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#Also my PCP is in-network with my insurance…

bigmammallama5 · 1 month

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mammallama if you have energy how did you find your adhd dr? I know I could use one but I'm trying to fight the inertia of getting a dr because of all the experiences of previous medical professionals not listening to me. thank you for reading!

Hey, I've got a little energy! You get my one level seven spell slot for the day lol

I am very fortunate that I have a primary care doctor that takes my concerns seriously and pointed me in the direction of my current specialist. I also have two very wonderful best friends with ADHD who gently slid my wig back and told me "go get tested, you sound like me". I recognize not everyone is lucky to have doctors that listen to them so this answer will be based off of my limited experience and local healthcare in my state in America, so please keep these as general suggestions! And I know it's hard to advocate for your own health, trust me I get it lol, but please stick with it. It's worth it to get the answers at the very least so you can start adjusting.

So if you have a PCP try asking them for places that are in your insurance network that could help you get tested/write you a referral letter if needed. I would suggest first looking for a behavioral therapist that specializes in diagnosing ADHD (like mine does) and treatment. I can't get actual cognitive behavioral therapy from them but they help me keep track of my ADHD and navigate my medication stuff. The extra special thing about my doctor is she was also diagnosed as an adult, so she truly understands to a certain degree of what I'm dealing with. Looking at her during my first visit was like looking into the future of the person I can be with the right help. Having a doctor that has what you have is incredibly valuable.

If you can't find a specialist, I would suggest looking for a psychiatrist that specializes in diagnosing and treating ADHD. You can also get diagnosed by a psychologist but I don't think they can actually prescribe medications? But either of those professionals will be able to test and diagnose you!

If you have trouble networking, my therapist suggested looking on Facebook (I know I know) for local/state groups that can help you connect with doctors in your area. You'd be surprised at how ready people are to help others find the care providers they need! You may not even have to ask, there may be a list of medical professionals that you can look over.

I will warn you that depending on where you go it's going to probably cost a fair amount. Even with my therapist's office taking my insurance my testing was still over 400 bucks, but in the end it was worth it for me. I will also warn you that some testing can be quite lengthy from what I hear, taking multiple sessions depending on the professional you're seeing. My testing and diagnoses took a little less than three hours and that's why I'd suggest looking for an ADHD behavioral therapist first. They know exactly what they're looking for and know you're there specifically for that test.

Another tip I can give you is frame your reason for testing as simply needing answers to improve your quality of life. Have that in writing. Don't even mention medication other than "I would explore that if you deem it a viable option for treatment." Getting medication right now is difficult if not downright impossible for some of us, so I would frame your needs on getting yourself picked up and put together. That's really what you need first anyways. Answers.

Be warned ADHD may also come with a side of fries (other general disabilities like OCD/OCD tendencies, anxiety, depression, ect ect that are often the result of untreated ADHD).

ADHD is legally considered a developmental disability and protected under the Americans with Disabilities Act. Know your rights!

In the meantime I always suggest taking a look through https://www.additudemag.com/ for information about symptoms and research and all that stuff. This is a trusted source that my therapist's office shares with all of their patients! The articles are kept up to date as new research is made available and is laid out in such a way that it's easy for people with ADHD to read and navigate. It's also a great source for parents that have kiddos with ADHD, so pass that around if you know someone who's struggling!

I do hope that your past experiences with poor doctors won't keep you from seeking testing. I can promise you not all of them are like that, and I hope you can find someone who will listen to you and take your concerns seriously!

#ask me stuff!#adhd #long post #but yeah i promise not all drs are Like That #i have drs and surgeons in my family and while i am gonna have to kick the snot out of my younger brother for some shit im seeing budding #my older family members are very good and listen to their patients #theyre out there i promise #pointing out this is a US based perspective #so if you are not in the US i would go through the health care channels that are the equivalent of your care network!

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lucysweatslove · 1 year

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I got a notification that a claim for my ADHD neuropsych testing was approved.

I wanted to write up a whole thing about how absolutely ridiculous this is. But it’s honestly too much effort. (Edit, lmao I proceeded to write up a whole thing anyway)

I have incredible insurance. We have BCBS through my husband’s work, and they have amazing benefits. Like, “not possible to get a plan this good on the marketplace” amazing. The best plan on the marketplace rn is like $1130/month for two people, with a slightly lower PCP copay but higher deductible, OOP max, AND coinsurance. Can’t remember how much we pay in premiums, but it’s like… a couple hundred?

So, I’m not super mad that I have to pay $360ish to the neuropsych for the testing. I know it could be worse.

And that’s part of the problem. Sure, I have Cadillac insurance. I’m LUCKY. Incredibly fortunate or blessed or whatever. And maybe my state’s Medicaid would pay out for this too, but I don’t know. What I do know is that there is a significant care gap ALREADY for rural and low-income people here. What happens if you don’t qualify for Medicaid but can’t afford good health insurance? What if you can’t find a neuropsychologist in network? What if you end up responsible for the original $2,580, or even “just” the $1,330 allowable for BCBS? People can’t just afford that here, and this particular office won’t release any reports to you until you have paid. Meaning if somebody requires this service for a diagnosis but can’t pay- highly likely because ADHD can make holding down a job difficult- they’re SOL. They can’t get treatment.

I had to see a total of five people to get to this point. To be frank, I don’t even know yet if the report will corroborate my loved experience. I still don’t understand the point of this testing to begin with; I’ve had three people in the sphere say it’s likely, two of whom (a PhD and a therapist who specializes in neurodivergence) formally diagnosed me with ADHD. But this wasn’t seen as “good enough” for the third (a psych NP and PsyD) to fully diagnose me to prescribe me anything. I’m considered a “complicated case” because I was good at school growing up, have a trauma history, and have a history of depression, an eating disorder, and likely autism (also diagnosed by the same neurodivergence specialist, but that wasn’t good enough I guess to have it on my medical record). But here I am, having spent thousands at this point in copays, therapy for behavioral interventions, medications to treat other issues to “rule them out,” and various assessments. Thousands most people don’t have. Thousands that could be tens of thousands for the uninsured. And this most recent assessment? It involved a test that literally CANNOT differentiate between ADHD and other forms of cognitive and attention deficit, such as depression.

ADHD is a clinical diagnosis. I don’t mean that there is never a place for neuropsychology, but in the psychiatric world that my family is part of (note: dad is a psychiatrist; sister is in residency to soon be a board certified attending psychiatrist too), it’s not a hard diagnosis to make based on a structured clinical interview. (Even my therapist, the PhD, who has not just taught but been a DEAN, agrees- she is frustrated with me).

Why are we gatekeeping this diagnosis so heavily? Why is there such a strong assumption that people malinger to get an ADHD diagnosis and access to the scheduled drugs they need to participate in society? Why, when we have research that shows that ADHD is a huge risk factor for actual illicit drug use, abuse, and SUDs? You know what happens when you treat individuals who you clinically diagnose with ADHD? Rates of illicit drug use, drug abuse, and SUDs go down. Not up.

I’m just mad about it all.

#personal #adhd

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catboyeddiediaz · 4 months

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Hey, I had a question I was hoping you could answer! How do you end up getting your therapist? I had a little bit of a crisis and think I should probably see one already after two people have told me I need to. Anyways, should I talk to my normal doctor first or just find a specialist that's in my insurance?

I got mine through my doctor, but I currently go to like. an lgbtq-specific clinic that has their own therapists and social workers! I was also on a waitlist for a while but not too long. If you have a pcp doctor you feel comfortable with they may be able to refer you to specific practice in your insurance network or send you home with some resources!

You can also definitely find one yourself by finding practices that take your insurance online. There's lots of options out there, I currently do tele-health therapy so I don't have to physically attend appointments (which is better for my mental health) and it seemed really scary at first but I think it's been worth it. Good luck!

#askbox

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windwardstar · 1 year

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that one t post

Since there's some of y'all who showed interested, here's the big rundown of my experiences with T. This covers being on T for 3 month at 26, stopping it for a few years, then the first 9 months of being on T at 28. Contains the changes that have happened while I’ve been on T + the interactions with my other health conditions + the process of accessing care. It’s safe for work/reading in public as far as any puberty/medical body talk is. Word count is ~8k.

T round 1 (2019 - I was 26)

If you followed me back in 2019, you might recall me getting on T at the end of that year.

I didn’t have a PCP and was in a very conservative state which made me concerned about finding a trans friendly provider, so I decided to go through Planned Parenthood knowing it was informed consent. The PP that had a gender clinic and was open on my day off was on the other side of the state/2 hour drive one way. But also, when I went to book an appointment they had one for the same week/the next day so I didn’t have to wait. I had insurance through my work that partially covered the visit, the lab work, and the prescriptions. This was out of network for my insurance so I paid more than if it was in network. My local pharmacy was the Sam’s Club which has $4 prescriptions for members- which is what I ended up paying as it was significantly cheaper than my insurance co-pay. (I did not get a prescription for a sharps container and bought one from the local store.) I got my supplies in 3 month batches and didn’t have any issues with the pharmacy.

