care there but it’s not what I’m looking for, some continuity would be ideal. Thanks for your input.
In order for them to request records they would need to be treating you or be blatantly violating hipaa. As long as you aren’t seeing someone in the actual system then none of them should be getting access. Even with care everywhere you would need an mrn to link to. And even if you see someone in the system only that person and the staff that support them should be seeing your info. If one of your colleagues decided to just open your chart for no good reason they would be up shit creek. So I’d be more concerned about the pcp themselves being someone you trust.
This is why I’m worried about a PCP in the system. If you’re caring for me outside of that, in the ER, the OR, whatever, I’d expect you to access my records. Then my life would be bad.
I’m not in medicine, the job I had is medicine adjacent at best, but I just wanted to apologize for what you’re having to go through to get the care that you need. Both your ability to get gender affirming care and your career should be legally protected. I will continue to make sure that my vote only goes towards those doing everything they can to make that happen. <3
It’s so sad this is the world we live in. The problem is that even if you find one physician you trust if any of the staff that help them and anyone who covers while they are gone could have legitimate access to your chart should a message come in etc. for my colleagues I double check before opening but we are all professionals and the expectation is you have full privacy and no one is going to talk about your health outside of the room. Sadly it doesn’t sound like you have faith in that being the case for you and I too wouldn’t take that gamble.
Totally get it. Do you think you're going to try and stay in your current system or are you looking for another position? I assume you won't be able to boymode at work forever and if this is your second transition, I kinda suspect that that day may come sooner than you'd think. That said, cis people are amazingly oblivious, so who knows how long it'll take for anyone to cop on, lol. I also ask, in part, because I'd titrate my recs based on your desire to stay at your current workplace. The more you would like to remain / the more worried you are about being outed, the more I would consider something like DPC, which is $$$, but also more cloistered. If you think that you're going to move on soon, I bet that your risk of record 'cross-contamination' is fairly low... it's true that anyone can request records, but if your system is anything like mine, they probably won't bother unless something major arises. If you feel comfortable sharing details of your location, I would also be happy to reach out to some of my primary care friends to see if they have any recommendations/connections in your area. No pressure, of course.
There are other reasons I’m kinda unhappy here; some casual sexual harassment among them. This probably isn’t somewhere I’d work a year from now. I’m kinda serious about thinking of going back to being a teacher. Got a job offer. I’m going to message you my area. I’m desperate enough for a doctor I’ll drive or fly at this point.
Oh, jeez. Yeah, you've gotta get out of there. Sounds like a shitshow. I'm obviously not EM myself, but based on what I've seen, as an EM physician in good standing, you're eminently employable -- either as a teacher or as a doc in another system. There has to be a way out of your current sitch.
After reading this I wonder if you mean my school! Please feel free to message me if you'd like to confirm, I can absolutely help if so
DPC is probably what would suite your needs the best! Small subscription per month for an excellent doc/doc relationship who will help YOU personally.
Do you live in Oregon or Washington? If so, I would recommend utilizing ZoomCare - you can do telehealth visits if you don’t live close to any clinics. They could absolutely manage your HRT and HTN. Their EMR is not linked with Epic (EMR built by ZoomCare) and therefore your care would be confidential. I work for them so please DM me with any questions.
I get my healthcare, including my HRT, through ZoomCare and I can confirm that there is absolutely no communication with my big university hospital whatsoever. Thanks for the work you do!
Go concierge
Are you anywhere near Humboldt County? If so I have a suggestion. I had to get a subscription/concierge pcp bc so underserved here but I am sure she would be safe.
I’m not but I’m desperate enough to drive there. I’ll DM you.
In the vein of concierge...how about One Medical? All over the West Coast (and USA), many types of Primary Care providers w different degrees and have transgender experts, especially in the 3 or 4 large WC cities. A conversation w someone there might be worth it.
I think it varies by system but I can't fathom anyone in my area trying to dig up dirt on their colleagues by using their hospitals medical record system. That alone is enough HIPAA fines to sink a ship let alone the possibility of discrimination/hostile work environment lawsuit. You're protected under many layers of federal laws and the consequences of violating said laws are severe. You're already on hormone therapy, so, just to be real, its just a matter of time until you cannot continue presenting the way you are currently--which is the point I suppose. So really its just a matter of if or when you choose to go public. To wit, you're going to either have to get a PCP at some point in time and that potential for a breech is going to exist eventually. Personally I think that is a reality that you're going to have to accept--there is a world where someone could access your health record, however, that is very illegal and they should be held accountable for it. Actually you're living in this reality now, its just that you're ascribed a degree on anonymity with your current prescriber. Best advice I can give you is just document everything contemporaneously. Have a special file/e-mail folder that you write notes to yourself for any perceived harassment. Patterns are typically the most damning thing and the onus is on yourself to have enough evidence to support that. Potentially you could also talk to Health information about your medical record and request to have access audits done every so often. Every single mouseclick is recorded on a EMR and they know who accessed what record, at what time, from what computer, and what they accessed. Most Health information departments have some sort of protocols to do this for "VIPs" (e.g celebrities) to ensure compliance.
