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From the moment I understood the weakness of my flesh, it disgusted me.
Kidding. Although that would be a cool project to do someday. The thing that actually disgusts me about my flesh is all this fucking testosterone it keeps making. This post is about the process I went through to fix that by forcibly replacing it with aftermarket estrogen.
I like to be cagey about the specifics of where I live, but for the purposes of this post it's important that I live in Alberta, Canada. As of writing, everything I've done so far should apply regardless of where in Alberta you are. Which is annoying, since it means I waited until after the move to get started on this for no reason.
## #Goals
So obviously the goal is to get estrogen. The next question to answer [#goals](https://www.tumblr.com/search/%23goals) wise is my preferred method of delivery. I have my answer already, but just for fun, let's go through the options.
According to someone I'll be talking to further down on the page, there are three common delivery methods for estrogen that are readily available in Alberta. There are some others out there, but I have no reason to believe you can get them here and they're not really strictly better, so I won't bother discussing them.
The first of these, and the one you're probably thinking of, is oral. Titty Skittles, etc. You take a pill a couple times a day. Incredibly straightforward. This has a couple drawbacks for me: Firstly, health risks. Oral estrogen carries the highest risk of blood clots and it can put undue strain on your liver. I'm weird, but that doesn't sound like a good time to me personally. Secondly, you have to take this stuff pretty frequently for it to work, and I have ADHD. I don't trust myself not to miss doses fuckin' constantly.
Then there's transdermal patches. You put a little adhesive patch somewhere inconspicuous and it absorbs through your skin over the course of several days. This avoids much of the health risk associated with pills, but patches have their own problems: Namely, they're the most expensive of the three options available to me, and they can fall off. If the adhesive is anywhere near the same grade as bandages. They're *gonna* fall off, constantly. No thanks. Plus, I've heard they're not the most reliable at getting you to desirable levels.
A shared drawback of both of these methods is that they absolutely require that you use androgen blockers. Androgen blockers are a giant pain in the ass, requiring their own daily pill regimen and having their own side effects and health risks regardless of which chemical you pick. I have the choice between spironolactone and cyproterone acetate, of which the former is rather infamously a better diuretic than it is an androgen blocker (though it's not exceptionally good at either), and the latter is known to carry a risk of hyperprolactinemia and meningioma. Those are some big words that I'm not qualified to explain to you any better than Dr. Google could, but the casual Chubbyemu viewer may have caught on that that second one means brain tumors. Yeah.
That's not to say you're, like, gonna die of brain cancer if you take cypro, or that you'll never see any results if you use patches or whatever. You can see good results from any combination of these, but they're just not quite as good at it and have more drawbacks than this next thing.
The third delivery method, and the one I strongly prefer, is injections. This one has the benefit of being far and away the most conducive to monotherapy, which is when you don't use blockers. I would also only have to inject every week or so, which will be much easier for me and my wonky fucking brain to keep up, and it's not like the injection is gonna fall out. The only real downside to injections is that you have to stick yourself with a needle, but I'm nowhere near as squeamish about that as you probably are if you're seriously considering pills after learning all that.
So that's what I want: Injection monotherapy. There's a couple different varieties of the injectable juice, and I have Opinions about which one is preferable, but it's kind of immaterial because based on my research only estradiol valerate is readily available in Alberta, so that's what I'm shooting for.
I'm absolutely *not* an authority on this, by the way. As eagle-eyed readers, or just eyed readers, or readers with a functional screen reader know, I'm not a medical professional nor do I have any firsthand experience with any of these drugs as of writing. If you want more information from someone who knows her shit about this, [pghrt.diy](https://pghrt.diy) is a good resource for actionable information on this topic.
## Actually getting the shit
HRT availability here in Canadian Texas is a bit of a mixed bag. Any GP can technically prescribe it through informed consent, but most of them don't feel comfortable doing that and will instead refer you to a provincial clinic with a 2+ year waitlist. There's a couple of doctors in my area who seem to be pretty cool about this, but they're also hard to get in to actually see, with referral requirements and lengthy waitlists of their own. This sucks, and if it was my only option I'd be strongly considering DIY HRT right about now.
Speaking of, I'm also not inclined to default to DIY, for a couple reasons. It seems like the drugs themselves are pretty safe if you know where to look, and I do, but I'd like to be able to get blood work done as part of this process, and I'm not sure how that would go in this context. Plus, availability seems limited from suppliers inside Canada, and I'm iffy on importing because I don't want my grey market drugs to be seized by customs.