At the appointment, I was given a big packet of “side effects” (aka the desired results) it included a handy chart of when certain changes would likely happen. My provider went over it with me to make sure I knew what to expect, and asked me a couple questions about my gender identity and transition goals to get a feel for me and make sure this was what I wanted. I was completely out at work and socially. I had very recently moved out of an abusive homelife and was catching my feet mental health wise, but I was in therapy at the time and on medications that had been as a consistent dose for about a year (aka: mental health problems were well controlled), so the doctor was comfortable prescribing me T. We decided to try weekly injections first to limit potential high/lows on a longer dose cycle.

The Labs for this provider were Initial Labs, 3 Months, 6 Months, Then Yearly. My 3 Month Labs hit right at the start of Covid Lockdown, I wasn’t able to get in for them (perpetually overlapping quarantines at work yo), the shift to telehealth hadn’t happened, and then I ran out of my psych meds (antidepressant and an antipsychotic/mood stabilizer) so my executive functioning skills went bye-bye for a while. So I couldn’t get my prescription renewed and had to stop T after like 3 months.

I took Testosterone Cypionate (0.25 ML, 0.50 MG) by Intramuscular (IM) Injections in my thigh once a week. The syringes had a twist on/off for the needles themselves (bigger one for the drawing up, smaller for the injection). They hurt a lot for me. I’d get a bruise around the injection site and the muscle would be very sore for 2-3 days after and hurt when I walked or used the muscle. It wasn’t enough to make me want to stop, but it wasn’t pleasant.

(Because of the long drive, the doctor didn’t have me come back for the first shot, just confirmed I was comfortable administering it myself and knew the process. She said if I ran into problems there were youtube videos I could look at or I could call.)

I did have issues with my needle phobia, but before getting to the part of actually seeking out access to T, I’d done a lot of work to manage it. The few years prior to starting T, I’d had to get a lot of blood drawn for lab work, several IVs, and quite a few vaccines which had helped me calm down so I was no longer having panic attacks around needles. The biggest thing that helped though was mental work and visualization. I started out just contemplating the concept of T injections in the abstract, then read posts with people talking about injections, looked at visuals of needles/syringes and people administering them. The last step was then thinking about giving myself injections and visualizing it. The whole time I tried to associate it with all the positive things I’d hoped to get from T and reminding myself the injections/ivs/blood draws of the previous years had all been perfectly fine and my anxiety was not reflecting what actually happened. (I also got a tattoo a month or so before I started T and after the initial anxiety I was mostly just fascinated by watching the tattoo gun, which was what really made me think I could do the T injections.) It took a long time to get to that point. When I started, I was only able to think about needles for a few seconds at a time. But I was able to give myself my first T shot with only a little anxiety (my hands shook a lot). And with each successful injection, the anxiety went down.

The Changes on T (1-3 Months):

Increased body hair. I noticed the hair on my thighs thickening and darkening around the injection sites, but not really much else. The peach fuzz on my face increased and I got a few dark hairs but there wasn’t really anything to shave. I think I shaved my face once because I wanted to not because there was anything to really shave…

Voice Changes: I sang quite a bit so I noticed that my lower register got fuller and the lowest end of my range got easier to access, but other than that there weren’t any vocal changes that I noticed. I didn’t get any voice breaking or cracking.

Bottom Growth: Yeah, there was some of that. Enough I noticed. Things also got very very sensitive and painful. OTC pain meds and ice packs helped. Loose clothes. Also manspreading.

Periods: They got lighter and less painful almost immediately, and I skipped one 3 months in. Then I ran out of T and got my period back the next month.

Acne: I didn’t get acne until the 3 month mark or so, but that also coincided with the start of wearing masks. It got really painful so I started using the OTC acne cream I used in high school, and it cleared up to something manageable once I was off T. (My teenage acne hit HARD at 13 and didn’t clear up until I was 24.)

Nightmares: The first month I started getting a significant increase in nightmares/remembering them upon waking up. This may have been because I had just moved into my own place and escaped an abusive environment, but my therapist at the time mentioned that nightmares were a common thing for people starting T (it is a big hormone change so y’know).

Other Changes: there may have been some, but it’s been a few years so I don’t really remember.

T round 2: 9 Months (2022 started at 28)

The goal was always to get back on T. It just took a while. Cross country move (liberal state now yo), new job, getting new insurance. Once I did, I had to figure out where to get T again. The planned parenthoods were all booked months out and none open for gender clinic stuff on my days off.

I went through my doctor’s office, found out they have a special gender health program for trans people and transferred care to them. I had to wait like a month to get an appointment, but it means my PCP/GP is versed in trans care and does all my hormones. The experience is fantastic. The whole office used my chosen name and pronouns before they got legally changed and had the ability to change the display name on my chart so everyone would use the correct one.

The initial visit was via phone. It was a lot of the same causal “tell me about yourself and your transition goals” as the last time. We skipped a lot of the “this is what t will do” since I already knew it, and folded it in with talking about my experience being on T previously, what I liked, what I hoped for, what I found difficult, etc. I was off the psych medications I had been on the last time, but since I’d been off for two-ish years and was stable, I was ok to restart T. We started me off on the same dose and frequency I had been on previously, but because the IM had been painful, we switched to SubQ.

I didn’t need any initial lab work done, but I’ve done them every 3 months after starting. I had to go in person to pick up my prescription (which I did the next morning after my initial telehealth visit, the pharmacist called the insurance to get the authorization & everyone there was super great) and meet with the nurse to administer my first shot. The doctor poked her head in to say hi in person.

My insurance covers the visits, lab work, and prescriptions. I did have to get prior authorization and have a letter from the insurance company stating my T prescription is approved for a year. I got a prescription for a sharps container this time since the stores did not have any on the shelves. (The pharmacy was out of the small ones too, so I ended up with the big gallon size. It takes up a ton of space under the sink, but it should last me several more years before I have to dispose of it.) My needles also just have a smooth pop on/off to attach to the syringe.

For the first six months, the depo was a 0.25ML/0.50 MG SubQ injection once a week. Because there were certain changes I wasn’t seeing, at 6 months my dose was increased to 0.40ML/0.80MG SubQ once a week.

The SubQ injections basically don’t hurt after I’ve injected them. A couple times I injected them too quickly (just sticking the needle in and pressing down on the plunger too hard and forcing the liquid in, then pulling the needle out immediately) and those are when I’ve noticed redness, swelling, and soreness around the injection site. So my process for minimal pain and bleeding: wait until I’ve got cool skin (not right after a shower), inject slowly, count to 10 before pulling out the needle. Warming up the vial in my hands so the T isn’t cold and making sure everything is dry from the alcohol swabs before injecting also helps with the initial injection pain.

The anxiety around needles has basically all disappeared so I have no issue giving myself injections.

(I have a problem with my T vials crystallizing. I’ve found they take ages to dissolve, so I stick them in a pocket/waistband to keep them warm against my skin for an hour or so as I go about my morning, shaking it every now and then to see how it’s doing. I do my shot on my day off when I generally have time to do that. This time it’s Fridays. Last time it was Wednesdays.)

I started T (again) in April 2022 at 28

(Idk how the math works on these changes when you start/stop/restart on T. I wasn’t able to find anything. Probably because there’s not enough data on it. Given the length of the break, the T levels in my system had definitely reset, and I hadn’t been on T very long previously. Some of my changes went faster than the expected timeline, some slower, some about the same. So know there’s a parenthetical +3 months to all of this.)

Voice Changes: I noticed a continuation of the pattern from the last time. My lower register got much fuller and easier. My upper range started getting harder to reach. Nothing cracking or breaking, but there were some notes I was struggling to reach by the time the choir concert rolled around in mid-May. I started off bordering soprano/alto and was clinging to the alto range before we broke for summer (1-2 months)

I caught COVID from work over Memorial day (~2 months in) and my voice cracked a bit. I went into COVID being able to talk, was sick for a week, and then when the Covid cleared my voice was fried. I sounded terrible talking. Singing wise, my lower range had extended and my upper had come down, but I was still easily able to slip into my head voice.

Started Summer Choir at the end of June. I spent the first few weeks feeling like the songs were a little low for my range. Then things shifted again (~3months) and my singing range shrank to about 3 notes, I could not reliably open my mouth and make a sound, my breath control disappeared. I had one volume I could sing in, no going louder or softer or the sound would disappear. I sounded like a squeaky clarinet. (I did a very good seagull impression.) It was terrible and I loved every minute of it because it was so euphoric. I didn’t sound like a girl. I was firmly in the Tenor range. I was experiencing the puberty I’d always wanted to. (It was hard to tell with the first drop since it happened while I had COVID, but the second time my voice really cracked, I also had a really dry and sore throat.)