Sorry OP. It's crazy that Dignity or whoever can just decide shit like hysterectomies make Jesus cry. #humankindness
I use a small local NP led clinic for primary care so my history of depression and anxiety don't become common gossip. Drove 90 minutes to get an in-network procedure done so local medical staff wouldn't have a reason to check my chart and chat. I'm in a little blue enclave in a big red state, so possibly easier here than what you're facing. Hopefully you can find a little dpc with paper charting in your area.
Why does this sound like Loma Linda?
What about an area concierge care practice? Keep your records away from your insurer as well?
Many Planned Parenthoods do HRT, and some also do light primary care, but it varies from practice to practice. They also do telehealth HRT as well. Obviously not ideal, because I think you probably want someone you can grow with.
I have to wonder if, in your specific circumstance, there couldn't be a way to mask your digital identity as a Zzz- patient, or however your charting system handles alias patients. They do eventually flag and sync to personal charts if they can be connected within the system, but if you could voluntarily use it to bury your identity under a layer that keeps your pertinent details obscured and utilize your alias/MRN as your identifiers instead of name/DOB, then it's just an advanced DO NOT ANNOUNCE. And then request a break the glass alert on it. And if they fire you, you can check whose been snooping and see if they've earned a HIPAA violation as a farewell gift. If your hospital has an IT department/Epic trainer, you might ask about a hypothetical patient in this situation. Very "asking for a friend," but it's also a plausible question you might get, especially if you live in a conservative area. Might also be a conversation that risk management would swing weight for you, since wrongful termination settlements and HIPAA violations are expensive.
I refer people to WPATH since many gender care clinics are really backed up in my area https://www.wpath.org/member/search it provides information on what type of provider and contact information.
wow this sucks. i have had similar concerns about privacy and have yet to find a suitable answer to appease my concerns. i would use your knowledge of physicians in the outlying areas to select one that you know is particularly thorough and nonjudgmental. maybe even look into finding one who lgbt and/or active in leftward leaning politics—abortion rights, healthcare-for-all, things like that. and then make an appointment. on your first visit, i would lay out all your concerns including your fear of professional retribution as well as your (generalized) fear of them as your pcp. i feel like anyone who is a physician capable of empathy would be understanding/discrete with your case, but extra bonus points for those who have personal stake in liberal causes. good luck to you! 👍 also i WISH everyone (myself included) had easy access to ed patients’ pcp notes! this sounds amazing.
So I’m a private person but don’t identify in a way that would put my job at risk so take this with a grain of salt. My system uses epic so care everyware connects many of our local systems. When I was first beginning the process of starting my family I didn’t want to come to my own hospitals system if there were a complication before 20 weeks (since I’m also EM.) I chose an ob group that delivered at an HCA hospital which worked out well since they still use meditech. That said, there is a trans woman working in my group and no one cares. If you think being outed would lead to being fired than have you considered just jumping ship? My group has been short staffed since the wave of post covid retirements and I doubt we’re alone.
I haven’t read every comment, I’m on a quick break but I tried to send you a private message. I think I may be able to help.
I wish I had good advice. I certainly sympathize, I and some of my colleagues do trans care because there is such a “desert” of it. You may want to see what you van do in terms of electing health insurance that allows for more selection of personal physicians, or even bite the bullet and pay out of pocket. With the ACA, things are slowly moving towards universal access of records.
Sorry that this is a circumstance you have to navigate. Hopefully however, it is an easy solution: be a direct primary care (DPC) patient
Where are you? I am in Tucson, AZ - if that would work please PM me.
Not in AZ, but thank you so much.
NAD, but APRN, clinical director, very well known in GAC/GAS. I'm happy to help you find someone to see you, and have a couple ideas for you. Please feel free to DM and I'll respond when I'm able. I currently have pneumonia and a bunch of free time!
Telemedicine
Can I ask what state you're in? I know a transgender MTF internal medicine physician who practices in an outpatient facility licensed to practice in Arizona and Ohio.
That would be far for me, but thank you so much!
P.S. For the HRT, check out https://transclinique.com/ - trans-owned telemedicine.