Luckily, I have other above-board options. My research into this topic led me to a private telehealth clinic called [Foria Clinic](https://www.foriaclinic.com/) whose main deal is prescribing HRT to trans people through informed consent, that's also covered under provincial healthcare so I can see them for free. Awesome! Unfortunately, the catch to that last part is that they have an extremely limited number of bookings per month. They distribute them on a "buying an RTX 3080 on launch day" type model, meaning on my first try booking with them I had about a 3 minute window to get the form filled out, and I wasn't fast enough. Unfortunate, but I can always try again if plan B falls through.
### Plan B
In the meantime, I started on plan B: There's a nonprofit out of Calgary called [Skipping Stone](https://www.skippingstone.ca/) that offers a bunch of different resources for trans Albertans (seriously, check them out) but relevant here is that they can refer you to a trans-friendly doctor to get a prescription. After dropping the ball on plan A, I filled out a form on their website to book what they call an intake appointment, and a week later I was on a video call with a very nice lady who took me through a questionnaire about my circumstances and needs and referred me to one Dr. Wang in Canmore. Luckily, this doctor was willing to also do telehealth as I don't live in Canmore. Unluckily, she apparently had a four month waitlist. Still, that's a damn sight better than two years or more.
Oh, what's that? Sorry, bit of a mix-up there. Turns out I actually need to do something called a "readiness assessment" before I can see this particular doctor. On first blush that sounds to me like some pathologizing gatekeepy bullshit, but the person I'll be talking to has their pronouns listed as "they/she" on the release form, so hopefully it shouldn't be *too* bad.
So, I like to draft these project logs as they happen to get everything down while it's fresh in my mind, and that last paragraph was written immediately after I got the email with that information, with the intent to try to convey how I felt finding this out.
Anyway, soon after learning this information I got an email from this new person to set up an appointment, and then had to email them to get them to fix (or un-fix, I suppose) my name on the release form *they* sent me — they had entered "Ada" in the field where I'd been putting my *legal* name, which is presently something else, as opposed to the preferred name field, and legal name was one of three fields I wasn't allowed to edit — so that was fun. Especially since the response I got was to the effect that it literally did not matter.
I also got a voicemail that day from the office of Dr. Wang to book the appointment I apparently hadn't yet jumped through all the hoops for, and then took like a week to get back to them because of how tight their phone hours are — I wound up calling them back sitting in my now-reparied Subaru in the campus parking structure before class. I was greeted by another very nice lady who went out of her way to call me Ada even after I opened by giving her my deadname to look up in the computer, and then told me there was no availability at present and to maybe call their sister clinic, which Dr. Wang apparently also works at, to see if they tell me something different. Calling the other clinic, I got effectively the same information but this receptionist promised to reach out the next time there was an opening. A couple hours later, the receptionist from the first clinic called me back and told me she was able to squeeze me in about 2 months out in December.
So we're down from 4 months to 2. That's not half bad by the standards of most doctors in this country. Although, it seems plausible at this point that how this is gonna go down is that I'll have an initial meeting with this doctor, she'll order some blood work, and then I'll see her again to get a prescription, which at a two month wait per appointment would get us back to four months, so maybe that's what the woman from Skipping Stone meant by four months.
With all that admin done, the next step was that readiness assessment thing. This was the only thing I had planned on Halloween, which is fine 'cause it was plenty scary, at least in the 10 minutes leading up the appointment. In reality, I was largely sketched out for nothing. The therapist I talked to was very nice, and they made it clear that their intent was not to try to tell me what to do with my body. The appointment itself lasted about an hour and a half and consisted of a questions about my mental and physical health, my history with regards to gender, what I was hoping to get out of this process and, importantly, what kind of regimen I wanted. She also went over the risks and effects of estrogen and what getting gender affirming care looks like here to make sure my expectations were in line with reality, which they were, because I looked the fuck into this before getting this far.
The end goal here was to compile all this information into a letter to send to Dr. Wang prior to me meeting with her, so she would know all that and, presumably, be able to skip directly to the part that actually requires a doctorate in medicine. It's also important to note that this appointment would have cost me $300 if I hadn't gone through Skipping Stone, who paid for it as part of their service. Genuinely can't recommend them enough.
At this point, it's been just over three weeks since I first filled out an online form to this end, and I'm officially past everything that landing an appointment with Foria would have let me skip. From what I saw on that booking form, Foria was booking about a month out, so I'm actually not doing too bad for time from first attempt at booking until seeing a doctor compared to if I had just waited until the next opening there and landed a booking then. Your mileage may vary, though. At any rate, I'm probably not gonna try again with Foria unless this falls through. I'm kind of in for a pound at this point.
### Plan B Part 2
I plan to post this the day I start hormones, so the timestamp on here is my HRT anniversary, as it were. Expect an update some time down the road in the form of an addendum to this post or a whole new one.
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