Enter August (~4 Months) my range was starting to re-expand. The low notes/chest voice coming back first. I was also figuring out how to make noise with the new instrument, because speaking and singing is all muscle memory. Which meant everything I knew previously was basically irrelevant at best and counter productive at worst. My brain would know how to produce a note on my pre-t vocal chords, so it would try to do what it had done before and either a) nothing would come out because my vocal chords are no longer capable of producing those notes or b) it would come out but be much lower. (I’m still working on retraining this 9 months in. My mental voice and physical voice do not match. I still think I sound like my pre-t self. Like, the thinking voice in my head sounds like my pre-T voice, it hasn’t dropped yet. Which makes singing difficult because I don’t know intuitively how I sound now. I have to adjust once I start making noise.) I was able to make my way through the concert at the end of August, but there were things too high for me since I wasn’t able to access that part of my range yet.

September/October/November/December (month 5-8) my singing range continued to expand and stabilize, the lower notes got much easier, volume control came back, my breath control returned with practice, and some access to my head range. My voice fatigues easily, but that’s getting better too. The vocal fry/clarity of my voice is getting better as well. I had to stop multiple times per rehearsal over the summer, but by December I was able to make it almost the whole rehearsal before reaching my limit. I do not have a smooth transition between notes and get stuck in low gear so to speak. Pre-t my favorite things to sing were songs where I jumped around my entire range. I miss that flexibility, but there are new things to enjoy singing now. I’m also only 9 (+3) months in, and my voice is going to continue to develop. My goals right now are just to continue exploring my singing voice as things change, and to try and get my brain to match what the new pipes can do.

(January 1st, Month 9 (aka today while I was waiting to do a final round of edits on this post) I had a moment where things finally clicked into place for my singing voice. I was singing while doing the laundry, and I was just able to actually sing without feeling any strain. It felt easy and natural coming out. I had to focus on what I was singing to a degree, but not to the exclusion of doing other activities. The sound didn’t crack or disappear on me, and I didn’t run out of breath mid phrase. I was able to actually sing. It was also a moment where I was able to hear my voice and think “this is what I sound like, this is my voice” as opposed to the transitory state it’s existed in since I first started noticing changes. It’s also just a sense of feeling completed and right. I cried, and there was joy, but the predominant emotion was just feeling that things had finally aligned into where they were meant to be and an overwhelming settling peace.)

My biggest thing right now is just how much more air it takes to make sound, speaking or singing. My laugh has turned from a giggle to just blowing air out through my teeth or a bunch of kekekekeke where the sound is from my tongue stopping the air rather than my vocal chords making noise. Singing, I am having to breathe much more frequently than before. Speaking, I sometimes don’t do enough air and sound doesn’t come out. I go nonverbal A LOT more than before because the physical act of speaking has become harder. That initial start up to making noise is sometimes more than my brain can figure out in the moment.

My speaking voice has also changed a lot. The pitch has dropped, it’s gotten much rougher, but I tend to speak in a very femme manner. People have definitely noticed it’s dropped, but it sounds more “cold/laryngitis” than “guy.” People have definitely started reacting differently when they hear me speak over the phone, but I’ve yet to get any comments and it’s not been enough to keep strangers from misgendering me. I have the ability to sound like a guy, there are times when I am relaxed and can hear it come out. The bulk of how my speaking voice sounds is from how I’m using it. I sound like a girl to others because of all those aspects of speech that have nothing to do with how high or low it is. (Aka sounding like a guy at this point for me is about technique not physical ability. This is where speech therapists would be useful.) My dysphoria over my voice has essentially disappeared. I love my voice now, and I’m filled with so much excitement over seeing what else unfolds with it as I get used to it and how to use it.

Acne/Skin Stuff: First off, Puberty 1.0 gave me terrible acne. It set in at like 13. Regardless of what I did as a teenager, I was unable to really control it. I had products but they didn’t really work and my mother wouldn’t get me to a dr for it. My skin was dry and oily. It would crack and peel and bleed and had reactions to every product I put on it. It got better in my twenties and was mostly gone by the time I was 24. It came back when I started T the first time + Covid Masking at 26. But by that point I’d found an acne cream + lotion combination of products that kept things almost clear.

I expected to have acne bad again on T because that’s just what my body does with hormones. By the end of the first month the acne was back. It progressed to being painful cystic acne by 3 months. I told my doctor and got a prescription cream. I’m meant to use it twice a day, I did at first, but it made my skin too dry, so I use it mostly once a day (generally after I’ve showered). I use it + a plain lotion for moisturizing/keeping things from getting too dry. I still have pretty bad acne, my face is red and skin is perpetually breaking out. But it’s not painful, and that’s my biggest goal with controlling acne. Especially because I react very strongly to products on my skin.

My acne still gets worse around my periods, so I know a lot of it is hormonal stuff going on. There’s some slight increase in body acne, but nothing that I even have to put cream on as it’s not painful and goes away on its own. The acne usually appeared in spots where hair was growing in for like a week or so while the hair started growing in thicker/darker.

The rest of my skin also got super oily. And I got super sweaty. And smelled funky for a little while. Previously I showered and washed my hair every other day because that was the balance of keeping my scalp happy. My skin also couldn’t handle more than that as it would get too dry and crack even with lotion. 1-2 months in, I was showering every day, over the summer (~3-6 months) I was showering once in the morning and once at night (mostly because sweat, but also smell) and washing my hair every day. I did not really experience any dry skin. Somewhere around the 7 month mark, that all decreased. 9 months in, I’m showering every day (with an extra shower if I get gross) and still have no problems with dry skin on my body.

The T has affected my scalp*. I started reacting to the shampoo I’d been using for years about a month or so into starting T. I switched to a different shampoo that worked for the most part, but then started causing problems about 7-8 months in. I’m currently trying a new shampoo + washing every other day or so, and hoping it works. This is getting brought up at my next appointment either for medicated shampoo or a referral to the derm if the current shampoo doesn’t work. *I don’t know if it’s causing a reaction to the products, or if there’s some interplay of the increased oils + increased sweat + my hair being wet for longer + more washings causing more dryness and more irritation + the hair dryer causing more irritation. All I know is my scalp is hurting and I am trying to figure out why + what I can do to make it stop.

Aka: I had terrible acne during puberty 1.0. Puberty T.0 is running about the same in terms of getting acne, but I’m able to manage it so much better because I’ve a) found a lotion I can apply to my face to help with the dryness and b) got a doctor to prescribe acne cream that actually helps. I’m having worse scalp problems now though, but working to manage them.

Facial Hair/Body Hair/Head Hair:

I started getting dark hairs on my chin first. It was within the first 3 months. It also coincided with the acne. Because my skin is so sensitive and the acne was so bad, I decided to use an electric razor since it doesn’t cut as close and tends to result in fewer nicks and cuts and ingrown hairs. I would not have been able to use a razor without cutting myself at the start. I also tend to react to shaving cream so the electric razor allowed me to not have to figure that aspect out too. I started off every few days, then every other day. Somewhere around 6 months I started needing to shave every day to keep the stubble away. If I have a few days off in a row I’ll skip the shaving so I can see what it looks like, but I shave clean if I have to work.

I’m not really sure when the body hair started growing. I noticed the leg hair on my thighs started growing in a little thicker and there was a bit more hair on my belly 4-5 months in (mostly because the bandaids from my shots started hurting when I pulled them off lol.) At 9 months I’ve noticed the hair on my arms and thighs has gotten darker and a little thicker, and my belly has gotten a lot more dark and thick hair, and there’s some chest hair appearing. I want to say somewhere around 6-7 months, I really started noticing the body hair and getting euphoric and happy about getting fuzzy. (Idk about lower leg hair since I frequently shave it due to wearing compression socks and finding them sensory hell and painful with leg hair.)

(Also got more hair on the butt and the butt crack, which was making getting clean after pooping during colitis flares difficult. Solution I’ve found is shaving/trimming that area (you know how it works with long-haired cats and dogs?) and using wet wipes if needed.)

One thing I did notice for both my facial hair and body hair, is that my skin would get mildly itchy the week or so before I started noticing more hair growing, and would continue for that first week or so + there tended to be some ingrown hairs during that stage. It was rather similar in feeling to what my underarms or legs feel like when I shave them and the hair starts to regrow. The itchiness is pretty mild for me so I didn’t really do anything about it.

The spot I inject the T got darker thicker hair first. And by spots I mean like the circle immediately around the injection sites was noticeably darker and hairier than the surrounding body part. It’s evened out on my thighs since my SubQ are in my belly, and the belly is starting to even out 9 months in.