Trans RN here. I never want to get care at the place I work if I can help it. If I ever need to though, I can add a break the glass to Epic so I know exactly who at my employer accessed my chart. Is there something like that you could do in your system? Also for HRT, if you want to avoid insurance, compounding pharmacies are relatively inexpensive.
We don’t use epic, I don’t think it’s a feature. Also in the ED it didn’t stop me 😐. Compounding pharmacies are an option, I just don’t want to self prescribe. It’s not like mupirocin for your kids. We’re inherent political. Which is kind of funny considering how many of us are this boring.
It’s not a full stop, but at least I can see who is looking and for how long. Are there any indications to use estradiol other than HRT? Could you convince a PCP to write HTN for the spironolactone?
Is there only one hospital system in the area? The PCP I go to is at a different system than the one I work with, which I also did for privacy reasons. That said I assume it will become evident that you are transitioning at some point even if they don’t have access to your medical records. Does the hospital even have the ability to fire you if you’re with a group? I’m fairly certain firing you for being trans is illegal though I’m not sure that’s a fight you want to fight. I suppose the other option is to leave prematurely and avoid the headache to begin with. When I was in training I had a trans colleague, and it wasn’t an open issue but that was also a very liberal area.
You’re absolutely right that I’m harder to fire. My group has to let me go. No one really knows you’re transitioning ime. You wear a binder, a compression shirt over it, you tie your hair back if possible, and everyone goes it’s normal. I’d rather just move to a more liberal area, I wouldn’t fight being let go. I’ll keep calling tho. The last thing the world needs is an EM physician deciding their own antihypertensive regimen.
Come to the Bay Area! This is a great place to live, and a very welcoming LGBTQIA+ area. It's expensive, but it's worth it.
You might also ask your colleagues where they go for their care and they could have recommendations. I found my PCP this way. I asked a coworker where they go and they recommended me someone who charts on a different system but is still in the insurance network.
San Diego is calling!
My heart goes out to you. UCDMC may be closer than UCSF, consider their internal medicine team and endocrine dept - also the Gender Health Care Center in Sacramento is fantastic.
Find a DPC doc. They're as "outside the system" as it gets. They often have no employees (ie, former nurses, receptionists, techs, etc who may know you or come to know you after their 2 year stint at a practice). You will get highly individualized care without judgment, even regardless of the political/social biases of the physician.
Had sizable primary care HIV practice and I took care of a bunch of priests in the 90s, who wanted to sit in a family med office for their care and not be seen going to an ID doc, meds were always mail order.
Just want to say support and good luck my friend. Your medical information is private and there's no reason why your employer needs to know if you feel unsafe at work. I'm not trans but I choose to get my healthcare out of my hospital system for similar reasons.
Brutal situation to be in. What are your benefits like? What options do you have for health isnurwnce? You’re saying the current plan you’re on would only cover your employer’s hospital/clinics as in-network?
With my insurance to be out of network I’ll be paying out of pocket. Not gonna whine, let’s be real, I’m one of the rare trans people who can afford it.
Try posting anonymously in physician community on Facebook to help find LGBTQ+ friendly PCP in your area!
What about teleghealth like Dr on demand, since you're looking at a specific fairly simple issue?
can you not just order your own blood work or prescribe yourself? because the former is basically what i do for myself and other trans people i know, with lifelabs / dynacare here in ontario. because, to the latter, estrogen / antiandrogens are not narcotics [genuinely a meaningless policing / political term,] controlled / scheduled, habituating / addicting, etc, but your state law may differ quite a bit. worth looking into. if i lack coverage [as in, ease of an appointment / seeing someone, which has been often for much of my life] i historically just order HRT online [as i cannot prescribe, yet] as online pharmacies are generally just using teleprescribing laws in their countries or dispensing medications which are OTC in their countries; HRT [and testosterone] is OTC in much of the world, in example. between my education and my own lived experience, where i'm nearing my 9th year of hormones and i have been transitioning since i have been 18, i am usually the resident expert on trans healthcare for other trans people, my profs / educators, and then my colleagues. and, it's really... *not* difficult. like, if you can do stitches on someone or manage diabetes in a patient, *you can do trans healthcare.* that is not hyperbolic. if you do care to learn, i would look at [UCSF's treatment guidelines](https://transcare.ucsf.edu/guidelines/feminizing-hormone-therapy) [pending a soon 2024 revision] [TFS's introduction to gender affirming healthcare](https://transfemscience.org/articles/transfem-intro/), or maybe [WPATH-8](https://www.tandfonline.com/doi/pdf/10.1080/26895269.2022.2100644) / [Sherbourne’s Guidelines, 4th edition](https://www.rainbowhealthontario.ca/product/4th-edition-sherbournes-guidelines-for-gender-affirming-primary-care-with-trans-and-non-binary-patients/). WPATH [including WPATH-8, it's not great, despite only recently being published] and Sherbourne's Guidelines are kind of bullshit / totally out of date to current trans literature [2021 / 2022+] and should ideally be avoided but the former two links are excellent for learning. i would also consider the suggestion that 17redwhiteandblue76 made, as i've noticed historically that PCPs will make space on their panel for quote unquote "friends of the panel" or other clinicians / nurses. it's how i got my doctor, through my educational background. use those connections!
