So I knew I was trans for like 3 years (I actually do not know) and been trying to get HRT for 2 years and then been on it for 1 year. They are still underdosing me too. Apparently, I wasted all of the time I was on it. Other trans people seem to freak out if their testosterone comes back too high, but my endo is fine with making me spend months in-between blood tests only to not give me any information about them. The two times I did get info, my results were within cis-male ranges.

Idk what my levels are now since my dose has increased since then, but not by much.

I'm on 4mg of estrogen and two tablets of (I forget how many milligrams) spiro and it took a full year to get here. They had me actually cutting the tablets in half since they were incrementing my dose by fractional amounts. I can't even be bothered anymore.

I legit cannot make sense of time anymore, maybe I never could, it feels like I've been frozen in this state of things forever. I cannot remember anything other than "early transition." I'm not even sure if I'm trans, I probably am, but I don't even feel like I'm human. These conditions just cannot create a human being, just absolutely nothing but shambling around like a zombie for years, no interactions with anyone I can remember aside from my abusive parents, going nowhere, no possibility of escaping, punctuated by unbearable suffering if I ever stop dissociating.

Time for some tough love.

You need to take ownership and responsibility for your own life and medical care. Start ordering your own blood work. Don't rely on any doctor's word.

You have wasted three years on this, yet you're still as reliant on this terrible doc as ever. You need to put on your big girl skirt and change that. That really means diy and stockpiling. You need a supply of medicine that you can control and can make informed choices with. A better doctor can help, but you're learning the hard way why no trans person should ever leave themselves dependant on any doctor.

I'm so sorry your going through so much 🫂

The only advice I can give is read into doing DIY, or specifically ask the endo to up the dose to reach target levels. If they decline, yeah really really consider diy. Check out https://diyhrt.info/transfem/intro/

I can't even remember to eat lately or remember any appointments I had. I could have missed them. I would do DIY, but it would require planning and long term chains of thought which are sometimes just impossible with my severe PTSD.

Like I spent a whole hour aimlessly pacing around the living room before I realized I was there to get cereal and I had also forgotten that I wanted to get cereal. Even if I realize it, I can't get out of it, like my external world is off like 90% of the time and I am only capable of daydreaming / reliving snippets of memories and going online.

I agree, you have to advocate for yourself. If someone who is supposed to be providing care is not doing a sufficient job at it, they need to be jettisoned for someone who will. It sucks, it's hard, it's unfair. You may need to be willing to travel, or put yourself into uncomfortable conversations or situations. But I think you also need to ask yourself if that's worse than keeping on with the current track that is obviously not working for you.

Edit: I will add that I started out at the same exact dosage as you and it wasn't enough to suppress my T levels. My liver also converted like the entirety of the estradiol tablets to estrone. I am now on 4 0.1mg patches a week, 150 mg of Spiro a day, and 2mg estradiol sublingual a day.

I don't have a means to travel on my own and I don't have any money.

Then I think you need to have a frank conversation with your provider that this shit isn't working for you.

I have tried, but my endocrinologist said I needed to be patient. I left with a slightly higher dose.

Which is fine, but it shouldn't take a year to get there, and you should be getting your blood tested more frequently until your levels are in the desired range. I was getting tested monthly until my t levels finally dropped around 3-4 months in. If they're not communicating with you, it never hurts to send them a message or call intermittently with a request for an update or to let them know that something feels off and you'd like to talk about why.

A lot of doctors actually do start their patients on 4 mg estradiol, and in many cases, that can be sufficient to have a good transition with labs in consistent cis girl ranges. My prescription was like yours (but with even less spiro) during year 1, and then my doctor upped me from 4 mg estradiol to 6. But the fact that your tests are not coming up that way and your doctor still didn't think to up your dosage is a bad sign. Have you talked to your doctor about increasing your dosage? Best-case scenario, you're likely going to need to broach the topic yourself because your doctor didn't bother to.

I know it feels like you've lost three years; I get it because I socially transitioned also for a long time before I got to take hormones. But you're only one year into a five-year HRT process. There's so much time left to turn this around and many of us don't start seeing big changes anyway until about two years. Some doctors are old-school or out of touch, and you may need a new doctor, telemedicine, or DIY if you can't get your dosage up, but I really hope things go your way with just a phone call or appointment.

Hmmm. Is there any way for you to access professional trans-friendly psychological help for the PTSD?

A psych may also help you find out if you have any conditions that may also be causing the brain fog and difficulties with organising your thoughts. Quite a few of these conditions can be at least improved immediately with medication, giving you more of a chance to fix everything else.

ADHD is a common one, and stimulant meds work well. You've probably got depression associated with your PTSD, so meds can help there, although you might know that already.

I'm not trans myself, and I do not have PTSD, but my partner is. (Afab nonbinary transmasc, currently deciding whether to go on T.)

They are dealing with the worst kind of trauma and associated CPTSD you could imagine, and have been for two years, ever since they realised they had DID. We both also have ADHD and autism.

I am not suggesting you fit any of these categories, just using them as an example, because of the difference it can make if you find you have something you can treat.

Getting stimulant meds for their ADHD actually made it far easier for my partner to be confident in their transition, as well as to live their life in general.

They did in fact decide to get a new psych for the trauma stuff after the stimulant meds made them able to see how the old one was not up to the job.

One thing I see with your own story: You have only one doctor guiding your transition? That seems like it might be insufficient to me. The trans people I know have a team of different specialists that they rely on to help plan their own transition, as well as other trans people.

They don't just follow the advice of a single person, doctor or otherwise. That is generally not a good idea.

Sorry for the wall of text. I just felt an immediate familiarity with what you said and a desire to help if I can.

I am pretty sure I have cPTSD, DID, and major depressive disorder, and autism, and ADHD, and no, I don't any way to access psychological help in my area.

There is only one endocrinologist who will treat trans people in my shitty city.

Hey, I hope I didn't come off as out of touch here. I'm so sorry you're going through this. I'm just going to plug c/diyhrt since the folks there are super helpful. I wish you had access to a more competent endo and that gatekeeping wasn't a thing. I struggled with this in my previous city and it sucks.

No it's fine.