You will have to tell your family physician eventually once you start to medically transition, or if that’s really not an option, you will have to find a new primary care physician (PCP) who you are willing to work with.

If you want to see an endocrinologist, it starts by getting a referral to the endo by either your PCP, or sometimes by a psychiatrist.

I live in the southeastern U.S. and here we have the Trans in the South Guide. I was in a similar position as you when my egg broke: older, supportive spouse, but not much else - I tend to be a hermit and cloister myself.

I used the Trans in the South Guide to find an endocrinologist in my area, and I called my PCP and told them I have gender dysphoria and I would like to be referred to the particular endo that was in the directory. By sheer luck my PCP was trans-affirming, and by coincidence already has some other trans patients (though I am his first trans woman patient).

The city I live in has a local LGBT+ Pride group, and there is a trans support group that meets - I started to go to support group meetings and just talked to people.

Connecting with your local community is usually the best way to find out which providers are good, which are bad, which insurance companies are good and which are bad, etc.

So first of all, find your local pride group, start going to regular in-person meetups and get to know people. You can ask questions there, but you will also get to hear people’s stories as they have tried to navigate what you’re about to go through. Even if there is no trans-specific group, just going to LGBT+ events will hopefully increase the odds of meeting other trans people that you can network with. Forming a group chat (or getting invited to one) was really helpful for collecting and sharing resources.

Finding a psychologist that works with trans patients is important, but the advice is about the same: research online (my local pride group has a directory of providers, I actually used the Trans in the South Guide to find my psychologist), and connect with community to benefit from word of mouth (talk to people and ask which therapists they went to, who they recommend, etc.).

I had to change my initial therapist because, even though she was trans affirming, she had never written letters or dealt with the bureaucratic process of patients going through surgeries - I needed someone with more experience because I was not prepared to guide them through that myself.

If you have to move forward and none of the recommended people work, you can always just take the risk and try to see a provider that hasn’t been vetted. Worst case scenario, you can try to navigate this with heuristics: in my experience a provider is more likely to be safe if they are younger, queer themselves, and / or a woman. It seems like straight, older, and male doctors are more likely to be overtly transphobic (obviously this is not always true, these are just stereotypes to fall back on help guide you when all else fails - there are plenty of counter-examples, my endo was old and male, my PCP is straight and male, etc.).

Much luck to you dear, I wish you abundant gender euphoria in your future.

I go through a service called Folx Health. They have been absolutely AMAZING for me. I would highly suggest anyone in the US to look into them. I had one video appointment, and that same day was picking up my HRT. Outside of labs once or twice a year, you’re only required to meet with them again annually for another video appointment. You can definitely setup more appointments and even use them for general care/pcp things - I just had one to get tretinoin prescribed to me. You can use insurance or not; I’m currently uninsured and paying out of pocket, and they have super reasonable prices. They can also provide lists and resources for different doctors if you choose to undergo any surgeries.

I’m in a similar situation, over 40 and just starting the process.

A lot will depend on where you live and your insurance situation. I decided to start with finding a therapist. I have an employer-funded Aetna plan that offers enhanced gender-affirming benefits, but I will need to get a gender dysphoria diagnosis if I want to claim things like hair removal and surgeries.

I haven’t tried going to an endocrinologist first, but if I did, I would find an LGBT+ clinic. They are pretty common in larger cities.

If you’re in the US, here’s a big list of resources that could help you figure out where you want to go! There are multiple provider finders for gender-affirming care, therapy, financial assistance, and all sorts of stuff. I do recommend seeing a therapist (like a LICSW)! Not only is therapy wonderfully helpful in finding out who you are, but if you’re looking for some types of care further down the line, insurance may require a letter from a qualified professional (sometimes even 2 different ones depending on what you want; I have a therapist and a psychiatrist so I go to them). Getting things documented and tracked would be to your benefit if you ever need a letter.

I wish you luck on your journey!

EDIT: Gender Justice League is based in Washington State, so there will be many resources specific to Washington, but there are also national resources listed that you can search through!

Your decisions are your own, obviously. I don’t know where you live, but in many places, DIY might be your better option for hormones. Given the state of things where I am (U.S.), I honestly regret going ‘legit’ and changing my documents sometimes. For a few hundred dollars, you can acquire everything you need for a lifetime supply of estrogen. This means never having to rely on a doctor or other gatekeeper to allow you to be who you know you are or giving you so little of the hormones you need that you are living in a perpetual state of perimenopause. It does seem scary, but the truth is everyone has unregulated amounts of hormones in their body. Happy to chat more about DIY or trans stuff via DM if you like.

To directly answer your question, if the standard answers like Folkx or Galileo don’t work for you, you may want to visit some local queer spaces and ask around. Folks who are already navigating this stuff will know what’s around and who’s trustworthy already.

Also, congratulations!