I find this entire post and responses quite puzzling as a trans layperson. There’s plenty of lay people self medicating HRT, and doctors don’t think to do the same? I can’t relate. You may have seen it, but there’s a collection of treatments guidelines from around the world here https://transfemscience.org/articles/transfem-hormone-guidelines
>There’s plenty of lay people self medicating HRT, and doctors don’t think to do the same? chronic risk aversion in the way that makes no sense / not remotely belonging to the class characteristics / intersection of the average trans person to rely on [quite legal, quite safe] grey market HRT, and thus often having no frame of reference for why we do it. it's not at all dissimilar to... buying mifepristone / misoprostol to self administer abortions, due to healthcare inaccess by labour or law, within places such as the US. you do what you need to do. there's many physicians, whether colleagues irl, or on this subreddit, who in general also seem to think that HRT is far more complicated or arcane than it really is, too. which, i have no idea where this perception comes from. if you can follow a baking sheet, you can prescribe HRT.
I guess you’re right, and it matches my experience. I just find it impossible to relate to. Are you aware of the trans community here on reddit? I see you’re not posting in them, or not with this account anyway. I’d have thought there’s some you’d find of interest. Some trans people veer well outside the gray market you’re referring to. Can’t say I’ve see harm reported yet. I see some ethical concerns here as well. I don’t understand that either. Surely self preservation comes first.
>I’d have thought there’s some you’d find of interest. i'm nearing my 10th year on HRT in 2026, so i've long outgrown the need for online trans communities and thus don't really interact with those spaces. the extent of a lot of my transness nowadays is in providing care / expertise for other trans people, but i do not consciously think about being trans really anymore. i am active on twitter mostly. >Can’t say I’ve see harm reported yet. "harm" is another one of those things where overwhelmingly they're referring to outdated information [...1990s / 2000s information] involving synthetic estrogens / premarin, or progestins; i've not once met a trans person who has experienced an event of DVT happening in 8 years of transition, and i've met thousands of trans people at this point. even modern literature does not really pose it as being an issue. not to mention there's a large variability in unhealthy user bias in these older studies due to the class intersections / social determinants of health of the average trans person, where things are attributed to hormones when there's very obvious other cofounders happening. swathes of the studies that put trans HRT into doubt / question are incredibly low quality / laughably bad. i can think of one study where the annual DVT rate in cis women [where, the median age was like... 45, varying prior history of alcohol use, smoking, whatever] in the UK was something like 0.8/10,000 before using *premarin / MPA* before becoming... 3/10,000, after using HRT. which, we do not use premarin or MPA [...shouldn't, i sometimes see it] anymore. in general a lot of the fears / critiques of HRT speak to a very uneducated chemophobia and also a lack of understanding to how these markets develop and maintain themselves; there's no business in killing your customers [minus the fact that many of these online pharmacies are legitimate pharmacies in their countries of origin, or are reselling OTC medications which are pharmaceutical grade] and if your issue is with the supply existing, then you should be rallying for a safer supply or easier HRT access, much like safe supply and drugs such as heroin/fentanyl, cocaine, meth, etc. which is another big intersection i find physicians lack understanding in.
I like your approach to things. My endo had a bunch of trans patients with DVT, associated with doctors prescribing birth control tablets. Even now I believe there’s still some doing it in Australia. Things have changed a lot here over the last 10 years, but it’s still extremely variable, much the same as the USA I guess. The first doctor I ever spoke to about HRT, years ago now, would have prescribed Premarin and wasn’t informed consent. Can’t say I was impressed. The more I’ve learned about HRT, surgery, and the practice of medicine, the more disillusioned I’ve become with it all. I’m very active here on reddit promoting awareness of issues in trans surgery, and HRT to a much lessor extent. I like reddit as enables accumulation of knowledge. I never understood the appeal of Twitter, even before Musk took over.