Head hair. It’s started thinning up top right around my part, and on the sides of my temple. Really only noticed it starting at the 8 month mark. I’m currently in the process of trying to figure out if this is related to the scalp issues (since they can cause hair loss) and reversible, or the permanent slow march of time kind of balding. I really like having long hair. It’s fun. I haven’t cut my hair (which would improve my chances of passing as a guy or at least not getting consistently gendered as a girl) because I like my hair. I want to keep it.

I know finasteride and minoxidil are both things that can be used to treat it. I’m hesitant to use finasteride since it blocks DHT and I want the effects of that more than I want to keep my long hair. I’m worried about minoxidil exacerbating my scalp problems and causing more hair loss.

I’m contacting family to find out more information about family history of hair loss (including the ones where there were auto-immune skin conditions that caused it) and will talk with the doctors to figure out what the best option for me is.

I was a lot more anxious about the potential balding when I first noticed, but after a couple months to process it I’m not as alarmed as I was. If I do go bald though, I like the idea of getting tattoos. It’s also something that hopefully will be slow enough that I’m not gonna lose everything right away and can still enjoy having long hair for a while. But also you know the meme, if you can’t produce your own, store bought is fine. Wigs do exist.

Muscles, Fat, and the whole Musculoskeletal Shit

My timeline on this is a little blurry. Mostly because I’ve always built muscle easily and been rather buff just through having jobs that require some level of physical labor. I’ve also got hypermobile joints + low back pain from falling down stairs in 2019 + chest, rib, & shoulder pain from binder (haven’t been able to bind since pre-pandemic) and bra. So my focus on/awareness of physical ability was less on ease of strength and more on whether or not I had pain that made breathing/movement difficult. I’m going to guess it was easier to build muscle fairly early since I did notice some other changes that would track with things being affected.

So first thing I noticed was that my hips weren’t as prone to slipping out of place as usual and the days where they were painful decreased as well as the level of pain. It got to a point where I basically wasn’t having hip pain except around my period (pre-T the pain would get worse around my period, this is a continuation of the existing pattern). I’m not sure if I noticed this by 3 months, but I did by 6 Months. My guess is that the T strengthened the connective tissues and helped build muscle to hold everything in place. When I did a lot of walking and fatigued my leg muscles, the hip pain would get worse pre-T, but now I don’t really notice that at all 9 months in. If I get sore after movement, it doesn’t knock me out for several days. I still have to be careful about how I’m sitting and sleeping as the joints can still get knocked out of place that way. But also, the threshold for pain happening is much higher and I have fewer days of it. I’ve also only had to use my cane a handful of times since starting T.

My rib/chest pain got less severe at some point… I know I’m able to tolerate wearing my bra all day without feeling pain most of the time. That shift happened some time over the summer. So 3-6 months. (This was because my body finally managed to heal from the injuries from binding and the stress injury from using the deli slicer 2-4 hours a day at work in 2018.)

My back pain has kind of been figuring out what makes it worse and better. It’s gotten better overall over the past 9 months, but idk how much I can attribute that to T and how much is just figuring out what makes it worse and not doing that.

I’ve also noticed a significant decrease in flexibility. To the point I can stretch muscles I’ve never been able to stretch before. I can stretch my muscles without hyperextending joints. I started to resume a lot of the stretching I stopped in 2018 because whatever support my joints now have is enough that I don’t risk being too bendy to hold them all in place. My hands basically don’t dislocate/sublux any more, and the pain in them is gone. My grip strength has never been better. I can open water bottles without fucking up my fingers. (Aka T has definitely helped with the hEDS.)

My skin has also gotten thicker and less prone to getting cuts. If you follow me, you probably saw the post I made about the changes on that, but basically, my skin is tougher. It doesn’t get cut up as easily and I don’t bleed as easily. My mouth doesn’t get cut up as much by rough foods like toast and cereal and brushing and flossing doesn’t cause bleeding and tearing (no gum health issues this is just hEDS stuff, although I also notice the sensitivity of my gums fluctuate with my period), I don’t get papercuts as easily, sewing is a lot less bloody. This has made it slightly harder to put the needle through my skin for the T injections, it used to go in completely painlessly but somewhere around 6 months it started pinching a bit.

I also have a little adam’s apple now! Which I wasn’t expecting since I’m nearly 30 and I figured things wouldn’t shift too much. I started noticing it grow 3 months in or so when I would touch my throat and it slowly got just a bit bigger. 9 months in there’s something visible in my throat when I talk or swallow, just a tiny visible bump but it’s more than it was before! It also tends to sit REALLY high in my throat, which I know is also part of the problem I have with my voice being high and strained. I have a couple vocal exercises that lower it and my voice and reduce strain. But also this was one of the things I wanted but was realistically not expecting to get so !!!

As far as muscle and fat (re)distribution and such, I noticed somewhere around 4-5 months that when I looked in the mirror after showering so a) i didn’t have my glasses on and things were hella blurry and b) the mirror was somewhat fogged, I had a more masculine look. When my hair covered my chest (it was waist length at that point) there was just enough shifting of things to look masc. (My boobs have gotten somewhat flatter/deflated. Around my period I definitely get a feeling that they’ve gotten bigger/swelled back up.)

Body wise, my shoulders have always been broad, and the ratio of tiny waist to huge hips has always been a source of dysphoria for me. There’s nothing T is gonna do about the underlying bones, but I have noticed my hips and thighs slimming down somewhat / my waist filling out. It’s changed my silhouette away from the hourglass and into something more masculine. It’s helped greatly with my dysphoria when I see myself in the above sink/counter level mirrors. (Full body mirrors/reflections are still hello dysphoria hips.)

My shoulders also got slightly broader, my neck thicker, and my feet got slightly larger. I know for sure around 5-6 months, as I pulled out my long-sleeves for winter and the ones that had been tight and with no stretch the previous year were too tight to wear comfortably. I also pulled out my performance clothes which I hadn’t worn since month 2 on T, and had to let out the collar on my bowtie by a solid inch and get new shoes as the previous ones were too tight (again I’m almost 30, my feet bones didn’t grow but I did have to go up a shoe size). I had thought around 4-5 months that my neck was getting thicker since it didn’t look quite as stick-like. Around that time my face also started looking a little swollen around the jawline. It may have been puffiness or just things shifting around. I’m faceblind so I don’t know if my face has changed, just around that time looking at my face made me think the jaws looked a bit like my sister’s did a week after getting her wisdom teeth removed. Whatever puffiness I saw then, I don’t notice now though.

Idk if I’ve gained or lost weight since I don’t own a scale and don’t actually pay attention to that because it’s not actually important. Shrug emoji.

Periods & Bottom Growth:

If you’ve read this far you’ve probably guessed my periods didn’t stop early this time. As I stated, the first attempt at T, they stopped three months in. My third period came two weeks early this time when I caught COVID. We increased my dose at 6 months because my periods hadn’t stopped. My 8th period happened a week late. This month for the 9th I’ve gotten some light cramping and joint pain (but another week or two will tell if it’s stopped).

I did notice by 6 months the pain/cramping and other things associated with my period were less. (The flow decreased somewhat and the cramps were less severe. I was able to still walk and function with the OTC pain meds, and I had to take fewer for a shorter time frame to get relief. My blood pressure didn’t tank as drastically, so I wasn’t at risk of passing out every time I stood up on the first few days of my cycle each month. I didn’t get chills and shaking. I still get increased acne, bloated, migraines, and my joints all get loose and painful.)

(Outside of my period, my POTS has also drastically improved. Around 7-8 months, all I really started to notice is the tachycardia. The blood pressure problems aren’t forcing me to sit down to avoid passing out, my low blood pressure migraines have mostly disappeared, and my heat intolerance has drastically decreased. The heatwave in 2018 is what ended up with me in the hospital. I made it through the heatwave this year without too much difficulty. I still get migraines when I get too hot, and get weak and exhausted, but I recover within a day rather than a week. My migraines have tons of triggers, but overall I’ve gotten fewer of them since starting T. The only trigger that’s increased in causing them is my low blood sugar.)

Bottom growth has happened!!! I was ambivalent to slightly apprehensive about this part prior to starting the last time, but discovered pretty quickly I was actually really on board with it. For a while this time I was worried starting/stopping/restarting T meant I wasn’t getting any this time around. But the past month or so (month 9) has given me indications it was just taking a while to happen (like my periods not stopping 3 months as previously). This time, I haven’t experienced much in the way of pain + too much sensitivity, but the sensitivity has really increased in the past couple weeks so that may start again as well.

