VA covers transition?

[Guest thalia]

ok so I was up early this morning and I got curious of what I had available to me as a way to get started on hrt. My search led me to the VA. After I looked at coverage and eligibility, it seems I may be very well be covered and the copays will be affordable enough to get started.. does anybody know anything further I might need to know about this? Or did I just hit the jackpot? This is making me feel anxious. I cant even call to find out anything more until after the holiday weekend.

[Guest Leah1026]

Maybe these will help:

http://transequality.org/PDFs/VHA_Trans_Health.pdf

http://www.bilerico.com/2011/06/transgender_community_win_at_the_va.php

http://www.tavausa.org

[Guest -guest-]

I've been getting my meds and care from a female doctor at the VA since 2010.

[Guest Merc]

The VA is definitely not a jackpot. It took me around 5-6 months(on top of my already 8-month wait for HRT) to get started. They have a lot of channels you need to get through.

And if you're not doing real-life experience, you can forget about hormones.

But you're right about the co-pays, with all the therapist visits and all the hormones they keep re-prescribing, it's pretty affordable. Just beware that even when you start HRT, they will most likely be pretty slow with incrementing your dosages. I've been receiving hormones for about 4 months now, and I'm still only on about half average dosage for Spiro and a third average dosage for Estradiol. As for the care you'll receive: some doctors are the bomb, others end up calling you a "transgender male" and proceed to indoctrinate statistics from the 70's to you.

[Guest Leah1026]

And if you're not doing real-life experience, you can forget about hormones.

As for the care you'll receive: some doctors are the bomb, others end up calling you a "transgender male" and proceed to indoctrinate statistics from the 70's to you.

Well that may be true where you are, but that's not true for all VA facilities. I've heard good reports about both the VA in Boston (Worcester), Philadelphia and San Francisco. These trans policies are new and it's going to take some time to get all VA facilities up to speed.

[Guest -guest-]

And if you're not doing real-life experience, you can forget about hormones.

Not at all facilities, apparently. When I first went in, I presented as male. After a relatively brief discussion with the endocrinologist, I got my prescription and was assigned to a doctor for ongoing care. She asked if I wanted to be addressed by a female name when I came in for appointments.

[Guest Merc]

And if you're not doing real-life experience, you can forget about hormones.

Not at all facilities, apparently. When I first went in, I presented as male. After a relatively brief discussion with the endocrinologist, I got my prescription and was assigned to a doctor for ongoing care. She asked if I wanted to be addressed by a female name when I came in for appointments.

Wow that's a stark improvement from my Endo team. Why is this? Is there anything I can show to my endo doctor that might make them think about it?

I'm already on it, of course, but I know there are a lot of transgender veterans in the Salt lake area, and I'd like to contribute to a better path to everyone(then I can say I did something good!).

[Guest -guest-]

And if you're not doing real-life experience, you can forget about hormones.

Not at all facilities, apparently. When I first went in, I presented as male. After a relatively brief discussion with the endocrinologist, I got my prescription and was assigned to a doctor for ongoing care. She asked if I wanted to be addressed by a female name when I came in for appointments.

Wow that's a stark improvement from my Endo team. Why is this? Is there anything I can show to my endo doctor that might make them think about it?

I'm already on it, of course, but I know there are a lot of transgender veterans in the Salt lake area, and I'd like to contribute to a better path to everyone(then I can say I did something good!).

Merc, that was in 2010. I'm surprised that not all facilities are up to speed yet.

Factors working in my favor were the VA endocrinologist's familiarity with the subject, my ability to discuss it with him at the same level of knowledge, the self-confidence that came with fully understanding and accepting my transgender condition and my maturity (69 years old at the time).

[Guest Merc]

Merc, that was in 2010. I'm surprised that not all facilities are up to speed yet.

Factors working in my favor were the VA endocrinologist's familiarity with the subject, my ability to discuss it with him at the same level of knowledge, the self-confidence that came with fully understanding and accepting my transgender condition and my maturity (69 years old at the time).

