Ask them if monotherapy is available and suitable for you. As a monotherapy user myself, I’ve not experienced many problems with hrt that others have. Also ask them if cypionate or enanthate is available.

But other than that, ideally, the doctor should be the one informing you. Though depending on many factors, the doctors might not tell you everything or might have incorrect information. Trans healthcare is in a poor state and you have to think for yourself.

Na₃N is right, don’t trust that your doctor is doing the right thing for you even if they are actually well-intentioned. This is a new science for them if they’ve even studied it extensively, and they are trained to be very risk averse. I have known very few trans girls that haven’t been under-dosed. The risks are very overstated with feminizing hrt. And you can push your levels much higher than many doctors think relatively safely.

I’ve heard (and seen) from so many trans girls that fat redistrinution really starts to take off after 2 years. This is all your mileage may vary, but don’t be disappointed if you don’t have the body shape you want even if your boobs are growing nicely already.

Personally, I don’t really think spiro is all that bad (as long as you aren’t taking high doses of it), at least to start with for quicker results until E has time to reduce T levels. Especially if you don’t want to start with needles (needles scary imo, so I couldn’t start with them - I was still doubting whether I wanted HRT a bit, so fear of needles would have prevented me from actually using it). Some plus sides to injections is it gives you a lot more control over your own treatment (you can just ignore what the doctor recommends and choose whichever dose you think is most appropriate) and you can stockpile reserves more easily.

I did the traditional path, started with Spiro, added E, switched off Spiro for Cyproterone (in my country its the next anti androgen if spiro isnt preferable or not working as mych). I didnt have any issues during that. I suppose I wish I was started on E faster but it wasnt that long either - it took me longer to decide if I wanted hrt at all than the two months from starting anti androgen to taking estrogen.

People will tell you and warn you about underdosing in the official system. My own personal experience, I was very happy with thr ramp up and Ive been happy at my current dose - there were a lot of mental and emotional changes I dont think I would’ve been ready for at the time and I had actually requested a step back at one point after crying at work a bunch. I also receive an adequate dose now anyway. There is good evidence that trans women should generally be getting higher doses for what its worth. When you go in to get your levels tested they will ask you how youre feeling - when theyre deciding on doseages for HRT, lab values are part of it but so is how you feel inside. If you tell them “oh everything is fine” but you dont mean it, they wont know and you might end up with a lower dose. Do not fawn and tell your doctor you feel fine at your current dose if you do not in fact like the progress, results or feeling at your current dose you have to tell them how you are actually feeling.

Spiro is a dieuretic, its gonna make you pee more. Its potassium sparing (it makes your kidneys change up what electrolytes theyre pushing out and reabsorbing), so you should be mindful of your potassium intake and levels but dont get anxiety over it, youll notice internally something feels off and youll get lab work to make sure everything is in balance. I did feel a little different because my blood pressure was lower than I was used to but I adjusted after about a week.

They will ask you about fertility preservation. I couldnt afford it but I still got tested to see if there was a reason to worry about it anyway. I dont regret not freezing personally, I am way happier.