Do you have any wisdom on getting hrt as a person with pmos? Any specifics challenges or things to keep in mind to keep yourself safe?
-a very nervous young transmasc with pmos
TL;DR: no, it's completely a non issue, HRT and PMOS are both things handled by endocrinologists so they know what to do and it's completely fine.
Honestly, it really hasn't been an issue at all. Like, okay, full disclosure here that I know some people with PMOS have heavy miserable periods and stuff, and that definitely is not me. So if your worry is about that, I'm not going to be helpful there. But my experience with getting HRT was pretty much the same as anyone else in an american blue state. I got my doctor to refer me to an endocrinologist who does gender affirming care, I had my appointment, we talked about my gender and my goals for HRT, and I walked out of there with a T prescription. The beauty of the informed consent method.
I've been on metformin for PMOS since I was like 13, so I did ask if I should come off of it because it wasn't necessary to keep my periods regular anymore, and she was like "if you don't have any side effects from it or anything, I'd rather not change multiple things at once." And knowing that my A1C is sketchy, and I was considered pre diabetic before I was on it but am not anymore, and also that one day I would like to have kids and for that I would need regular menstrual cycles again so it'll probably be easier if I just stay on metformin instead of going off and back on again, I'm fine with staying on it. So we never messed with it. I do still take it.
I know a lot of people use birth control to regulate PMOS, and some birth control methods are not advised for people on T because they use estrogen and thus kinda cancel it out, but that's not a thing I had to deal with. I was never on the pill for PMOS. (As for actual contraception, I had a hormonal IUD when I started it, which is good for people on T because those hormones only effect the immediate area of your uterus and ovaries, they don't actually enter your bloodstream at all. And then I realized I don't actually like vaginal sex and got it out and now I'm not on any birth control at all.)
My PMOS has pretty much been irrelevant to the entire process. Like... Pretty much the only way it mattered was that it was easier to hide going on HRT from my parents, because when they looked at their insurance statements and asked about the new endocrinologist I saw, I could say that I decided to get a new one for my PMOS since my old one was a pediatric one. Which wasn't even wrong; I do see only the one endocrinologist, and she prescribes my metformin so she is also my PMOS person. She does all the insulin resistance related labs that a person with PMOS should be getting for me, so. Like. She does also take care of it in the very limited way it's relevant. But mostly it isn't.
But yeah, my PMOS had essentially no impact on anything. My periods still stopped after about a month. I responded very well to testosterone. I didn't have any issues with it or anything like that. Even like... I've always had a lot of acne, which is presumably a PMOS thing, and I just assumed that would get worse from going on T because they tell you it might give you acne, given it's puberty 2 and everything, but no. No my acne stayed exactly the same. Not any better, I guess, but definitely not worse. I've always had a high libido, and I thought that might be a high T from PMOS thing, so I was very scared when everyone was like "look, if you're going on T, buy a sex toy and be prepared to be masturbating all the time. It's going to make you super horny at first until you get used to it," because like, I already masturbated at least once a day even without T, but I guess your libido can only get so high because mine didn't change at all. It stayed right at its normal high level.
So yeah, my advice is that your PMOS is basically a non issue for going on T. HRT is prescribed by an endocrinologist, and PMOS is also an endocrinologist thing, so they know how to handle it... but also largely they don't have to. I would definitely advise going through a dedicated endocrinologist instead of like, a Planned Parenthood or trying to get it from a PCP, like some people do, precisely because they can also take over management of your PMOS and then you don't need an extra doctor. I have talked to other trans people and discovered that people without PMOS don't have as much bloodwork ordered by their endocrinologists as me, just their hormone levels and the hemocrit. But even then, I get my blood drawn at the same frequency as other trans people, they just take more of it and I have to fast first and they don't.
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