What was in 2010? The new WPATH or something? Every time I go there I seem to talk to them about it, but they keep telling me that they follow WPATH and that those are their policies(to be on RLT for HRT). I guarantee that if I showed up to my next endo appointment as a dude, they would cut hormones.

It's not that I totally disagree with their policy either, but I think if they are going to follow a standard, they should actually FOLLOW it. If another VA clinic is doing something different, somebody here isn't following it. [and as vets, I'm sure we all know how important standards are huh?]

[Guest -guest-]

What was in 2010? The new WPATH or something?

I don't know. My process was so smooth that I never had to think about it.

This was at a relatively small clinic, but even at its parent hospital, where I had started my relationship with the VA as a transgender person in 2007, the physician's assistants I dealt with were very understanding and did everything but prescribe the hormones - because they didn't have an endo on staff who felt qualified. The one they located was at the clinic about 45 miles away, and strictly by coincidence I ended up moving to his service area shortly thereafter.

I did get good counseling there at the hospital, although it was almost entirely a case of them learning from me..

[Guest Merc]

What was in 2010? The new WPATH or something?

I don't know. My process was so smooth that I never had to think about it.

This was at a relatively small clinic, but even at its parent hospital, where I had started my relationship with the VA as a transgender person in 2007, the physician's assistants I dealt with were very understanding and did everything but prescribe the hormones - because they didn't have an endo on staff who felt qualified. The one they located was at the clinic about 45 miles away, and strictly by coincidence I ended up moving to his service area shortly thereafter.

I did get good counseling there at the hospital, although it was almost entirely a case of them learning from me..

Well, I guess this just proves how different similar-type experiences can be

Because my counselors knew everything about it!

[Guest thalia]

Well all I can do is try I suppose. Thanks for the comments too, its helped me think out my approach to the VA about this. I live full-time and have since October last year, So I think ive got that part covered, but I only went to therapy one time. (stopped b/c the therapist was unbelievably closed minded.) so i'm not sure how or if they require attendance there.

[Guest -guest-]

I live full-time and have since October last year, So I think ive got that part covered, but I only went to therapy one time. (stopped b/c the therapist was unbelievably closed minded.) so i'm not sure how or if they require attendance there.

Thalia, I didn't mean to leave the impression that seeing a therapist was a requirement in my case. I wasn't even in a treatment program for my gender issue. I had confided in the physician's assistant whom I saw for regular checkups, and she asked if I would like to discuss the subject with a psychologist. I had a couple of friendly chats with a nice young lady, and that was it.

I notice you're in Florida. My initial visits were at the Orlando VA Medical Center, and I later moved to Ormond Beach, where I transferred my records to the Daytona Beach clinic. That's where I talked to the endocrinologist and got my prescriptions. The whole process was as easy as anyone could want it to be.

[Guest CassieX]

I read this thread twice before thinking about how to answer...

Hi Thalia,

I've posted in a number of threads in the forums about my adventures with the VA and transition, but after getting past the initial 'getting a Primary Care Manager appointment' where I got my referral to see an endocrinologist, it has been plain sailing. Next week I go for my second (very comprehensive) set of labs at my local VA clinic. I approached getting care with the VA slightly differently than many other veterans transitioning because they jerked me around waiting for 6 months for my initial PCM appointment and were telling me getting a referral to see the resident endocrinologist might take 6-9 months, EURGH!.

So I took matters into my own hands and back in January I got the contact information from my local support group of a trans friendly doctor in the area and after seeing him and getting my therapist to fax my recommendation letter, was immediately started on HRT. A couple of weeks later I finally got to see my PCM at the VA clinic, and although she was not in any way familiar with my condition, she was very nice and allowed me to assist her in writing my referral to see an endocrinologist. 10 days after that, the unthinkable happened, the VA updated the Directive and miracle of miracles I received a letter telling me I had an appointment two weeks later.