Appetite & blood sugar :

The increased appetite has probably been my biggest most noticeable thing in my day to day life and the only thing that has actually caused me distress (as opposed to annoyance and irritation with the acne). I noticed pretty quickly an increase in my appetite. This brought back problems with my blood sugar just crashing (and tanking my blood pressure with it) that I’d had while growing up. I would also wake up hungry in the middle of the night. 3 Months in it was the biggest change I noticed.

6 months in I was up to eating every two hours, waking up twice at night, and if I skipped one my body would get ravenously hungry and would have headache and shaking. But I was also getting more used to the routine so I got better about keeping food on me and my blood sugar didn’t crash as often/as severely. My grocery budget effectively doubled so that was yikes to my bank account. I also couldn’t get full or stay full. I was constantly hungry. Since I had a history of food insecurity as a kid, the constant feeling of hunger was distressing and started making my anxiety and ptsd get worse.

(There is a link between testosterone levels and blood sugar. Most of the data is on cis men. But the little information packet that comes in the box of my testosterone vial includes: In diabetic patients, the metabolic effects of androgens may decrease blood glucose and therefore, insulin requirements. Presumably, the doctors know to monitor this with diabetic patients and to mention it to them. But also, a reminder to read all the paperwork you’re given because neither of my prescribers mentioned this aspect to me, even when I mentioned having problems with my blood sugar dropping.)

9 months in, my appetite has decreased to pre-T levels which also coincided with getting heart burn/acid reflux for a solid week and a half. I’d never had a problem with that before, but I was also eating/drinking and then immediately laying down (aka eating right before bed and a midnight snack) for like six solid months, which is a big clue to the cause. The biggest surprise there is that it took six months to become a problem. I’ve been mindful of staying upright after eating and after a few days the problem went away.

Dysphoria, Mental Health, Mood and Energy;

T has been fucking amazing. Like. It’s fantastic and I’m thriving and have never felt so stable and capable of handling life. I can’t attribute everything to T because I’ve done a lot of work on my own mental health and my living situation improving (moving away from abusive family, getting engaged with friends and community, fulfilling job) but its positive impact on my mental health and general mood is undeniable.

My dysphoria is so much less than it was before. I love my voice now, I am starting to remember what it feels like to be comfortable in my body. There’re still a bunch of things that are dysphoria inducing that will take more time or surgery (top, hysto, bottom) to change and relieve, (and when I am reminded about the dysphoria inducing things like boobs and people misgendering me as a girl, it feels terrible and I want to crawl out of my skin). But the entire experience of being on T has been a daily blessing of euphoria as everything happens.

I used to joke that you knew trans people were really trans because who else would willingly go through puberty a second time. Puberty 1.0 had been soul destroying terrible. I hadn’t had a single positive experience from it. Everything about puberty 1.0 had made me hate my body more and the changes just kept getting worse. I couldn’t imagine anyone willingly going through that a second time. Somehow despite knowing I wanted all the changes T would cause, my brain didn’t make the connection that I’d like the process aka puberty 2.0. I’d figured I’d suffer through puberty again and in the end I’d have a body I liked and was comfortable in, so it’d be worth all the suffering of puberty.

I was terribly wonderfully wrong. The first time I was on T, I didn’t really notice a ton of changes, but even the small ones I did I liked. It wasn’t terrible. And then, I was off T and the strength of my desire to get back on T and go through those changes was a physical ache. The past 9 months have been full of joy and excitement. Every little change I’ve noticed has made me happy and been something I loved to find. (Barring the acne, and hunger, and potential hair loss.)

Puberty 2.0 is so powerfully positive for me. I love it, and it’s letting me love my body.

My mood is a lot more stable than it was. With my dysphoria lessened, I’m not constantly feeling shitty about that which overall helped my mood. I’m not as depressed (and when I am, it’s so much more mild than before). My mood tends to be either in a stable state or hypo/manic. But there’s no irritability or violence or any of those fear mongering things. T didn’t suddenly change me into the TERF and bio essentialist’s boogey man. T doesn’t change your personality. If you have anger issues on T, you likely had them before. (Also I really want to stress this because I saw warnings about T and bipolar disorder for years: T did not make me irritable or angry or violent. It hasn’t changed the profile of my mood disorder to include symptoms that were never present.)

(As for crying. I don’t cry out of frustration or anxiety as much--which is likely because my mental health has improved and I’m not pushed into those strong negative emotions as often. But I tear up just as easily when I see heartwarming news stories or videos of puppies or see something heartbreaking on the news. I haven’t been cut off from health emotion, or healthy crying.)

Energy wise, I have so much more energy than I did before. I’ve managed to wake up easily all winter rather than take an hour to drag myself out of bed every day. I can work a 12 hour shift, and/or not take a nap and be fine with 8 hours of sleep (or less) at night. I can run around and do things on my days off. I have enough energy to function. I don’t have to have an entire day off just to sleep (although I still enjoy a good afternoon nap and sleeping in).

I don’t notice my energy level fluctuating with my shot (I do weekly injections to avoid my levels fluctuating and causing other things to do so as well), but I did notice my energy levels increased within the first month. But! There’s also a lot of other things going on that are affecting my improved energy levels. Some of this might be because I actually started taking a vitamin d supplement (and I definitely notice less energy when I forget it). The lessening of my dysphoria has freed up a lot of mental energy for other things, the lessening of my dysphoria has lessened my depression* which gives me more energy, the reduction in joint pain + other chronic pain means I’m not constantly having that low drain on my energy and resting better at night, and the reduction in POTS symptoms means I’m not having that massive daily drain on energy reserves.

(*I’ve noticed an increase in energy at my stable baseline, and an increase in the sustained energy while hypo/manic from my pre-T mood cycles without an associated increase in the severity of other symptoms. My depressive moods have reduced in length and severity because there aren’t as many things fucking triggering me during them (which can also be attributed to the better living conditions and social connections, since I noticed this prior to restarting T), but I also have an increased energy during them as well. Which all tracks with the physical conditions improving and no longer draining my energy as much.)

(I still notice when my blood sugar drops, I get my period, or I have an anxiety attack that my energy levels for the day drop accordingly. But I’m also quicker to bounce back to my new baseline. My anxiety has more or less stayed the same. Also randomly feeling tired has become a much more reliable migraine aura because now being tired tends to have an easily identifiable cause.)

As I mentioned in the appetite section, there has been some downsides to my mental health while on T. The constant hunger was triggering for me, but since I'm in a stable environment and have money for food, it’s something I’ve been able to work through. I’ve also experienced more nightmares since being on T, especially around when I first started and when my dose was increased (biggest changes in hormone levels). But the nightmares also increased in general, which I also want to attribute to having more energy while on T. Before T I had a tendency to be so utterly exhausted I didn’t dream and/or I woke up too frequently during the night due to joint pain/needing to reposition that I didn’t complete sleep cycles and wasn’t dreaming/having nightmares. (The biggest argument for this is also that I’m straight up actually having non-nightmare dreams now too. I rarely had dreams and/or remembered them before. I get them decently often now. Which is nice! Dreams can be fun! And weird. Dream logic does not make sense upon waking up.)

“Passing” / How people perceive my gender / General Reception

Gender is a party and transitioning is the grab bag. I’m basically completely on board all the physical changes T is making to my body (bar the acne and the balding). Presentation wise, I lean heavier into the men’s clothing than the women’s and would prefer to be read as a guy rather than a girl if people gotta gender me, but I’m not a guy and not actually interested in passing as a guy. So I don’t put any effort into passing as a guy. Being my authentic self and transitioning into my nonbinary genderqueer gender basically means I do what I’m comfortable with and just vibe (until someone misgenders me and then I dark side dysphoria vibe).

Basically for those keeping track: I have long hair, I shave clean (and wear a mask anyway), my boobs are still visible (can’t bind), my hips are still a thing, and my voice sounds mostly like I have a cold (lower but with girly customer service inflections). My chosen/legal name is still femme. I’m also 5ft/160cm and relatively small. I dress in men’s clothes for the most part. Strangers still assume I’m a girl. Even in trans friendly spaces I get she/her’ed by default.

(I’m out to management at work but very few others. There’s been maybe one person who might have noticed something. Most people I interact with through work--if they notice anything-- notice my voice change. But all the comments I’ve gotten indicate they think I’ve strained my voice from singing, have a cold, or it’s related to my breathing problems. (I had to wear a mask/scarf outdoors before covid due to the cold making it impossible to breathe, same with smoke. Also I caught COVID right before my voice cracked so…))

As I said, I don’t bind and my hair is long and don’t try to pass as a guy, so it makes sense I won’t. I’m sure if I had short hair and didn’t have visible boobs the default gendering by strangers would shift to a different percentage of girl vs guy vs awkward pause as they guess. So if you’re wondering how long it’ll take you to pass as a guy or confuse everyone, I’m not gonna be too helpful. But if you were concerned about being able to hide being on T/keep your transition on the DL until you’re ready to come out, you can definitely do it, just come up with some excuse for your voice because people will notice that.

