The risk aversion is deviation from their standard plan and from possible mortality as a side effect of bica. Yes, I 'm aware that it’s an exceedingly low chance. They are still stuck in the early 2000’s for treatment plans.

Spiro also carries mortality risk, a greater but similar risk AFAIK as bica. My liver enzyme levels were elevated on bica, but my endo was not concerned about it, he said they often just stabilize and it's not a reason to stop. I only stopped bica because it didn't act on the CNS and help with my biochemical dysphoria - I was just as miserable from the T in my body with it vs without. (So I did monotherapy instead.)

The risk of heart issues is actually the spiro, which appears to be happening but they still aren’t responding to the request.

Your doctors are not sufficiently educated and are putting your life at risk as a result. That's unfortunate, but at least it sounds like you know what to do.

My doctor happens to be a trans woman. Howewver, she transitioned more than a decade ago and is comparing everything to her experience. I’m not sure if she’s bothered keeping up with things. I’m not here to judge, just to get myself in order.

tbh, I don't know that being trans makes a difference, Caitlyn Jenner is trans and that doesn't stop her from being an anti-trans menace on Fox News. You would hope being trans would help, but it sounds like it's actually hurting your care, since she is not educating herself.

Try as I have, this part has been exceedingly difficult. The only meetups are youth oriented or singles mingles at bars.

I'm in a conservative southern city, but even we have a local pride organization that runs the annual pride event - they had a trans support group that I went to and that's how I got connected. Sometimes it's just a matter of finding the right person to let you in the door, so to speak. Maybe reaching out to the local pride org and asking around to see if any other events you don't know about are happening, or even suggesting hosting a trans event if you ever feel like it.

Either way, it's probably just a matter of persistence and continuing to network - there are trans people where you are, and someone is probably organizing something. If not, you could always try to get a directory going, make a group chat, etc. and start to get people connected. That's more effort, but it's quite valuable to have your local trans community's experiences available to you - it tells you a lot, what places to go to, what places to avoid. Which hair dresser is safe and good, which dentist is safe, etc. - there are so many reasons that network is so important.