So, after an interview with the endocrinologists very nice assistant I got to talk to him and he immediately prescribed me the very comprehensive labs I mentioned earlier. This is the funny part. By 'doing the right thing' for myself and getting myself on HRT prior to going to the VA, I had side stepped all the bureaucratic sludge that slows us down from getting the care we are entitled too and desperately need. I wont say he was completely happy that I was already on HRT and did question what my civilian doctor had prescribed me, but I informed him that I was very happy with what I had and would keep it thank you! I was asked if I wanted prescriptions through the VA, but I declined as its pretty inexpensive with what I have. The new directive actually covers what I did and basically says that since I am already on HRT, it is dangerous to stop so don't unless there is an overriding medical reason to do so.

Oh, and my first set of lab results 3 months ago bore witness to the fact that my civilian doctor knew exactly what he was doing.

A nice thing about the VA is that there is a secure messaging system so you can communicate with your doctors which is a very good thing as the appointment system is totally abysmal.

I have kept going to see the civilian doctor, as apart from the fact that he is prescribing me my HRT, is also very knowledgeable in treating transgender patients and has been for many years. He charges very little for office visits. He is a good counterpoint to my endocrinologist who is not yet experienced with treating transgender/transsexual patients but is willing to work with me. An example of this is that initially at the VA, they wanted me to have me do labs every six months with a followup until I pointed out that I should be doing them every 3 months as per the endocrine society guidelines for treating transgender/transsexual patients and provided my endocrinologist with the reference. He immediately responded that he concurred and ordered the labs and request for followup appointment as I had asked.

So the cost for going to through the VA is free or minimal, depending on whether you want get HRT through them and you don't have to jump through all the hoops unless you really want to.

Hope this helps!

[Guest thalia]

thank all of you! This will deffinately help me. i just hope it doesnt take years to do

[Guest Merc]

I wont say he was completely happy that I was already on HRT

Yeah I was on Spiro when I went there, and that actually did plow through some bureaucracy. Your idea about going to a civilian doctor first is a good one. I just wish I had a knowledgeable endo doctor in my county

[Guest CassieX]

Hi Emily.

I'm not sure if you are referring to an endo doctor at the VA or civilian provider? Any good practitioner should be amenable to having an informed patient who can provide them with information that will better improve that patients care. The civilian doctor that prescribed my HRT was not an endocrinologist but an internist experienced in transgender/transsexual care and actually knows my endocrinologist at the VA professionally. Its a small world in the medical community when you look at specialties for a region and endocrinologists further specialize within their own fields. So, its not unusual to not be able to find a civilian endocrinologist that will be comfortable or experienced enough to treat transgender/transsexual patients.

So, self knowledge is power. Personally, I never stop searching for new info to enhance my transition and to share with others. These forums in themselves are an awesome reference.

[Guest Merc]

I know I'm necroposting, but it's related to the discussion.

I hate Endo appointments, HATE them so much! I think I'll walk in as a male because I'm not entirely ready for real life yet. It's time to notify them of their archaic standards. The head endo doctor kept telling me of some mysterious section in the WPATH that says something about real life test, but I've read that thing front to back, searched keywords for months now, and there is no mandated bullet list that includes that for HRT. It would be one thing for the VA to make a policy on that, but since they follow the WPATH it's safe to say this clinic needs to get up to speed.

I guess patient feedback is the best way to a better healthcare...

[Guest Seanna]

RLE is NOT a requirement for HRT by any standards. In fact, the VA directive states that therapy is not even required. All you need is a diagnosis of GD, which can be given by your primary care or endo. Here's the directive:

http://www.google.com/url?sa=t&source=web&cd=2&ved=0CCsQFjAB&url=http%3A%2F%2Ftransequality.org%2FPDFs%2FVHA_Trans_Health.pdf&ei=4XDLUdKQM4T28gSSyIHoCQ&usg=AFQjCNGCgSGE42uixXIt-N2tOkD-QS1Csg&sig2=R_bTTr4h-ApDVCmxfXe2VQ

Good luck! I am well acquainted with how much of a pain in the butt the VA can be.