Congrats I guess if you’ve read this far. Hopefully this was helpful and/or informative. The TL;DR of it is that the bulk of the changes kicked in somewhere between 3-6 months and are gonna continue for another good while. It’s having a lot of positive effects on my various health conditions (POTS, hEDS, migraines). I’m having a blast with everything that’s happening and am delighted by puberty 2.0. The drawbacks are just kind of inconveniences (and aside from potential balding, seem entirely temporary) and are nothing compared to the overwhelming joy and euphoria of slowly getting to exist more comfortably in my skin.

if you've got questions, feel free to ask. Just know depending on the question and whether or not I even know who you are will influence if I answer it or block you.

tagging myself so i can reblog if i need to @owlsofstarlight

#tag for me #also wow this post got long #and took forever to write and edit up #i apologize if it's hard to follow #but also don't complain if its too long i'm not forcing you to read it #the big t post #t timeline

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actualaster · 2 years

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So, the good news is that physically speaking I CAN get top surgery!

The downside is insurance are being butts and I'd have to pay out of pocket which puts it outside my price range, most likely even if I had help from family.

The quote is apparently good for a year or so, so I'm gonna talk with my family and see some things but my idea is try and push through the jaw surgery ASAP and then, after that, try and switch insurance as soon as is feasible after to a plan that will cover it at least partially.

...The alternative is try and schedule a consult with a fatphobic dick who is consistently rated as shit bedside manner with heavier patients, and that likely couldn't happen until mid next year at the earliest then get rejected and have my PCP write to insurance saying "hey need you to authorize this OON provider" and pray insurance will agree, if they don't then fight with them and depending on how all that shook out that could take months or years if they wanted me to get rejected from every single person in-network even if those people do NOT offer gender services. And I refuse to go to somebody who doesn't do gender stuff but goes "well I guess we could do it for you" because fuck that lmao I don't trust that.

So it's both a massive relief and also a major frustration, especially considering a variety of other factors.

But, as frustrated as I am it's good to know that it's not actually impossible and I DO have a plan of attack.

I also forgot to get the guidelines for their letter of readiness so I gotta call Monday and try and do that, hopefully my usual therapist can do it--she would but IDK if they'd consider her qualified. No way in hell would I have my psych do it she knows nothing about me (yes this means she sucks as my psych, I've seen her a few times and am only with her due to insurance, I do hate it)

#trans #update on yesterday's apt i guess #mixed news but more good than bad :3

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ptlsalp · 3 months

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Insurance: Certificates of Coverage for Marketplace plans -- is there no "one per lifetime" limitation?

I'll need to switch to a Marketplace plan effective 3/1 anyway, so I've been shopping for a plan.

What's a Certificate of Coverage?

Here's a good working definition: "A certificate of coverage is an official contract that outlines what an insured is entitled to, and what they aren't insured for, under a health insurance policy."

Of the Marketplace plans available to me, most haven't published Certificates of Coverage, but some have. In my unusual situation, I can only consider Marketplace plans that have published Certificates of Coverage.

Implications of Certificates of Coverage

Regarding the possibility of self-pay:

Some of the Marketplace plans' Certificates explicitly include coverage for treatment of complications related to non-covered services. Notably, none of them exclude this coverage. In contrast, my current private insurance plan explicitly excludes this coverage.

Regarding possible coverage as sterilization:

Under my current private insurance plan, coverage of sterilization under diagnosis code Z30.2 [Encounter for sterilization] is limited to one procedure per member per lifetime. However, these Marketplace plans' Certificates don't state the same limitation. Certificates are contracts, and typically insurers try to exclude everything they can; so, while the absence of an exclusion doesn't imply an inclusion, it's a good sign.

I also noticed that certain other procedures--like bariatric surgery, for example--are limited to one procedure per member per lifetime by these Marketplace plans' Certificates. That tells me that Marketplace plans can impose "one per lifetime" limitations in general, which makes it more notable that there is no stated "one per lifetime" limitation on sterilization coverage.

No stated limitation--I can't be sure yet that there is truly no such limitation, however.

Regarding possible coverage under gender-affirming care:

All Marketplace plans available to me cover gender-affirming care, so this is still a potential route.

Additional considerations

Network: I can only consider Marketplace plans under which all relevant providers and facilities are in-network.

No referral to see a specialist: I can only consider Marketplace plans that don't require a referral from a PCP to see a specialist. I haven't involved my PCP in this process at all. I'd prefer to keep it that way, even if it means I have to pay more for a PPO plan.

#insurance::marketplace #insurance::certificate #insurance::network #insurance::hmo-ppo #insurance::marketplace::bcbs #insurance::marketplace::bcn #insurance::marketplace::uhc #insurance::marketplace::molina #strategy::self-pay #strategy::sterilization #strategy::gac

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killbaned · 8 months

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yknow what's almost funny is i told my pcp the last time i saw her, the same visit she scheduled the ultrasound, about how i keep getting so feverish. and how like i'll check my temp and it'll be 100-101.5 but it never lasts. it happens for hours at a time and then stops. and then it just comes and goes, and she asked if i needed to give a urine sample to see if i have another UTI and i said no because it's been going on for so long if it was a UTI at this point i'd be in the hospital from not treating it.

and then we find out there's a foreign object in my fucking bladder.

like. could The Object be why i keep popping these short fevers?

i'm also worried that it's gonna turn out the only urologist in my insurance network is the one that fired me as a patient because i refused to get a major surgery and get a fucking electro nerve stimulator permanently grafted to my fucking spine at 21.

i found out after the fact he was getting an insane amount of money on kickbacks from the company that makes it, and while researching the device i found out the company was in the middle of MULTIPLE class action lawsuits because of the devices malfunctioning and damaging people, people being unable to get them removed because insurance wouldn't pay for the removal, and a few cases of people that ended up wheelchair bound because of the device short circuiting and fucking electrocuting them.

so he refused to keep seeing me and claimed i was being a combative/non-compliant patient.

i don't know what i'm going to do if i have to do this out of fucking pocket.

#if it comes to that i WILL make an actual donation thing and chris finds it bc of my name he can die mad about it #or do something useful and give me money lmao

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health-insurance-struggles · 10 months

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Types of Health Plans

This post is going to suck to read. I know it will, because it sucks to write it because it’s boring.

Time to put on your big kid pants, because it’s important.

Let’s talk about the three major types of plans and three major types of healthcare accounts, and the talking points of each.

Preferred Provider Organization (PPO) - A general health insurance plan, and (in my experience) the most common. You can go wherever you want for healthcare, but you’ll pay less if you stay within the preferred provider list (a fancy way of saying in-network providers). You don’t need a PCP to refer you to a specialist.

Exclusive Provider Organization (EPO) - You only have coverage for in-network providers. You have no out-of-network coverage, except for emergencies. You don’t need a PCP to refer you to a specialist.

Health Maintenance Organization (HMO) - A very specific insurance policy that covers only certain healthcare provider systems (think hospital systems across a large metroplex). It is usually cheaper, but your choice is significantly more limited. You will need a PCP to refer you to a specialist, and you’ll need special permission from your insurance for an out-of-network provider to be covered.

Fun, right? Not confusing at all. It gets better! There are also healthcare accounts that your policies can offer. Let’s talk more about them.

Health Savings Account (HSA) - Pre-taxed money lets you pay for medical expenses (that qualify). You can invest money into the HSA and it rolls over every year to any employer. Basically, the funds never go away—new employer, new policy, and retirement don’t affect your HSA. This is usually associated with a high deductible, lower premium plan.

Flexible Spending Account (FSA) - This is associated with more traditional health plans. It’s also pre-taxed money, but it expires at the end of the year. Both you and your employer contribute to the fund, but anything you don’t use goes back to the employer, not you. The money doesn’t roll over each year or accumulate between employers. There are FSA plans all over the map in terms of deductibles/premiums, so it’s hard to generalize which one it’s associated with the most.

Health Reimbursement Account (HRA) - I’m going to be honest, I don’t know as much about this one because I personally haven’t worked with one. From what I know, it’s an employer-owned and funded account to help members bridge the gap on their health insurance. You can usually use it to pay copays, deductibles, and coinsurance. This doesn’t roll over and you don’t carry it with you, but your employer is the only one who pays into it.

Confused? Yep.

So how do you pick one? Well. I can't tell you, because it's up to you. But in my opinion...

I have a lot of health problems, so I want the largest network possible. I don't want to try to make a PCP appointment every time I need to see my specialist(s). I'm young and I don't plan on staying at the same employer forever. I'd pick a PPO HSA plan, because of the flexibility of the provider network and the rollover of the account. This will probably be a more expensive premium each month, but for me, it's worth it.