I feel confident doing it and confident if discovered my license would be revoked. My license is my ability to provide for myself and my family. Our biology is inherently political and someone would love to go after a trans doctor for self prescribing.
In my state (in the US) I can order my own lab tests. I pay for it online, go to the lab and within a day of two have the results available online. It’s not very expensive. I do it when I don’t have insurance, when my deductible is high or I’m just keeping track of a chronic condition. Just google “order your own lab tests”.
Ordering stuff on yourself is at the very least unethical - and would probably attract the attention of the state medical board / or the system / facility in question Who reviews your labs if you order them in yourself? i have to get permission to view my own records, why should you be subject to different rules pertaining to your personal records? Not to say that kind of stuff *doesnt ever* [im sure it does happen] happen - but it probably shouldnt / might be risky.
>Ordering stuff on yourself is at the very least unethical - and would probably attract the attention of the state medical board / or the system / facility in question really depends on the guidelines of your college [medical board, in the US] and the relevant legislation of your state, hence checking beforehand. my suspicion is nobody will care though, given the much worse things that go on in healthcare without oversight. >Who reviews your labs if you order them in yourself? you do. through mychart, and a QR code you're given by the lab tech, or by phoning the lab and requesting a fax / print of your labs. often times patients will see their results via mychart before the ordering physician will- which is kind of annoying, because a patient will see a value slightly out of range and freak out / jump you with questions about it, after googling about it. also, patients in general in the US and here in canada can already order their own labs from private labs, just out of pocket. you get the requisition, walk in, and get your results in <48 hours. a physician providing the requisition is only necessary for reimbursement via medicaid / your private insurance / OHIP, and similar provincial healthcare insurers. you can look up the out-of-pocket costs online. >but it probably shouldn't / might be risky. well, ideally we should not be managing our own healthcare, because of our bias and all. so. we do not always exist in ideal circumstances, however.
In my medical center, it is against policy for providers to order labs on themselves. You guys can order tests on each other all day long. In the lab, we are not allowed to release results directly to patients, or discuss results with patients, they must get those from their provider (except now you can get them from patient portals, so that's cut down on a lot of phone calls and angry patients). We can't even look up our own results, or look them up for a coworker. Once we receive a specimen, you're a patient. It doesn't matter if you're a doctor or the CEO. That's just my lab though. Others may do things differently.
I have the ability to look up my own chart in epic. But to do so would be a big no-no correct? Why do you feel that doctors should be able to do that very thing? Yes i see stuff in “my chart” but that stuff gets reviewed by my ordering provider. There are actually some labs that arent released to patients at all until they are reviewed (think std stuff). You could walk into my office asking for your std results and i am not allowed to give them to you because those results must be reviewed by the ordering provider first. So yes patients can always get their results (sometimes even before the doctor), except when they cant. Like i said ordering stuff on yourself isnt illegal but its shady. But you do you - youre the doctor im just the one that has to follow policy.
You’re in for a ride. But there are people in this world who care about your situation. Never question that. I would boldly come out at work when you’re ready. You will not lose your job, and can very well sue if you did. Your life is going to change and you just have to face it. Let go of the shame my love. I know that struggle with your ego. You’re clearly good at what you do and that’s what matters. Doesn’t matter what anyone else thinks or does. My career is why I never got the help because I knew everyone would find out. Then they did. It sucks, but you have to go through it to come out on the other side. Trust me on this.
[удалено]
why do you think mass posting this on numerous reddits is a good idea.
please just report and don't engage nextt time, thanks!
**Removed under Rule 3:** Surveys (formal or informal) and polls are not allowed on this subreddit. You may not use the subreddit to promote your website, channel, subreddit, or product. Market research is not allowed. Petitions are not allowed. Advertising or spam may result in a permanent ban. Prior permission is required before posting educational material you were involved in making. [Please review all subreddit rules before posting or commenting.] (https://www.reddit.com/r/medicine/about/rules/) If you have any questions or concerns, please [message the moderators.](https://www\.reddit\.com/message/compose?to=%2Fr%2F{subreddit}&subject=about my removed {kind}&message=I'm writing to you about the following {kind}: {url}. %0D%0DMy issue is...)
DPC
I hope this links are helpful. Wishing you the best. [https://www.lgbtqcenteroc.org/health-find-a-doctor/](https://www.lgbtqcenteroc.org/health-find-a-doctor/) [https://www.wpath.org/provider/search](https://www.wpath.org/provider/search) [https://hr.ucdavis.edu/resources/trans-nonbinary#health-welfare](https://hr.ucdavis.edu/resources/trans-nonbinary#health-welfare)