~Sheala

[Guest Seanna]

Sorry, that link was just an overview. Here's the full directive:

http://www.google.com/url?sa=t&source=web&cd=1&ved=0CCgQFjAA&url=http%3A%2F%2Fwww.va.gov%2Fvhapublications%2FViewPublication.asp%3Fpub_ID%3D2863&ei=4XDLUdKQM4T28gSSyIHoCQ&usg=AFQjCNFi2pXyHqawA50H1zD6xp1LsEVqJw&sig2=48MZDmMi6wFn2r-pvjqLbw

~Sheala

[Guest Seanna]

I don't mean to flood this thread, but I just re-read the directive and need to modify my previous statement. A mental evaluation is required unless you are already on HRT. This evaluation should be for the purposes of ruling out other psychiatric problems.

~Sheala

[Guest Amanda Whyte]

The VA is definitely not a jackpot. It took me around 5-6 months(on top of my already 8-month wait for HRT) to get started. They have a lot of channels you need to get through.

And if you're not doing real-life experience, you can forget about hormones.

But you're right about the co-pays, with all the therapist visits and all the hormones they keep re-prescribing, it's pretty affordable. Just beware that even when you start HRT, they will most likely be pretty slow with incrementing your dosages. I've been receiving hormones for about 4 months now, and I'm still only on about half average dosage for Spiro and a third average dosage for Estradiol. As for the care you'll receive: some doctors are the bomb, others end up calling you a "transgender male" and proceed to indoctrinate statistics from the 70's to you.

Find out who the patient advocate is at your VA and speak to them.

[Guest CassieX]

I don't mean to flood this thread, but I just re-read the directive and need to modify my previous statement. A mental evaluation is required unless you are already on HRT. This evaluation should be for the purposes of ruling out other psychiatric problems.

~Sheala

Yup, I actually talked to my Endo doctor at the VA about seeing a counselor there for the purposes of meeting the requirement for GRS. He put in a request for a consult and noted that fact on the request. Two weeks later, still waiting on any word. Gotta love the appointment system, NOT!

The VA is definitely not a jackpot. It took me around 5-6 months(on top of my already 8-month wait for HRT) to get started. They have a lot of channels you need to get through.

And if you're not doing real-life experience, you can forget about hormones.

But you're right about the co-pays, with all the therapist visits and all the hormones they keep re-prescribing, it's pretty affordable. Just beware that even when you start HRT, they will most likely be pretty slow with incrementing your dosages. I've been receiving hormones for about 4 months now, and I'm still only on about half average dosage for Spiro and a third average dosage for Estradiol. As for the care you'll receive: some doctors are the bomb, others end up calling you a "transgender male" and proceed to indoctrinate statistics from the 70's to you.

Find out who the patient advocate is at your VA and speak to them.

Its all a matter of educating the provider when they don't know. I have a good relationship with mine and am not shy about asking questions or answering them for that matter. The secure messaging system if working at your va clinic is a good way to contact your provider and actually get a response. I found the appointment line to be totally abysmal.

To be honest, In the past year I have found the patient advocates at my clinic worse than useless. When I was trying to get my initial appointment they just quoted party lines about the director of the clinic said this and that and actually did nothing to help me get my appointment moved up from 6.5 months wait time. It took calling the appointment line every day for two and a half months to galvanize someone into actually giving me an initial PCM appointment to shut me up. Of course, by that time I had already lost patience and went through a civilian provider for HRT.

The second time I went to see the patient advocate was over concern for a veteran friends health and once again, they failed miserably and did nothing to help. So no, I can't really recommend them.

Cassie

[Guest CassieX]

Little update/correction: I just found out that my consult worked as intended and I did in fact get an appointment set up 9 days from now. The appointment line just happened to call my spouse two days ago instead of me, didn't tell them anything, and then proceeded to make an appointment without actually contacting me like they promised my them they would. So I still just love the va appointment system.

Spousal message retrieval system working as the powers that be intended.

Cassie