Maybe you're in excellent health. You've worked at your company for decades and have no plans of leaving, and you go to your annual check-up and that's it. Great! Maybe you are fine with an EPO or HMO plan and an FSA. Those could be cheaper premiums.

It's up to you. It depends on your needs and your spending preferences.

#health insurance struggles #health insurance #healthcare #health care #medical #medicine #insurance #medical care #ppo #hmo #epo #hsa #fsa #hra #healthcare spending accounts #healthcare accounts

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elihslife · 11 months

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Hospital Run

What started with checking out my mouth a few nights ago... ends up with an uninsured Hospital Bill.... YAY!

Been having quite a sore throat for some time now. Honestly it's embarrass to say a few months now... but like. No insurance and trying to manage it with over the counter ish. Welp...

I finally got tired of the sore throat. Hurting gums. Bleeding gums. Brushing, mouthwash, etc. etc. Nothing helped. I decided the other night imma just look in my throat and see...

Weeeellllllll. I saw. I saw something.

I went to touch it, what was in the back of my throat. And I swear it was like a Dr Pimple Popper moment. One touch and BAM out came some hard white/yellowish stuff. Not just a little amount either. Quite a lot. It was honestly so euphoric just to watch something pop that big. But even so.... in your throat? It looked like small teeth. And I freaked. Then I was like... it cant be teeth. It just can't. It smelt and squished in between my fingers.

Looking up on Google, from tonsil stones to cancer. I bugged.

I decided imma go see my PCP. Though my usual Dr was booked, I decided Ill just see anyone.

What was a 2 hour Dr visit, prescribing antibiotics to me, then receiving a call an hour after getting home did they tell me I needed to go to the ER because they're afraid its close to my airways and yada yada. Debating with them for quite sometime about my predicament and such... I got ready and left to the ER.

Honestly. What a fucking bust. Basically an uninsured trip to tell me the exact shit the PCP told me. So I'm soooooo excited for that bill.

Even so. I networked with some ladies in the ER and passed on some info. Today I had an interview that lasted well under 15 min, loving my energy and such - I'm waiting to hear back from the Director for a proposal on a job offer. So I guess in hindsight yay? But even so... I'm really not looking forward to that bill. It's gonna kill me for sure.

On another note. I saw my ex wife yesterday. Got a job with a local grocery store and turns out since Im in my car, without housing they allowed me to go in person to a store near me to fill out the paperwork. That store happened to be my ex. Well, also because she's a manger and could help with the paperwork. So guess we'll see about that.

Where will I end up? Houston? Austin? Hmmmmm.

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onlyherefortheshowmances · 1 year

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1 week from today is my last day in the apt. I’ll put the whole description of the situation below a read more if you haven’t heard about this yet.

Please continue to share and donate as you can.

eB@y Listings (more to come): https://ebay.com/usr/dandyc60

GFM: https://gofund.me/978fb41c

V$nmo: @.clbrown91

I also have Chime, so moots if you do, too and wanna transfer that way, DM me.

Hi, I'm Cassie. I'm 32, and I have a laundry list of mental and physical disabilities that have made it impossible for me to work any longer (since September 15, 2022). I have undergone a lot of testing and am still working out with some providers exactly what is causing all of my symptoms. Most notably I am switching PCPs for the 2nd time in a month (but at least I’m just switching back to where I should’ve just stayed at the office my mom still goes to and a doctor I know from when I went there as a teen/young adult) and rheumatologists for the second time in 3 months (because the one I actually liked left the practice). I also need to see dermatology, but the soonest new patient appointment at any location in their network (that takes my insurance) when I called them in December 2022, was in SEPTEMBER 2023, so that’s gonna be awhile.

I managed to escape January and February's rent at my current apartment thanks to the donations I received on this fundraising page. However, there was a hearing on April 4 before the local judge for my eviction due to non-payment of rent. I was able to explain to the judge and rep from my rental agency (who went to school with my mom; small town) what was going on, and the judge agreed (as did the rental agency) to what’s called a pay and stay. I had 10 days (until April 14) to pay them all the back-owed money and then could just keep paying every month. Of course that did not happen and earlier this week a notice was taped to my door that I will be forcefully evicted May 1 at 12:01 am if all back owed rent and and their legal fees (which I don't plan to do at this point because it’s just a game.)

Going forward, my plan is to obtain a larger vehicle that it would be more possible to live out of (a van or or larger SUV). If anyone local (Central PA) has any leads on somewhere or someone that might have a relatively inexpensive minivan or cargo van-type vehicle available, please let me know. As I, unfortunately, totaled my car last Wednesday (April 19) coming home from Urgent Care no less, I no longer have that trade value to rely on even. So I need to come up with at least $3k to just buy an old but operational van and ideally as soon as possible so I can start figuring out what I can keep with me, what will go to storage, and what I can sell or donate or throw away.

The county in which I reside doesn't have any emergency shelter resources where I'd be welcome as a queer, single, disabled, atheist. The only shelter in the county is run by a religious organization, and they require you to attend and actively participate in religious services to stay there. There are a few smaller organizations, but they are all for very specific populations (single mothers, domestic violence survivors, recovering addicts, etc.) or already have years-long waiting lists (including getting a section 8 voucher which isn't even accepting applications and hasn't been for over a decade because there are that many people on their waiting list). The local LGBTQIA+ organize does have housing grants, but they require you to have proof of at least some income to get them. My therapist is trying to get me into the county behavioral health case management program which may open some other doors, but it is not guaranteed. She sent the referral almost 3 weeks ago and I have heard nothing since; I know they’re already overworked, so I was probably just too complex of a case to add to someone’s work load.

List of my disabilities (I am more than happy to field questions regarding these and how they affect my ability to work, etc. via email, twitter, tumblr ask box, etc.):

Rheumatoid Arthritis (for which I am on immune-suppressing medications that have side effects including chronic fatigue and increased susceptibility to all illness - including the one I have right now which only immune-suppressed people ever get)

Fibromyalgia (for which I have adverse reactions to the first 3 of 4 medications on the market. l am titrating up on the 4th and final medication on the market and crossing my fingers at this point. I am in Physical Therapy two times per week; was three for many months to help with stability and strengthening).

Osteoarthritis (in almost all of my major joints; knees, hips, elbows, shoulders, as well as throughout my spine). My right knee has given me problems all my life (for a reason I don’t really want to get into today); I tore my labrum in my right shoulder in June 2018 and had it repaired surgically on December 21, 2018. When I went in for my follow up first thing was ‘You’re allergic to adhesives. That should NOT be that red or itchy.” Oops. Second thing he said was “Had to check your wrist band after I got a look inside your shoulder (cause the surgery is done face down) to make sure I had the right patient. The inside of your shoulder looks like you’re in your eighties.” I was not even 28 at the time.

Hypermobility Syndrome (which causes instability and proclivity to injury; it also means that the ways I’ve learned to sit that a comfortable to me are probably absolutely wild for anyone else. My PT caught me sitting in a chair with the soles of my shoes together and the outside of my feet against the floor and looked at me like I was insane. I also dislocate joints without realizing it on occasion.) - it's probably actually hEDS but the closest doctor that'll test and adult for that is 90 minutes away.

PCOS (I’m not on Metformin ER to help control this, though I haven’t seen many changes yet. I am under the care of an endocrinologist for this).

ADHD (for which I am medicated with a stimulant - the one that’s been making the nation’s neurodivergent population rage because it’s been on back order for a year)

Various Attachment and Trauma-Based mental health disorders including cPTSD and clinical anxiety. I also believe I am autistic and am about to have an evaluation with the local center for autism and developmental delays as the neuro-psychological evaluation I had at the end of that year was a waste of time and gas money, but that’s another story for another day).

Recurrent Occipital Neuralgia (which causes headaches and difficulty moving my head/neck)

Chronic Migraine (at least 2 or 3 per month; I have Imitrex, but it can only do so much).

Severe seasonal allergies (especially to tree pollen). Like severe enough they had to put intermittent asthma in my chart to get a rescue inhaler approved cause they get that bad.

I am also excessively nearsighted (with astigmatism) to the point where my ophthalmologist has warned me that my retinas are so thin they could detach at pretty much any second.

Even with the new plan going forward, I will still need to pay for phone service (which will like increase so I can use the mobile hotspot feature) as well as car insurance the new vehicle. I hope to be able to afford a campsite at a local campground with electric access for at least part of the summer. If I do not have that option, I would at least like to purchase a small rechargeable (preferably solar charging) generator to have electricity available without killing my car battery every night. I will also continue to need gas money to get to and from appointments and the pharmacy and such and money to purchase necessities not eligible for food stamps (i.e., toilet paper, paper towels, etc.).

More about me for anyone that doesn’t know:

I'm a gray-aro/ace cis-female. Much closer to ace and aro than not.

I'm single (see above) and have no children (nor any interest in ever having any for a variety of reasons; I’m going to ask my OBGYN next time I see her if she can at least take my ovaries out so the PCOS will stop, because the Endocrinologist refused that option).

I don't have pets because my apartment doesn't allow them, but I would love to eventually obtain a service dog (mobility and anxiety/PTSD cross-trained, preferably) and/or have cats. I think if I get a van and get it set up properly, I will probably get a kitten in June. My cousin’s cat just had a litter the other week.

I don't currently use any mobility aids, but my bad days are starting to make it obvious that I will need to in the nearer future than I would like. I got a handicap parking placard just recently which is the first real step in that direction.

I enjoy cooking and baking, but it is becoming increasingly difficult to complete such tasks due to pain. And will be impossible living in a van, though if I get a camp sight I want to get one of those single burner propane camp stoves. I also plan to try to have a mini fridge and microwave in the van itself.

I write fanfiction (which you probably knew if you know me).

I went to college for three years, but I don't have a degree. I was a social work major, and the major classes weren't at all transferable and I could not get through field placement junior year. I've considered going back to school, but at this point, I'm not sure what good it would do, and money would be the ultimate factor.

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ghostonly · 2 years

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Planned Parenthood isn’t the only source of hormones

Hi there! If you’re trans and want to go on hormones, you’ve probably heard that you should go to Planned Parenthood. Yes, PP is a great source for informed consent hormone treatment, but it’s not the only one.

In many states, PPs are few and far between and many of them have stopped taking new patients since the start of the pandemic because they only take new patients in person and won’t do first-time appointments through video.

I had been planning to start T in March of 2020. Right before I was about to make an appointment with PP, the pandemic blew up and I couldn’t.

Because I had been convinced by the internet and trans friends that PP was the only way to get hormones that weren’t outrageously expensive, I figured there was no way for me to get hormones until PP opened up to new patients again.

Almost a year later, I heard from one of my doctors that there was a doctor in their circuit who knew a lot about trans care and who did most of the trans care in the area. I booked an appointment with him.

When I went in to my appointment, it wasn’t ten minutes after he’d gotten to know my situation that he asked if I was interested in HRT and/or surgery. I was shocked.

“Yes, but it’s not covered by insurance, is it? I can’t afford to pay out of pocket.”

He told me, “It is covered by insurance. State insurance in PA has to cover trans care since X law was passed.”

I was shocked.

He wrote me a prescription for T and, once my insurance approved it about a week or two later, I was starting injections.

All states are different, and all state laws may not be the same. However, if you’re not absolutely positive that your state or insurance doesn’t cover HRT, set up an appointment with a family medicine/PCP/general physician in your area who knows stuff about trans care (ask your PCP/GP if there are any doctors who do trans care or look up trans care doctors on Google or trans forums to find one)

A doctor who does a lot of trans care will know for sure if HRT is covered and can potentially get you started on hormones.

If I had known this when the pandemic hit, I could have started hormones a year earlier than I did, but the misinformation that PP is the only way to get hormones without paying hundreds out of pocket did me dirty.

Hormones aren’t the only thing that can be covered entirely by insurance. I also have a top surgery consult in January and my surgery will be completely covered.

If you’re picky about who does your top surgery, you may not be interested in local surgeons, or you may not have any local top surgeons (you might tho - do some searching into cosmetic surgeons), but if you’re not picky, you might be able to get top surgery completely covered by insurance

The trans care doctor who helped me get on hormones also set me up a video session with a doctor who could write me a letter of recommendation for top surgery. I spent like an hour talking to her about my social transition, medical transition goals, support network, and so on. She was very chill and, at the end, she said she would absolutely write me a letter. That letter of recommendation is now in the system of that medical group and I can ask my trans care doctor to send it to any surgeon I need him to.

so basically, don’t be afraid to inquire about transition care in your primary doctor’s office. Just because it’s a more generalized medical setting that’s not specifically focused on sexual/reproductive healthcare (like Planned Parenthood), doesn’t mean it’s not adequate at getting you the treatment you need.

#trans #transition #hrt #top surgery #ftm #mtf #hormones #hormone replacement therapy #queer #lgbt #lgbt+#lgbtq #lgbtq+#lgbtqia #transgender #healthcare

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nothorses · 3 years

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do you know if being fat and having saggy breasts makes it harder to get top surgery? is it more complicated, are doctors going to deny me the surrgery just bc i'm fat?? i see so little representation of fat transmascs that idk much at all. also if you have recomendations of fat transmascs that would also help a lot

I will leave this open to fat transmascs who can contribute personal experiences! If yall add your voices on this post or in my inbox, I will boost them.

That said, my knowledge level is that weight can play a role in finding a surgeon who will work with you on top surgery. It's less that top surgery isn't possible with larger sizes, and more that the procedure changes for different sizes, and some surgeons are bitch-ass babies who refuse to broaden their knowledge and skill set to include fat people.

Saggy chests shouldn't disqualify you from top surgery, though; it can change the types of surgery that would be effective on your chest (ex: I would qualify for buttonhole surgery if my chest was less saggy, but as it is, my nipples fall below the lower pec line and fishmouth is a more viable option for me). Options like T-anchor and double incision are likely still viable for your chest!

To my knowledge, the move is to work with your PCP, insurance, and local network of trans people to find a surgeon who will work with you. Try to find fat transmascs who can tell you what their experiences were like with that surgeon, and when you go in for your consultation with them, ask to see pre- and post-op pictures of top surgeries they've performed (particularly on larger folks).

I know fat people who have found surgeons and had great experiences. There is absolutely some hope for you there, and I wish you the best of luck in finding someone great who treats you with the respect you deserve.

#advice #transmasc #top surgery

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norcumii · 2 years

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just venting about medical bullshit, don’t mind me, trying to sort out my thoughts again

So let’s get this straight. I spend all my time exhausted. More sleep doesn’t help much. We’re talking a 1-4 hour nap every. fucking. DAY it’s physically possible to get one, on top of 7 hours average, wherein I go to bed (approximately) when tired and get up when I’m done with the sleeping thing.

A sleep study claims I’ve very minor sleep apnea. Like, less than I expected. And the suggested approaches are:

Lose weight (fuck off)

a cpap machine which will/must connect to a network to report to the mothership ALL THE DETAILS about my sleep patterns, and it’s advertised as a PLUS that I can also get these details on an app on my phone! :D (yes, I would LOVE to live broadcast when I’m asleep the quality thereof how OFTEN I’m sleeping onto a machine with decent to good odds of being easily hackable, and let’s not even start on the suspicious tirade of wondering if they repossess the damn thing if they think I’m not using it well/often enough)

a dental device on the upper end of $2000 to $3000 (because I do gig work and therefore don’t have the income for better-than-minimal insurance, so it’s not covered and that’s all out of pocket)

ALL OF WHICH I AM FAIRLY CERTAIN WON’T BE RELEVANT TO SOLVING MY PROBLEM ANYWAYS, ‘CAUSE AS MENTIONED BEFORE, THE APNEA IS LESS THAN EVEN WHAT I THOUGHT IT WOULD BE.

and that’s the part that makes me want to break down crying in frustration. Like, any of these are theoretically doable, but it’s a lot of misery, money, and discomfort for a pretty stupid long shot.

ugh. time to yell at the pcp again, i guess.

#not looking for suggestions #medical bullshit #thinky thoughts #just venting #why do i need to sleep anyway?

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lichfucker · 2 years

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hhhh okay I think I finally found the CORRECT document that explains what my healthcare policy will cover and. it still doesn’t say anything specific or definitive about whether or not they’ll cover top surgery. it says they WON’T cover “cosmetic surgery” unless it’s to treat An Illness, and it says they’ll use the dsm-5 to determine what counts as a “mental illness,” so like. maybe? maybe it’ll count as treatment for gender dysphoria? I’m still worried they’d decide it’s not “medically necessary and appropriate”

I was talking abt this the other day with betsy and she ended up doing some cursory research and she found a surgeon very close to me who does top surgery, and he’s affiliated w the, like, network of doctors my pcp, gi, and obgyn are part of (so theoretically he’d likely be in-network for my insurance?? if they’ll cover it at all lmao), but all the language on his page (and the other surgeons in his office who also do top surgery) is soooooo binary and he says he’ll only work on patients who’ve been on hrt for at least a year and all the photos and the descriptions are really geared towards Looking As Close To Cis As Possible and that’s just so far from what I want

idk. it’s hard not to feel discouraged. I know that’s just one person’s policy and there are other doctors out there who are better but it just. feels bad

#personal #bluh bluh #anyone who rbs will be blocked on sight

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